The Sims Position: Always the Left Side for Good Reason
As both a gamer immersed in medical simulation design and an advocate for patient education, one of my most frequent areas of reader curiosity is clarifying best practices around use of the Sims position.
So to directly answer the leading question: Yes, the Sims patient position specifically refers to lateral positioning on the left side rather than the right.
Below I‘ll share research-backed rationale exploring why left Sims has endured as a standard, along with actionable insights for properly administering techniques like enemas using this time-tested posture.
A Primer: Defining the Left Lateral Sims Position
Pioneered in the 19th century by Dr. J. Marion Sims to improve gynecological access and visualization, this semi-prone patient posture is characterized by:
- Lying on the left side rather than right
- Left leg extended straight
- Right leg flexed at both knee and hip
- Left arm placed behind the back
- Right arm falls naturally in front of body
This left-sided oblique variant enables gravitational advantage and anatomical alignment allowing improved procedural access, while optimized comfort aids patient compliance – a win/win!
Over a century of medical practice has demonstrated left Sims as ideal for interventions like:
- Enema administration
- Digital rectal exams
- Gynecological procedures
- Certain surgeries (e.g. kidney)
- Pregnancy/childbirth positioning
Now that we‘ve defined the fundamental patient orientation priorities of left Sims, let‘s move on to practical guidance for harnessing its advantages.
Mastering Sims Positioning For Enema Administration
Equipping patients to confidently self-administer rectal interventions at home is a passion of mine.
Here is an evidence-based step-by-step guide to properly preparing and positioning oneself or a patient to introduce enema solutions using the left lateral Sims posture:
Set Up
- Gather enema supplies: solution, tubing, lubricant
- Protect bed surface from potential mess
- Offer bedpan or help reaching bathroom afterwards
Positioning
- Lie on LEFT side with pillows for support if needed
- Extend left leg straight, bend right leg for stability
- Bring left arm back to rest palm against lower spine
- Allow right arm to extend forward naturally
Insertion
- Lubricate tip of enema tubing
- Gently insert 3-4 inches into anus
- Open tubing clamp to instill solution 5-10 minutes
- Close clamp and withdraw tubing
Completion
- Remain in Sims posture 2-5+ minutes until urge to defecate
- Sit on toilet or bedpan to expel enema contents
- Can repeat enema process if more evacuation needed
Following this protocol including properly getting onto the left side instead of the right allows gravity to improve solution instillation and absorption while also enabling easier access to reliably insert and direct the enema.
Why Left Over Right Matters for Enemas and More
Beyond a slight gravitational edge, are there other functional reasons supporting the longevity of left-sided Sims positioning as a standard across nursing and medicine?
Anatomical Alignment
Our sigmoid colon curves across the left abdomen. When patients are rotated onto the left, this section of large intestine shifts lower in the pelvis.
Enema tubing can thus more easily reach and distribute solution around the descending and sigmoid colon on the patient‘s left side. Access deeper into the transverse colon is also enhanced.
Visualization Improves
The left Sims posture reliably exposes the anus and buttocks region to improve visualization during interventions like enema or suppository placement.
Obstetric and gynecological procedures also benefit from tissue exposure as well asopened pelvic diameters offered by left Sims compared to right side-lying.
Trends in Clinical Practice Data
In reviewing recent medical literature, there are no studies demonstrating advantages of right-sided sims positions over properly executed left-sided postures for any procedures.
Meanwhile, clinical practice continues to favor left lateral decubitus technique for enemas and colonoscopies especially:
- 94% of surveyed Japanese facilities recently reported left Sims as standard enema positioning
- Left lateral most common for colonoscopy (enables sigmoid access)
Now that we‘ve explored why left Sims is prioritized, what does research indicate around alternatives?
Right Sims Strategies: An Occasional Exception
While the left decubitus posture is properly called the Sims position, research indicates some potential benefits to right side-lying alternatives:
Gas Relief
For patients experiencing intestinal gas pain, rotating onto the right side with both legs flexed has been shown to help lift pressure and reduce discomfort.
Injury Accommodations
If a patient has an injury or condition precluding lying on the left side, right-sided adjustments can enable posture benefits.
Improved Distribution
Some recent nursing debates have discussed whether alternating side positions could allow gravity to spread instilled enema fluid more evenly.
Overall however, current literature affirms left lateral positioning as the gold standard Sims technique for procedures like enemas and colonoscopies warranting access to the sigmoid colon and rectum.
Takeaway Tips for Patient Care Professionals
With the level of detail I‘ve included above, I realize absorbing all the vital nuances around when and how to leverage left decubitus/Sims positioning could still be overwhelming!
So in closing, I‘ll offer a condensed checklist of top tips for properly harnessing left-sided Sims posture:
- Always double check orders/protocols specify "left" lateral
- Extend left leg straight & bend right leg for support
- Arm placement facilitates procedure access
- Enema insertion depth 3-4 inches into rectum
- Have patient remain left side-lying until bowel movement urge subsides before sitting up
It is my sincere hope this guide serves you in confidently accessing the expansive benefits of left-sided Sims positioning for interventions like enema administration for those under your care! Please reach out with any other questions.
