Role of dangling when moving from supine to standing position

Abstract

This article focuses on the cardiovascular adjustments that take place when an individual makes a change in his/her position, particularly when moving from the supine to the standing position (orthostasis). Some individuals may experience a drop in their blood pressure on assuming the standing position, which may lead to dizziness and/or fainting (orthostatic intolerance). Dangling, which is often an intermediary stage of assisting people into the sitting position with their legs hanging over the side of the bed, before moving them into the standing position, is therefore used to ensure that patients are moved safely. This can help to prevent notable reductions in blood pressure. Nurses, therefore, need to be aware of the cardiovascular changes and compensatory mechanisms that take place during orthostasis, in order to be able to make decisions not just about whether their patient can be moved out of bed, but so that it can be done safely without any of the adverse effects of orthostatic intolerance. Those at greatest risk of developing such adverse effects include those with diabetes mellitus, cardiovascular disease and also those with an age-related vagal dysfunction. Some pharmacological agents may also be implicated in contributing to orthostatic intolerance in some individuals. Recommendations for practice include ensuring that dangling the patient is incorporated as part of the procedure of slowly assisting patients out of bed, encouraging leg and foot movement and continually assessing the patient during the procedure. Should any patient show any sign of not tolerating the position change, the procedure should be halted and the patient assisted back into the supine position.

Understanding Critically Ill Patients Hemodynamic Response to Mobilization

“…[39][40][44][45][46][47][48][49][50][51][52][53][54][55][56] The final body of evidence is the most recent and includes studies conducted on early mobility in critically ill patients that provided data on feasibility, safety, and care processes. The evidence comes from 3 specific areas.…”

“…SvO 2 is an indirect reflection of the relationship between oxygen supply and demand. [49][50][51] The most recent study by Price 50 examined the impact of sitting on the side of the bed on heart rate, blood pressure, SvO 2 , and oxygen saturation in 55 male patients after coronary artery bypass graft. In some studies, the reduction was as high as 22% in patients with low cardiac reserve.…”

Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

“…20, 26 Similar results have been demonstrated when initiating the dangling posture in critically ill patients. [31][32][33] In the most recent study, Price 32 examined the impact of sitting on the side of the bed on heart rate, blood pressure, SvO 2 , and oxygen saturation in 55 men who had undergone coronary artery bypass surgery. The results showed that most patients experienced an increase in heart rate, decreased blood pressure, and a reduction in SvO 2 that returned to baseline levels (for supine position) within 10 minutes.…”

“…21,22,[26][27][28][29][30][31][32] The third body of evidence is the most recent and includes studies of early mobility in critically ill patients that included data on feasibility, safety, and processes of care. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] responsiveness, contributing to postural hypotension and tachycardia as a result of reductions in stroke volume and cardiac output. 8,9 Head motion alone can reduce cardiac reflex response to central stimulation of the carotid baroreceptors by 30%.…”

Determining the prevalence of orthostatic hypotension and its associations with hypertension and functional decline in the community-dwelling elderly in Vietnam

“…Supine to standing blood pressure-measurements provoke a greater reduction in blood pressure and increase the prevalence of OH when compared with seated to standing posture changes. 21 Studies differed in the segment of the population like age range or institutions also show fluctuated result of OH prevalence.…”