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Intensive Care Nursing/Prone Position Proceedure

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Indications:
  • Severe ARDS
Contraindications:
  • C-spine precautions
  • Haemodynamic instability (although can still perform CPR in prone position)
  • Increased or concern with abdominal pressure
  • Extreme obesity
  • Increased intracranial pressure
  • Staff not trained/skilled or not enough personnel to carry out safely

Initial Prone Position Manoeuvre:

 Team Discussion
  • Role designation
  • Team leader (likely airway person) to communicate all steps of the procedure. Clarify terminology on start and stop for safety.
 Plan Resources
  • Anaesthetist or appropriate medical personnel skilled in airway procedure 
  • Nursing staff to perform procedure (minimum of 4, assessment of situation will need to be performed)
  • ICU Team on standby
 Preparation
  • Sliding sheets
  • Position ventilator, drains, catheter and medication pumps in preparedness of new position
  • Provide all cares before procedure. Eye protection is required.
 Review
  • Sedation
  • Paralysis
  • Monitoring
 Time Out  Pause to prepare team
 Safety  Re-Check:
  • Airway
  • IV lines, drains
  • ECG monitoring is no longer on anterior aspect
 Start Position
  • Start with patient in supine position
  • Place patients hands under buttocks
  • Place padding or pillows across ankles, pelvis and chest
  • Place sheet on top and roll together with bottom sheet ('The Cornish Pasty') 
 Slide Across  Slide across to edge of bed
 Side Lie   Slide patient into side lie position
 Re-check
  • Airway
  • Vital signs and ventilator readings 
  • IV lines, drains
 Side lie to prone position
  • Process to prone position
  • Turn head and maintain airway as moving into prone position
  • Gel pads can be used to protect head and other at risk areas
  • Reposition 1 arm and head for 'swimming' or 'superman' position
 Posture Change  Every 2hrs
  • Anaesthetist or appropriate medical personnel skilled in airway procedure 
  • Reposition arms to side of patient
  • Position ventilator, drains, catheter and medication pumps in preparedness of new position
  • Slide up bed so head off the bed with Anaesthetist supporting head and airway throughout
  • Rotate head to face opposite direction as previous position maintaining airway
  • Slide down bed so body fully supported
  • Reposition other arm for 'swimming' or 'superman' position


Video Resources:

Note:this is not a formal guide or competency checklist for performing prone position procedure

ICUnurses (discusscontribs) 11:12, 11 September 2014 (UTC)