What's your procedure for PRONING a pt?

[lifeLONGstudent]

This is a nightmare for me, and no procedure.... so I want to know what you guys do?

Do you get an air mattress to help prevent breakdown (First-Step)?

RT and MD at bedside? How many RNs?

change out EKG to back side (and in same order? White on right, smoke over fire.... etc)?

extra tubing for your lines? just to give you some slack (like maybe 1 extention tubing per line). These are usually sicker patients with many drips.

If they are on pressors, do you see big swings in their vitals? (not necessarily SpO2).

prop with pillows? how do you turn q2 hours to prevent skin breakdown? and what parts do you turn or reposition?

how do you position the pt before, during, after the turn?

Use a towel roll?

How long do they stay proned? 6hrs, 8hrs... do it twice a day? and for how long (usually) before VQ mismatch or shunts improve to where you don't need to do this anymore?

Thanks in advance for your tips and pearls!

LifeLONGstudent

[jbp0529]

Here is what I know and what I found out:

The ideal way to prone is to have a specialty bed (ex: Rotoprone from KCI). I am including a link to the Rotoprone website but here's a few bits of info:

According to KCI, the recommended time in prone position is about 3 hrs 15 min, then back supine for ~ 45 min. While prone, pt should be rotated 40 degrees side to side. ~ 18 hrs a day in prone position.

Lines should have enough slack, as well as ETT. The Rotoprone bed has a special set of "hooks" coming out near the top of the head rest, thru which all IV's/invasive lines/ETT come through and are secured. The bed itself looks like a big enclosed "tanning bed", so its not possible to have tubing come out the side... plus, if you think about it, when the bed rotates, things could get pulled out if they came out from the sides.

Transducers for pressure lines are secured outside the bed near the head as they come out of that special hook device. Since the transducers arent lined up next to the pt's side (mid axillary line), you just have to kinda estimate phlebostatic axis. Pressure reading can fluctuate with rotation some.

Contraindications would be: spinal fractures, high ICP.

Need aggressive sedation and/or paralytics.

As with anything related to t/x of ARDS...the sooner implemented, the better.

Anyway, here's the link i found, probably explains it better:

http://www.kci1.com/Prone-RP_Guidelines_for_Use_2-B-138.pdf

[Creamsoda, ASN, RN]

We have a special bed that our Nurse practitioner and clinical nurse specialist devised. It has a spot for the head kind of like you would see when you get a massage, but room for the ETT to easily come through, the head part is moveable, and swings down when we turn the pt, so the neck doesnt hyper extend, then we can lock it back in place.

We always either have a Doc on the unit, or a NP to supervise the proning. Always have 1 RT securing the tube to the patient on a bagger, and another RT hanging around if the other RT is having trouble. We pull the bed out a bit, put the IV pole at the HOB so we dont really need any extension tubing for lines.

We Have 1 nurse holding/stablizing the head while the RT holds the ETT, 2-3nurses on either side of the pt, and we slowly flip the pt. over...its tricky so we do it slowly.

We always turn q2h. Always on a side...never flat on the stomach. We have to call the RT for the turn...they watch the ETT. If the patient is laying on their left side, so right side is up, the right arm goes upward and rests above the head, swimmer style. The left arm at the pt's side.

The bed stays in reverse trend. position.

I cant remember how the leads go..if it would be opposite. Its been a while since weve proned a pt.

Always make sure the face doesnt have any pressure areas, sores ect.

[WindwardOahuRN, RN]

Transducers for pressure lines are secured outside the bed near the head as they come out of that special hook device. Since the transducers arent lined up next to the pt's side (mid axillary line), you just have to kinda estimate phlebostatic axis. Pressure reading can fluctuate with rotation some.

You can still line up the transducers at the phlebostatic axis by using extensions on the pressure tubing. Since the pressure does fluctuate with rotation you can only get an accurate reading when the patient is flat.

If you're doing CRRT on a Rotoprone patient the vascath has to be in the neck area (left or right IJ) or you'll have have big problems with the return and access pressures.

The only time we manually prone a patient instead of using the Rotoprone bed is when the patient cannot physically tolerate the Rotoprone because of skeletal deformities or some other problem that precludes its use.