Correct patient positioning

Quality Statement 3

A patient experiencing anaphylaxis is laid flat, or allowed to sit with legs extended if breathing is difficult. An infant is held or laid horizontally. The patient is not allowed to stand or walk during, or immediately, after the event until they are assessed as safe to do so, even if they appear to have recovered.

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Purpose

To reduce adverse outcomes during or after anaphylaxis due to low blood pressure. Fatality can occur within minutes if a patient stands or sits up suddenly while they have inadequate perfusion.

What the quality statement means

For patients

When you are experiencing anaphylaxis, you will be advised to lie flat, or sit with your legs outstretched if breathing is difficult. Your legs can be elevated if you feel faint. An infant should be held horizontally (across your body). Do not hold an infant upright or over your shoulder. If you are pregnant you should lie on your left side to ensure continued blood circulation to your baby.

If you stand up too quickly after anaphylaxis, your blood pressure may drop dangerously. You should not stand up after having adrenaline - wait until a clinician assesses it is safe for you to get up. Do not stand or walk anywhere, even to the bathroom, ambulance or into the emergency department. This is usually a minimum of one hour after one dose of adrenaline, or four hours if more than one dose is given.

For clinicians

Ensure the patient is in a supine position; do not allow them to stand or walk. Monitor the patient’s blood pressure and elevate their legs if their blood pressure is low. Fatality can occur within minutes if a patient stands or sits up suddenly while they have inadequate perfusion (see Figure 1).

A semi-reclined position sufficient to relieve respiratory distress is allowed while the patient is monitored carefully for any circulatory collapse. Patients who are pregnant or vomiting should be placed on their side in the left lateral (recovery) position.

Infants should be held horizontally (across the body). They must not be held upright or over a shoulder.

Ensure the patient understands that they are not to stand up suddenly or walk until after they have been treated and assessed, and why this is important. Communicate this to other staff caring for the patient.

Assess for circulatory stability after the patient has been adequately treated and before they are allowed to mobilise. This is usually a minimum of one hour after one dose of adrenaline, and four hours if more than one dose of adrenaline is administered.

Figure 1: Correct positioning during and after an anaphylaxis event

Acute Anaphylaxis CCS Figure 1 - Correct positioning during and after an anaphylaxis event

For health service organisations

Ensure acute anaphylaxis management protocols are in place to:

  • Provide guidance on appropriate positioning for patients with anaphylaxis
  • Specify that patients should not stand or walk until assessed as safe to do so after treatment with adrenaline.

For patients

When you are experiencing anaphylaxis, you will be advised to lie flat, or sit with your legs outstretched if breathing is difficult. Your legs can be elevated if you feel faint. An infant should be held horizontally (across your body). Do not hold an infant upright or over your shoulder. If you are pregnant you should lie on your left side to ensure continued blood circulation to your baby.

If you stand up too quickly after anaphylaxis, your blood pressure may drop dangerously. You should not stand up after having adrenaline - wait until a clinician assesses it is safe for you to get up. Do not stand or walk anywhere, even to the bathroom, ambulance or into the emergency department. This is usually a minimum of one hour after one dose of adrenaline, or four hours if more than one dose is given.

For clinicians

Ensure the patient is in a supine position; do not allow them to stand or walk. Monitor the patient’s blood pressure and elevate their legs if their blood pressure is low. Fatality can occur within minutes if a patient stands or sits up suddenly while they have inadequate perfusion (see Figure 1).

A semi-reclined position sufficient to relieve respiratory distress is allowed while the patient is monitored carefully for any circulatory collapse. Patients who are pregnant or vomiting should be placed on their side in the left lateral (recovery) position.

Infants should be held horizontally (across the body). They must not be held upright or over a shoulder.

Ensure the patient understands that they are not to stand up suddenly or walk until after they have been treated and assessed, and why this is important. Communicate this to other staff caring for the patient.

Assess for circulatory stability after the patient has been adequately treated and before they are allowed to mobilise. This is usually a minimum of one hour after one dose of adrenaline, and four hours if more than one dose of adrenaline is administered.

Figure 1: Correct positioning during and after an anaphylaxis event

Acute Anaphylaxis CCS Figure 1 - Correct positioning during and after an anaphylaxis event

For health service organisations

Ensure acute anaphylaxis management protocols are in place to:

  • Provide guidance on appropriate positioning for patients with anaphylaxis
  • Specify that patients should not stand or walk until assessed as safe to do so after treatment with adrenaline.
Related links
Acute Anaphylaxis Clinical Care Standard
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Clinical Care Standards
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