Jump to content

Proning patients, face and neck positioning

by Wildplaces Wildplaces (New) New Nurse

Specializes in Critical Care. Has 7 years experience.

Cross posted from other board, hadn't gotten any responses yet so not sure if the MICU/SICU forum is very active.

Hello everyone, I've been working on a specialty COVID-19 positive ICU since the pandemic started. I typically work in the MICU and while we proned patients once in a while, every intubated patient on the specialty unit is now being proned. Most of our patients are currently on a schedule including 16 hours in prone position. We are having difficulty trying to find the best positioning for the patient's head and neck, (particularly if they lack much of a neck). Everyone has tried something, from the OR prone pillows (not having much success, oddly. They are awkwardly large and seem poorly made), to pillow positioning to 1L saline bags on foreheads, to towels rolled into different shapes, and yet nearly everyone's face remains smashed into the wrong position. Arm placement has been usually at 90 degrees by the face but we have tried tucking them by the patient's side as well on some patients as well in attempt to find the most comfortable spot. I understand everyone is different and some patients will be calm in particular positions while others may get irritated (I have some that absolutely HATE being prone, their vital signs showing distress until they are flipped back to supine), but I'm looking for tips and suggestions of you have any to offer. Thank you!

SquatsNScrubs, BSN, RN

Specializes in Med-Surg, CVICU. Has 4 years experience.

For our COVID pts that are prone, we use foam pillows that resemble a donut and rotate the head/neck q2h between left, right, and center.

For arm placement, we do one arm at a 90 degree angle by pt's face, and other arm extended at side with palm facing up (we call it the "swimmer" position). Arms also get rotated q2h

Agreed that every patient's face looks smashed and uncomfortable regardless of position :(