Preparation |
1. Check for
contraindications. |
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a. Facial or pelvic
fractures |
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b. Burns or open wounds on
the ventral body surface |
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c. Conditions associated with
spinal instability (eg, rheumatoid arthritis,
trauma) |
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d. Conditions associated with
increased intracranial pressure |
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e. Life-threatening
arrhythmias |
2. Consider possible adverse effects of
prone positioning on chest tube drainage. |
3. Whenever possible, explain the
maneuver to the patient and/or their family. |
4. Confirm from a recent chest
roentgenogram that the tip of the endotracheal tube is
located 2-4 cm above the main carina. |
5. Inspect and confirm that the
endotracheal tube and all central and large bore
peripheral catheters are firmly secured. |
6. Consider exactly how the patient's
head, neck, and shoulder girdle will be supported after
they are turned prone. |
7. Stop tube feeding, check for
residual, fully evacuate the stomach, and cap or clamp
the feeding and gastric tubes. |
8. Prepare endotracheal suctioning
equipment, and review what the process will be if
copious airway secretions abruptly interfere with
ventilation. |
9. Decide whether the turn will be
rightward or leftward. |
10. Prepare all
intravenous tubing and other catheters and tubing for
connection when the patient is prone. |
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a. Assure sufficient tubing
length |
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b. Relocate all drainage bags
on the opposite side of the bed |
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c. Move chest tube drains
between the legs |
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d. Reposition intravenous
tubing toward the patient's head, on the opposite side
of the bed |
Turning
procedure |
1. Place one (or more) people on both
sides of the bed (to be responsible for the turning
processes) and another at the head of the bed (to assure
the central lines and the endotracheal tube do not
become dislodged or kinked). |
2. Increase the FiO2 to 1.0 and note the
mode of ventilation, the tidal volume, the minute
ventilation, and the peak and plateau airway
pressures. |
3. Pull the patient to the edge of the
bed furthest from whichever lateral decubitus position
will be used while turning. |
4. Place a new draw sheet on the side of
the bed that the patient will face when in this lateral
decubitus position. Leave most of the sheet
hanging. |
5. Turn the patient to the lateral
decubitus position with the dependent arm tucked
slightly under the thorax. As the turning progresses the
nondependent arm can be raised in a cocked position over
the patient's head. Alternatively, the turn can progress
using a log-rolling procedure. |
6. Remove ECG leads and patches. Suction
the airway, mouth, and nasal passages if
necessary. |
7. Continue turning to the prone
position. |
8. Reposition in the center of the bed
using the new draw sheet. |
9. If the patient is on a standard
hospital bed, turn his/her face toward the ventilator.
Assure that the airway is not kinked and has not
migrated during the turning process. Suction the airway
if necessary. |
10. Support the face and shoulders
appropriately avoiding any contact of the supporting
padding with the orbits or the eyes. |
11. Position the arms for patient
comfort. If the patient cannot communicate, avoid any
type of arm extension that might result in a brachial
plexus injury. |
12. Auscultate the chest to check for
right mainstem intubation. Reassess the tidal volume and
minute ventilation. |
13. Adjust all tubing and reassess
connections and function. |
14. Reattach ECG patches and leads to
the back. |
15. Tilt the patient into reverse
Trendelenburg. Slight, intermittent lateral
repositioning (20-30º) should also be used, changing
sides at least every 2 hours. |
16. Document a thorough skin assessment
every shift, specifically inspecting weight bearing,
ventral surfaces. |