Padding in Bed
The goal of padding is to relieve pressure between your bones and the surfaces you sleep or sit on. The following instructions are only guidelines, not rules, to use when padding in bed. You must watch your skin and make adjustments to padding, as needed, based on your individual needs.
Padding is just one aspect of preventing and treating pressure sores. Whenever using a new product, like foam pads or “quad pads,” a new pillow, or a new mattress, make sure it reduces pressure especially to the boney areas of your body. If you notice any redness or skin irritation, remove pressure from the area and contact your wound care specialist or primary care provider immediately.
Revised: 1/2015
Back or "Supine" Position
| Pad #1 | Head | Place a pillow under the head and upper shoulder for comfort and to keep neck neutral. |
| Pad #2A Pad#2B | Tailbone | Place pad 2A above sacrum and pad 2B below sacrum. When pads 2A and 2B are placed correctly, a flat hand can be placed between the body and the bed to ensure that pressure has been relieved. If pressure has not been relieved, an additional pad can be added under 2A and 2B. |
| Pad #3 | Knees | If the knees appear to be hyper-extended, pad above the knee space; otherwise no padding is needed. Pad must NOT be placed directly under the knees. |
| Pad #4 | Heels | Pad above the heels to prevent pressure. |
| Pad #5 | Feet | Pad the feet to provide proper foot position. |
| Pad #6 | Lower Legs | Pad between the knees and ankles to prevent pressure at the knees and inside of the ankles. |
| Pad #7a, 7b, 7c | Arms | Position pillow to keep chest open and shoulders back as in the diagram below. |
Half-Back or "Semi Supine" Position
| Pad #1 | Head | Place a pillow under head and upper shoulder for comfort. |
| Pad #2 | Back | Place a pillow behind patient’s back. Do not push pillow up against shoulder blade. Keep shoulder blade in a back position to keep chest open. |
| Pad #3 | Lower Arm | Do not pinch the lower arm under the body. Support arm with a pillow. See diagram below. |
| Pad #4 | Upper Arm | Keep elbow of upper arm at side. Position the upper arm so the chest is open. Support arm with pillow (per diagram). |
| Pad #5 | Lower Back | Turn hips to side and support position with pad to lower back. |
| Pad #6 | Lower Legs | Place a pillow lengthwise between the lower legs. The top leg is positioned forward on the pillow. Do not position legs directly on top of each other. May need to bend the knee more to prevent from rolling back. |
| Pad #7 | Ankle | Pad above the ankle bone on the bed. |
Stomach or "Prone Position
| Pad #1 | Head | Place a pillow under the head for comfort. |
| Pad #2 | Chest | This is an optional pad for comfort. |
| Pad #3A Pad #3B | Hip Bones | Place pad 3A above hip bones and pad 3B below hip bones. When pads 3A and 3B are properly placed, pressure is relieved: 1) on the hip bones, 2) on the suprapubic catheter, and 3) on penis and scrotum of the male patient. These pads also allow for proper body alignment and ease breathing. NOTE: Pads 3A & 3B are not standard on all patients unless required to promote catheter tube drainage or prevent pressure on male genitalia. |
| Pad #4 | Knee | Pad above the knees to maintain the natural curvature of the knees and relieve pressure on the knee bone. |
| Pad #5 | Lower Legs | Place pillow(s) crosswise under both lower legs (the shins). This pillow allows: 1) the lower leg and foot to be slightly flexed at the knee, 2) pressure relieved at knee, 3) correct extension of muscles of the thigh, and 4) prevents foot-drop if feet do not extend to the end of the bed. |
| Pad #6 | Between Lower Legs | Pad between the knees and ankles to prevent pressure at the knees and the ankles. |
Side Position
| Pad #1 | Head | Place a pillow under the head for comfort. |
| Pad #2 | Back | Place 2 pillows behind the patient’s back to maintain side position. Top hip will be slightly rolled back to prevent patient from lying directly on the hip and leg bones. A 30 degree side lying position is best. |
| Pad #3 | Waist | Place a pillow or pad lengthwise from the armpit to the waist to support body weight and to decrease shoulder pressure. |
| Pad #4A Pad #4B | Hip | Place pad 4A above the hip and pad 4B below the hip. When pads 4A and 4B are placed correctly, a flat hand can be placed between the body and the bed to ensure that pressure has been relieved. If pressure has not been relieved, an additional pad can be added under 4A and 4B. |
| Pad #5 | Lower Legs | Place a pillow lengthwise between the lower legs. The top leg is positioned forward on the pillow. Do not position legs directly on top of each other. May need to bend the knee more to prevent from rolling back. |
| Pad #6 | Ankle | Pad above the ankle. |
3/4 Stomach or "3/4 Prone" Padding
| Pad #1 | head | Place a pillow under the head for comfort. |
| Pad #2 | Arm | The shoulder should be protracted with the arm forward on a pillow. Bottom shoulder should be pulled backward to decrease pressure on shoulder. |
| Pad #3 | Leg | The upper leg is in front of the body on a pillow. Bottom leg/hip needs to be rotated to ensure there is no pressure on the hip or the top of the leg bone. |
| Pad #4 | Ankles | Pad above ankle to prevent pressure. |
Halo Best / Back or "Supine"
| Pad #1 | Head | A soft pillow or small pad can be placed under the patient’s head. AVOID direct pressure on the halo ring. The halo ring must remain off the mattress. There is to be no firm pressure under the neck area as this may cause hyperextension of the cervical spine. |
| Pad #2 | Below Vest | A pad is placed below the back vest hardware to prevent the hardware from puncturing tilt tables, mattresses and linen, and to keep weight off of the halo ring. |
| Pad #3A Pad #3B | Tailbone | Place pad 3A above tailbone and pad 3B below tailbone. When pads 3A and 3B are placed correctly, a flat hand can be placed between the body and the bed to ensure that pressure has been relieved. If pressure has not been relieved, an additional pad can be added under 3A and 3B. |
| Pad #4 | Knees | If the knees appear to be hyper-extended, pad above the knee space; otherwise no padding is needed. Pad must NOT be placed directly under the knees. |
| Pad #5 | Heels | Pad above the heels to prevent pressure. |
| Pad #6 | Feet | Pad the feet to provide proper foot position. |
| Pad #7 | Lower Legs | Pad between the knees and ankles to prevent pressure at the knees and inside of the ankles. |
Halo Vest / Side
| Pad #1 | Head | A soft pillow or small pad can be placed under the patient’s head. AVOID direct pressure on the halo ring and head. The halo ring must remain off the mattress. There is to be no firm pressure under the neck area as this may cause hyperextension of the cervical spine. |
| Pad #2 | Back | Place a pillow behind the patient’s back to maintain side position. Top hip will be slightly rolled back to prevent patient from lying directly on the hip. A 30 degree side lying position is best. Avoid direct pressure on shoulder. |
| Pad #3 | Waist | A pad is placed lengthwise from the armpit to waist to maintain proper body alignment, for vest support and pressure equalization and to prevent undue pain and pressure on the shoulder. |
| Pad #4 | Hip | Place pad 4A above the hip and pad 4B below the hip. When pads 4A and 4B are placed correctly, a flat hand can be slid between the body and the bed to ensure that pressure has been relieved. If pressure has not been relieved, an additional pad can be added under 4A and 4B. |
| Pad #5 | Lower Legs | Place a pillow lengthwise between the lower legs. The top leg is positioned forward on the pillow. Do not position legs directly on top of each other. |
| Pad #6 | Ankle | Pad above the ankle. |
