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Trendelenburg position
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==Current uses== [[File:Reverse trendelenburg position 01.gif|thumb |alt=subject is lying on their back with legs lower than their body |Reverse Trendelenburg]] *The Trendelenburg position can be used to treat a venous air embolism by placing the right ventricular outflow tract inferior to the right ventricular cavity, causing the air to migrate superiorly into a position within the right ventricle from which air is less likely to embolise.<ref>{{cite journal |vauthors=Orebaugh SL |title=Venous air embolism: clinical and experimental considerations |journal=Crit Care Med |volume=20 |issue=8 |pages=1169β77 |year=1992 |pmid=1643897 |doi=10.1097/00003246-199208000-00017|s2cid=24233684 |url=https://zenodo.org/record/1234786 }}</ref> Most recently, the reverse Trendelenburg position has been used in minimally invasive glaucoma surgery, also known as MIGS. This position is commonly used for a superior sitting surgeon that uses a combination of downward patient tilt, of approximately 30 to 35 degrees, microscope tilt towards themselves at the same angle and an intraoperative [[gonioscopy|goniolens]] or prisms that allows them to visualise the inferior trabecular meshwork. Some joysticking of the globe may be required with an appropriate goniolens to bring the meshwork into view.{{Citation needed|date=November 2017}} * The Trendelenburg position along with the [[Valsalva maneuver]], termed as modified-Valsalva maneuver, can also be used for the [[cardioversion]] of [[supraventricular tachycardia]].<ref>{{cite journal|title=Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial|journal=Lancet|volume=386|issue=10005|pages=1747β53|doi=10.1016/S0140-6736(15)61485-4|pmid=26314489|year=2015|last1=Appelboam|first1=A|last2=Reuben|first2=A|last3=Mann|first3=C|last4=Gagg|first4=J|last5=Ewings|first5=P|last6=Barton|first6=A|last7=Lobban|first7=T|last8=Dayer|first8=M|last9=Vickery|first9=J|last10=Benger|first10=J|doi-access=free|hdl=11287/593988|hdl-access=free}}</ref> * The Trendelenburg position is helpful in surgical reduction of an abdominal hernia.<ref name="pmid9445243">{{cite journal |vauthors=Buchwald H |title=Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese |journal=American Journal of Surgery |volume=175 |issue=1 |pages=63β4 |year=1998 |pmid=9445243 |doi=10.1016/S0002-9610(97)00233-X }}</ref> * The Trendelenburg position is also used when placing a [[central venous catheter]] in the [[internal jugular vein|internal jugular]] or [[subclavian vein]]. The Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins, as well as the external jugular vein. It plays no role in the placement of a femoral central venous catheter.<ref name="Amesur">{{EMedicine|article|422189|Central Venous Access Imaging}}</ref> *The Trendelenburg position can also be used in respiratory patients to create better perfusion.<ref name="pmid3355478">{{cite journal |vauthors=Powers SK, Stewart MK, Landry G |title=Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion |journal=Aviation, Space, and Environmental Medicine |volume=59 |issue=3 |pages=239β45 |year=1988 |pmid=3355478 }}</ref> *The Trendelenburg position has occasionally been used to produce symptomatic relief from septum posticum cysts of the subarachnoid space in the spinal cord, but does not bring about any long-term benefits.<ref>{{cite journal |vauthors=Teng P, Rudner N |title=Multiple arachnoid diverticula |journal=Archives of Neurology |volume=2 |issue= 3|pages=348β56 |year=1960 |pmid=13837415 |doi=10.1001/archneur.1960.03840090112015 }}</ref> *The Trendelenburg position may be used for drainage images during [[endoscopic retrograde cholangiopancreatography]].<ref name="Fundamentals of ERCP">{{cite book |first1=Joseph |last1=Leung |chapter=Fundamentals of ERCP |chapter-url=http://www.gastrohep.com/ebooks/ebook.asp?book=1405120789&id=2 |editor1-first=Peter B. |editor1-last=Cotton |title=ERCP |publisher=GastroHep |doi=10.1002/(ISSN)1478-1239 |s2cid=246400819 }}</ref> *The Trendelenburg position is reasonable in those with a [[cord prolapse]] who are unable to achieve a knee-to-chest position.<ref name=GLOWM2017/> It is a temporary measure until a [[cesarean section]] can be performed.<ref name="GLOWM2017">{{cite journal |last1=Lore |first1=Marybeth |title=Umbilical Cord Prolapse and Other Cord Emergencies |journal=The Global Library of Women's Medicine |date=March 2017 |doi=10.3843/GLOWM.10136}}</ref> *If a patient in a [[Fowler's position]] or semi-Fowlers position has sunk too far down into the bed, they may temporarily be put in a Trendelenburg position while staff reposition them. This does not have a direct therapeutic action but rather provides a mechanical advantage<ref>{{Cite journal |last=Latimer |first=Sharon |last2=Chaboyer |first2=Wendy |last3=Gillespie |first3=Brigid M. |date=July 2015 |title=The repositioning of hospitalized patients with reduced mobility: a prospective study |url=http://dx.doi.org/10.1002/nop2.20 |journal=Nursing Open |volume=2 |issue=2 |pages=85β93 |doi=10.1002/nop2.20 |issn=2054-1058|pmc=5047314 }}</ref>
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