Additional Prone Positioning Considerations:

Prone positioning for non-intubated patients Preparing the Patient for Assisted Manual Pronation Therapy:

1. Assemble equipment needed, Ensure patient has NIPPV full-face mask2. Prior to prone positioning, perform any nursing interventions that require access to the

anterior body surface (e.g., oral care, suctioning, wound dressings, emptying of ostomybags, etc.) to minimize the need to return patient to a supine position.

3. Verify the position and security of the NIPPV mask.4. Readdress and secure all vascular lines, ensuring there is sufficient slack to complete

positioning safely without dislodging.5. Move ECG leads to patient's back to minimize risk of skin breakdown while in prone

position. Evaluate for waveform quality and arrhythmias.6. Move any securement devices (e.g., StatLock® for urinary catheter securement) to the

medial leg. Urinary catheters and chest tubes should be aligned with either leg at foot ofbed.

7. Assure all 4 side-rails of the Stryker® InTouch ICU bed are engaged

Procedure for Assisted Manual Pronation Therapy:

1. Room RN takes the leadership role and gives clear directions such as "toward or awayfrom the NIPPV" instead of "right or left" and "toward head or foot of bed" instead of "upor down."

2. When able, patients can initiate their own movements and nursing staff can help in easingthe process. When unable to adopt prone positioning themselves, Stryker® InTouch Turnassist feature can be used to help patient move from lateral decubitus position to proneposition. Figure 2.

3. Pillows will be located underneath their chest, supporting their legs and arms in classicprone “swimming” position. Figure 3.

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Figure 2. Stryker® InTouch Turn assist feature

Figure 3. Pillow support and “Swimming” position.

4. Pressure ulcer risk mitigation: pressure points will be frequently assessed for non-blanchable redness or breakdown. Foam dressings can be placed (e.g., Mepilex®) on highrisk areas (e.g., , knees, shins, pelvis, chest) if needed.

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Prone CPR: Starting prone CPR versus turning supine for CPR is patient specific and would depend on initial rhythm and how many staff is readily available (what staff are currently in the room etc.). May need to do prone CPR for 2-4 minutes, until enough staff present to safely return to supine position.

February 2017 • Volume 124 • Number 2 DOI: 10.1213/ANE.0000000000001369

CPR Prone Anesth 20-17.pdf

InTouch Bed w/ Zoom Handle Adjustments for CPR Boards Adjust zoom handles by placing them in the downward position as shown prior to placing CPR boards for prone positioning

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In-person resources: Andrea Lehnertz, APRN, CNS, M.S.N Jenn Elmer, APRN, CNS, D.N.P, FCCM Medical ICU charge RNs: (25)5-5757 Ei 10-3/4 Charge RNs: (26)6-7513 MICU/ 10-3 Medical Respiratory Therapists

Competency Documents:

2019_Topic_Proning.docx

Pronepositioninguidetemplate.docx

Last uploaded: 4/16/2020©2020 Mayo Foundation for Medical Education and Research