A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor
Correct Answer: B. Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the client on the left side with knees bent. Preparation for a colonoscopy is the biggest complaint that most patients have about receiving the procedure, and is a primary reason for non-compliance to screening colonoscopies. The technician or nurse is there to assist with preserving stability and preventing the patient from rolling forward or backward. Also, they are there to help provide counter pressure to the abdomen to assist the endoscopist in navigating corners and turns.
Option A: Placing the client on the right side with legs straight wouldn’t allow proper visualization of the large intestine. Performing a colonoscopy requires practice and is a skill that is difficult to master. While watching an experienced clinician perform a colonoscopy may appear simple, the technique is something that requires time, patience, and a lot of practice. Navigating through a cylindrical tube that can flex, dilate, contract, and move is not an easy task.
Option B: Placing the client prone with the torso elevated wouldn’t allow proper visualization of the large intestine. The patient should be positioned in the left lateral decubitus position. Although, some clinicians may prefer the patient on their back or right side if circumstances require. The legs being flexed toward the chest help to relax the puborectalis and pubococcygeus muscles. This allows for easier entry and traversing past the angle at the sacral prominence.
Option D: Placing the client bent over with hands touching the floor wouldn’t allow proper visualization of the large intestine. On the left-sided position, the patient’s legs should be flexed, and pillows should be placed around their back, head, and between their knees to help prevent injury to the bony prominence and to help maintain position.
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