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Prone Positioning in the NICU

Hello all. I previously posted this in the Student Assistance forum, but thought maybe I can get more help here...

-I'm a nursing student doing a project on positioning preemies in the prone position. From my research so far, I've found that most NICU nurses roll up towels or blankets and place them under the baby. Some others use existing positioning aids (filled with gel or cushioning) and fold or roll those up until they do what they want them to do. One question, is there something out there whose specific purpose is to put/hold babies in the prone position? What other methods do NICU nurses use to position preemies prone? What kinds of things would you look for in something that specialized in prone positioning? I've heard about the "knees-to-nipples" and "elbows-to-nipples" concepts; are there any other major concerns when positioning prone? Any comments related to prone positioning of preemies would be welcome. Thank you in advance for all of your help!!!

We have "snugglies", which keep them nested, whether prone or supine, etc. We still reposition to avoid toaster heads, and don't leave them prone all shift. After seeing kids in our developmental clinic months and years down the road, it's amazing how much damage a malpositioned head can do.

As far as concerns when postioning a baby prone, there are a few. Most premies prefer the prone position, but not all. There are those that get *too* comfortable and my have an increase in a/b/desats. Those babies may do better in a side lying postion. IV placement is also a concern. A PIV in the foot may be difficult to assess and more likely to infiltrate or get kicked out in the prone position. We have positioning aids, but they often are too large for our 400-600grammers. I prefer blanket rolls for a custom fit. Once they reach about 1700gms we wean them to an open bed and try to keep them supine or side-lying. Sometimes though, the only way they'll sleep is on their tummies.

I make 'pillows' out of small pieces of fluff cut and rolled to the right size for the baby. It works well with those 400-600 grammers that are soooo tiny that even a thin cloth diaper folded up seems either too big or too rough. Then of course it's elbows tucked in and knees in. Another fluff pillow use is to get a cpap kiddo into side lying or prone without his head being twisted. The fluff seems to be just the right depth to make up the difference to clear the cpap off the bed.

gotta just love fluff...

I make 'pillows' out of small pieces of fluff cut and rolled to the right size for the baby. It works well with those 400-600 grammers that are soooo tiny that even a thin cloth diaper folded up seems either too big or too rough. Then of course it's elbows tucked in and knees in. Another fluff pillow use is to get a cpap kiddo into side lying or prone without his head being twisted. The fluff seems to be just the right depth to make up the difference to clear the cpap off the bed.

gotta just love fluff...

What is fluff? Where do you get it?

I make 'pillows' out of small pieces of fluff cut and rolled to the right size for the baby. It works well with those 400-600 grammers that are soooo tiny that even a thin cloth diaper folded up seems either too big or too rough. Then of course it's elbows tucked in and knees in. Another fluff pillow use is to get a cpap kiddo into side lying or prone without his head being twisted. The fluff seems to be just the right depth to make up the difference to clear the cpap off the bed.

gotta just love fluff...

Is fluff like sheepskin??? IF SO, then yes, I use it like that too, and I love it~

prmenrs, RN

Specializes in NICU, Infection Control.

We bought some of the positioning devices from the above website. One of the nurses made a pattern for them, then made them for us. She also created incubator covers, and a special cover for the open cribs to decrease the light and noise. Since those things are very expensive, that saved us a LOT of money.

The hospital volunteers office has a "crafts unit" that made us some of the rolls, too.

And for swaddling, we use a 22" square of lightweight calico, hemmed on all sides. This is a great "community" project for Brownie Troops! We've gotten several sets of those squares that way!!

What is fluff? Where do you get it?

Sorry for the delay in gettng back - gotta love those three in a row...

Fluff is indeed fake sheepskin. All of our premie beds get it new every night. It comes in large pieces that can be cut into four pieces. It's awesome.

prmenrs, RN

Specializes in NICU, Infection Control.

Be sure to put something between their faces and the "fluff"--we had a baby that died several years ago, they found that stuff in it's mouth!!!

Thank you everybody for all your comments about prone positioning. It's really interesting hearing about how different NICU's have their different methods. Keep 'em comin'!!

In regards to the fluff, is that something that is machine washable between uses, or are you constantly cutting new pieces and throwing them out afterwards?

Another question, if a baby has tubes or wires coming out of his stomach area, do you still position him prone?

KRVRN, BSN, RN

Specializes in NICU.

We use sheepskins too, but we only change them as needed, rather than every day. We have a washer in our unit for washing them. We sort of lose the full benefit from them because we have to put a cloth diaper or blanket between the sheepskin and the baby. They told us a story of a baby that died, and that on autopsy they found sheepskin fibers in it's mouth or larynx or lungs or something.

(Prmenrs, I bet it's the same baby?)

Leeny,

We would not position an infant with a UAC &/or UVC prone. In our case, the babies are not stable enough and need to be supine for better cardio-resp and femoral/pedal pulse assessment. Hard to know if the PMI has shifted if they're on their tummies! Also, a wiggly baby might dislodge the catheter; if it's a UAC, a baby could theoretically bleed to death and it not be noted. (Of course the monitors would probably go crazy with the drop in BP before that happened.) They can be positioned on their sides.

Now, we will put stable babies that have a central line-jugular or femoral broviac- prone provided they can tolerate it, the dsg. is dry and secure with a tight tubing connection at the end.

prmenrs, RN

Specializes in NICU, Infection Control.

I think they still use sheepskins (the fake kind.); the moms can take them home and wash them when soiled, but we had to discard them at discharge.

For a while a few years ago, we were actually using REAL sheepskins. Now that was nice!

Gompers, BSN, RN

Specializes in NICU.

We use the fake sheepskin - that itchy white synthetic stuff that comes in big rolls. My grandpa had a real sheepskin when he was in a nursing home - that WAS nice stuff!!! The sheepskin we have...one of our nurses is even allergic to it!!! Some people do put it directly under the babies but I can't stand the stuff. If a blanket seems too rough, I'll just use a pillowcase to cover it because they're smoother. We'll use sheepskin under the blankets, on top of the scale or mattress, until a week or two before discharge. At that point we also stop putting the babies prone and lower the head of the bed, so the baby is back-to-sleep ready when discharged.

We used to have the snugglies from Childrens Medical Ventures, but they all disappeared. We just use blanket rolls or swaddle babies to keep them in position. I like to put a folded up pillowcase under a prone baby, kind of like a body pillow, so they can curl their arms and legs around it instead of having their shoulders and hips abducted.

prmenrs, RN

Specializes in NICU, Infection Control.

When I had a really, really sick baby (pharmacologically paralyzed, PFC, mec asp, heart surgery, what all), I would tape two sheepskins together (long sides) so that it made one BIG pad. If I rolled one side up, I could "tilt" the baby side to side w/o disturbing it too much. I could also roll blankets and put them under either side so their shoulders, arms and legs were supported in a more normal position.

use of a blanket to sling the babies to keep them prone is a very good idea.

I make 'pillows' out of small pieces of fluff cut and rolled to the right size for the baby. It works well with those 400-600 grammers that are soooo tiny that even a thin cloth diaper folded up seems either too big or too rough. Then of course it's elbows tucked in and knees in. Another fluff pillow use is to get a cpap kiddo into side lying or prone without his head being twisted. The fluff seems to be just the right depth to make up the difference to clear the cpap off the bed.

gotta just love fluff...

what kind of fluff are you using?

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