Intensive Care Nursing/Prone Position Procedure


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 using 'swimming' or 'superman' position

See Also

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  1. Airway Adjuncts
  2. Mechanical Ventilation

Reference:

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Guérin, Reignier, Richard, Beuret, Gacouin, Boulain, . . . Ayzac. (2013). Prone Positioning in Severe Acute Respiratory Distress Syndrome. The New England Journal of Medicine, 368(23), 2159-2168.

Video Resources

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