Appendix C: Prone Positioning in Patients with ARDS

PREPARATION:

1. Check for contraindications.

- Facial or pelvic fractures
- Anterior torso wounds or burns
- Spinal instability
- Increased ICP

2. Confirm ETT placement with recent CXR.

3. Ensure that ETT and all invasive lines/monitors (chest tubes, IVs, central lines) are secured.

4. Consider how patient’s head, neck, shoulder girdle will be supported.

5. Stop tube feedings, evacuate stomach, cap/clamp feeding and gastric tubes.

6. Prepare airway suctioning equipment.

7. Prepare all IV tubing, catheters, etc., for prone connections.

- Assure sufficient tubing length
- Relocate drainage bags to opposite side of bed
- Move chest tube drains to between legs
- Reposition IV tubing to patient’s head on opposite side of bed

TURNING

1. Place personnel on both sides and head of bed.

2. Increase FiO2 to 1.0, and note TV, minute ventilation, peak/plateau pressures.

3. Place new draw sheet, put patient into lateral decubitus position.

4. Remove EKG leads and patches. Suction airway, oropharynx, nares as necessary.

5. Continue to proning, and reposition patient in center of bed.

6. Turn patient’s face toward ventilator. Ensure airway is not kinked and has not migrated.

7. Support face/shoulders appropriately; ensure no contact of padding with eyes/orbits.

8. Position patient’s arms for comfort. Avoid arm extension that might cause brachial plexopathy.

9. Auscultate chest for mainstem intubation; reassess TV and minute ventilation.

10. Reconnect and adjust all tubing, check functions.

11. Reattach ECG patches and leads to back.

12. Tilt patient in reverse Trendelenburg. Intermittent slight (200) lateral repositioning every two hours, if possible.

13. Document skin assessment on weight-bearing surfaces every shift.