Therapeutic Prone Position

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Indication

  1. Moderate to Severe ARDS
    1. Pa02:Fi02 <150mmgHg (20kPA)
    2. Fi02>0.6
    3. PEEP>5cm H20
  2. Acute cor pulmonale
  3. High risk of over distension / barotrauma
  4. CT appearance

Contraindications

  1. Difficult Airway / Recent Tracheostomy
  2. Raised intracranial / intraocular pressure
  3. Neuro / maxillo-facial surgery or trauma
  4. Unstable spine, femur or pelvic fractures
  5. Severe hemodynamic instability / recent CA
  6. IABP or recent cardiac pacemaker
  7. Pregnancy
  8. Obesity
  9. Recent abdominal surgery
  10. Anterior Chest Drains

Method

Staffing: 5 minumum, 6-8 recommended Equipment: Pronation pillow highly recommended, 3 or more pillows, 2 flat sheets

Order for prone positioning should be noted in the chart

Pre-Pronation

  1. Perform necessary wound care
  2. Make sure patient adequately sedated / paralyzed
  3. Verify that ET Tube is secured
  4. RT to pre-oxygenate the patient with 100% oxygen
  5. RT to suction patient
  6. Remove unecessary lines
    • Maintenance Fluids
    • BP / Cardiac monitoring (will replace leads behind patient)

Positioning

  • RT at the head of the bed
    • RT is responsible for ET Tube placement
    • RT to hold ET Tube and will turn with patient
    • RT to coordinate with Turn leader
  • Turn leader at the foot of the bed
    • The only person to speak while maneuver is being performed
    • Will visually check that lines are secured
  • Two Nurses on each side of the bed