Pronation and pressure sores. - page 2

by dissle 3,938 Views | 16 Comments

Hi, We regularly prone our patients. It works well for the most part however we are finding more and more that these patients end up with terrible presure sores over the fore head and chin especially where the ET tape lies. I... Read More


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    Our unit policy states that patients can remain proned for up to 24 hours with head and arm position changes every 4 hours IF stable enough to do so.
    This may seem prolonged but it works, the gasses are miles better a very short time after pronation.
    We only prone when the pateint gasses are poor on 80%fio2 or above. so established lung injury. Pesonally i think it should be used a bit earlier than this.
    Its usually the sickest of patients who we dont know what else to do with! Its a last ditch attempt to save them.
    Interesting that you use pronation as an alternative position, i dont know why we dont use it for this more often, i suspect that it has allot to do with the inconvenience of all the bits ans bobs that have to be rearranged!
    XB9S likes this.
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    bear in mind it has been over 6 years since I left ICU, things will have changed greatly since then and having read through some of the literature today there was very little about how often or for how long prone should be used.

    If it works for your patients then it works and as you say your using it on the very sickest who will have very poor skin integrity anyway therefore will be at greater risk of pressure injuries.
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    What type of face pillow is being used when the tapeing is resulting in a pressure wound in the prone position and how long is the patient left in the prone position?
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    Quote from dissle
    Hi,
    We regularly prone our patients. It works well for the most part however we are finding more and more that these patients end up with terrible presure sores over the fore head and chin especially where the ET tape lies.
    I have sourced a type of "frame" for the patients head that acts as a pressure relieving device.
    However, I wondered if any of you have any experience with products for this as the market seems to be limited to this device only.
    I have googled various descriptions of the proning word and have not found any match so far.
    I notice that the majority of this website is for American based nurses so i am not sure if i have put this in the right section, could any one advise about talking to UK based nurses please.
    Thanks
    dissle

    Im curious, are you proning the patients mostly for surgical reasons or for ventilation reasons such as ARDS patients with poor oxygenation? Hillrom makes a bet that is pretty amazing and is made specifically for proning a ventilated surgical patient, however Im sure the cost of it is insane. As far as proning patients for ventilation reasons (if you are doing that), research has shown that simply putting a patient into a steep bed rotation on a bed equipped to do rotation is very similar to prone ventilation.
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    "research has shown that simply putting a patient into a steep bed rotation on a bed equipped to do rotation is very similar to prone ventilation."

    Do you remember the source in which you found this? If steep rotation works just as well, I'd like to implement it at our hospital. I'm always afraid the ETT will become dislodged when turning an already very compromised patient. Also, as many of you have probably witnessed, the patient's O2 sat often takes a long time to recover with any activity.
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    Whenever pronation is ordered in either of our ICUs, we rent a specialty bed from KCI called the "Rotoprone". Before that, we used a brace called the "Vollman Pronator". It required multiple staff in order to use the straps and "flip" the patient from supine to prone. The head was stabilized in-line with the torso. The intensivist who was fond of ordering the treatment would stand at the bedside and maintain the airway. I think the Vollman Pronator actually padded the face and kept it elevated off the bed, keeping the endotrachial tube from being compressed beneath the head. The advantage of the bed from KCI is that continuous lateral rotation is used. Also, doors under the patient's backside can be opened to aerate the surfaces, relieve pressure, do dressing changes, etc.

    http://www.kci1.com/317.asp

    http://www.vollman.com/prone_positioner.cfm
    SWEnfermera likes this.
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    Quote from SWEnfermera
    "research has shown that simply putting a patient into a steep bed rotation on a bed equipped to do rotation is very similar to prone ventilation."

    Do you remember the source in which you found this? If steep rotation works just as well, I'd like to implement it at our hospital. I'm always afraid the ETT will become dislodged when turning an already very compromised patient. Also, as many of you have probably witnessed, the patient's O2 sat often takes a long time to recover with any activity.

    Yes, a critical care intesivist/pulmonologist that I worked for had it a few years back. I will ask him next time I work where he got it. Basically, with prone ventilation you are trying to change the V/Q match/mismatch to areas that are not being ventilated as efficiently. I dont recall the exact angle of rotation that was mentioned, however it was pretty steep but could be accomplished via a rotation bed. The rotation that Im talking about isnt the standard air bed. In our ICUs we have Hilrom beds that you can place a turn module in and specify the % or angle of turn. That type of rotation is what Im referring to.
    SWEnfermera likes this.


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