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Procedure
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Rationale
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1.
Obtain the following minimum number of staff:
-
1 respiratory
therapist (responsible for airway)
-
2 RNs
(on either side of bed)
-
1 physician
(unless the patient is very stable)
-
Prior
to starting, administer sedation and/or analgesia.
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The
respiratory therapist (or physician) is responsible for ensuring the airway
is secure. Turning should be on the count of the person assigned
to the airway.
Most
patients being turned prone are critically ill; unless the patient is very
stable, a physician should be in attendance.
At
least 2 RNs (one on either side of the bed are needed). |
2.
Perform hand hygiene and don non-sterile gloves, assess need for gown, facemask and shield.
Position all lines and IV tubings that are inserted above the patient's
waist towards the head of the bed (e.g. subclavian or upper extremity IVs,
radial arterial lines, NG or feeding tubes). |
In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policiesin an effort to reduce risk of transmission of microorganisms and secretions.
This
will minimize tangling during the turning procedure. |
| 3.
If ECG electrodes were placed on the back while prone, reposition them
towards the shoulder and sides, avoiding areas of pressure. |
Ensure
that electrodes are not left on the back before turning supine. |
| 4.
Position all lines and IV tubings that are inserted below the patient's
waist towards the foot of the bed (e.g. foley drainage bag, chest tubes,
femoral lines). |
This
will minimize tangling during the turning procedure. |
| 5.
Position patient's face towards the ventilator. |
Following
turning to the supine position, the patient will be facing away from the
ventilator. This head positioning reduces the risk for ETT dislodgment
or kinking of the ventilator tubing. |
| 6.
Place a pillow or roll beside the patient's head, on the side furthest
from the ventilator. |
When
the patient is supinated, the roll will ensure that the neck is protected
against abduction or injury. |
| 7.
Remove nerve protectors and place arms above head. |
Raising
the arms above the head protects them from being injured during the turn. |
| 8.
Using the draw sheet, move the patient close to the edge of the bed nearest
the ventilator. |
This
will ensure there is sufficient room for the patient when supine. |
| 9.
Cross legs at the ankle with leg closest to the ventilator on top. |
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10.
-
Tighten
straps.
-
Tuck
turning straps underneath the patient, so that the straps are towards the
side of the bed with the ventilator.
-
Tile
patient to 45 degree ankle. Turn on the count of the person responsible
for the airway.
The
nurse on the side of the ventilator pulls the straps to facilitate the
turning from 45 degrees to supine.
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| 11.
Remove straps and unfasten the positioner. |
Pressure
sores may develop if the patient is left lying on the straps. |
| 12.
Reassess patient. Reposition IVs and tubes. Re-level pressure
monitoring equipment. |
|
13.
Monitor for evidence of skin breakdown on the face, ear, knees or other
pressure points.
Remove PPE and perform hand hygiene. |
Massive
facial, bucal or scleral edema may collect as edema settles to the dependent
areas. This will gradually resolve, but may be disturbing to the
patient's visitors.
In accordance with the MoHLTC 4 monents of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions. |
| 14.
Document procedure and patient response. Note the time interval between
turning and oxygen improvement. |
|
| 15.
Obtain arterial and mixed venous blood gases and cardiac output measurements
30 minutes after completion of turn. |
To
evaluate effectiveness of therapy. Monitor to ensure that cardiac
output remains adequate. A rise in mixed venous oxygen saturation
indicates improved tissue perfusion (decreased need to extract).
A
goal for improvement in oxygenation is a PaO2:FiO2 gradient > 300. |
| 15.
Reassess need for pronation following minimum 2 hour rest period. |
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