CONTINUOUS LATERAL ROTATION (CLRT)
STANDARDS OF NURSING CARE (SONC)

1. Select Patient
2. Identify Clinical Indicators for Therapy
3. Identify Contraindications
   

4. Determine Therapy Goals
5. Monitor Clinical Indicators of Tolerance
6. Identify Indicators for Discontinuing CLRT

STANDARD OF NURSING CARE

 1.

Select Patient

CLRT use is only indicated for patients with impaired gas exchange due to pneumonia or atelectasis.

Obesity alone is not an indication for use.

Documentation in the AI record must include the reason for starting CLRT.

 1.

Although current research evidence is limited, there is some evidence that CLRT therapy is associated with improved pulmonary function when used in patient with pneumonia or atelectasis.

Weight is not an indication for CLRT use.

 2.

Identify Clinical Indicators for Therapy

• Need/impending need for mechanical ventilation
• P/F ratio <200
• Desaturation induced by nursing care
• Hemodynamic instability during manual turning
• Immobility with respiratory compromise

 2.

These indicators indicate worsening pulmonary function.

 3.

Identify Contraindications to Therapy

Therapy is contraindicated in patients with the following conditions:

• Unstable head injuries
• Uncleared cervical, thoracic or lumbar spine injuries
• Raised intracranial pressure
• Long bone or cervical traction
• Severe agitation
• Severe diarrhea
• Severe nausea/vertigo that fails to respond to medication
• Open abdominal wounds (evaluate with physician on a patient specific basis)
• Terminal illness (unless indicated to promote patient comfort and no patient with medically treatable indication in need of module)

3.

Head, neck, spine and limb alignment cannot be maintained/guaranteed during rotation.

Rotation or neck alignment changes may increase intracranial pressure.

Rotation may worsen nausea/vertigo or agitation.

Open abdominal wounds may be fragile and unstable. Consult general surgeon to determine if CLRT is appropriate for use in individual patient.

Modules should be made available to patients who may benefit from CLRT. In terminally ill patients, CLRT may be considered if patient comfort is increased by CLRT use.

 4.

Determine Therapy Goals

• To improve oxygenation
• To decrease length of ventilator days
• To demonstrate resolution of pneumonia/atelectasis

Currently, CLRT is not indicated for the treatment of skin breakdown. Ongoing skin integrity monitoring is important to ensure that CLRT use is not associated with adverse integumentary outcomes.

 4.

These goals demonstrate improved pulmonary function.

 5.

Monitor Clinical Indicators of Tolerance

Monitor the following clinical indicators and document in the graphic record q1H:

• Mechanical ventilation parameters
• Pulse oximeter reading
• HR and BP
• VAMASS

Monitor the patient's position (e.g., left, right or supine) when changes in oxygen saturation are note, and document relationship in the AI record.

Track tolerance/response to CLRT in the AI record. Monitor for nausea or vertigo and document in the AI record. Reassess q4h and prn.

P/F ratio should be calculated daily during ventilator rounds and prn. The goal for the P/F ratio is >200.

If signs of intolerance are identified, adjust therapy to the previously tolerated settings. See Procedure for Initiating CLRT.

5.

These findings may indicate intolerance to CLRT. Attempt to adjust therapy or treat symptoms until patient is able to tolerate CLRT.

 6.

Identify Indicators for Discontinuing CLRT

Consider discontinuing CLRT when the following goals have been achieved:

• Improved chest xray
• Improved breath sounds
• Decreased secretions
• Increased patient mobility
• Hemodynamic stability during turning is achieved
• A change occurs in the patient's condition that contraindicates continued CLRT use
• Patient intolerance
  

 6.

Therapy is no longer indicated when these criteria are met.