SOP - Ventilated Patient Proning

Indication

 Early Acute Respiratory Distress Syndrome

 PEEP more than 7 or FIO2 > 60 %
 Moderate to severe respiratory failure

Preparation

 Inform relatives about procedure risk factor

 Five Nursing must be present at the time of proning
 One Anaesthetic/Doctor should be present
 Potential resuscitation within easy reach “Crash cart should be ready and on standby”
 Central line/Artrial line requirements should be assist and if required  insertion.
 Foleys catheter and Ryles tube should be in SITU.
 Closed suction kit should be attached.
 Ensure the ET tube/lines are well secured by Dynaplast or bandages.
 Ensure patient should be well sedated and paralyzed
 Protect both eye with ointment and eye pads
 Empty all drainage bags (Ileostomy/colostomy/catheter)
 Adjust the remaining lines and monitor leads to prevent kinking and disconnections.

Procedure

 Place the pillow over the patient’s chest and pelvis to avoid abdominal pressure from the
mattress.
 Place a pillow over the shins to flex the knee
 Place a sheet over the patient

Nursing staff placement

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 SOP - Ventilated Patient Proning

Turning of patient

 The first direction of first turn should be towards the ventilator, where possible to minimize the
risk of disconnection or extubation.
 Two staffs will hold the bed sheet from one side and another staff will support the patient with
hand underneath of the patient’s upper body and soon after staff will turn the patient towards the
other side.
 Once the patient is prone, attach monitor leads on back of patient after proning.
 Place the rolled linen sheet / ring underneath the head of patient.
 Ensure pressure points are padded to avoid pressure sores.

Nursing interventions

 Eyelids should be closed using eye pads to prevent corneal abrasions

 Perform regular oral suctioning
 Monitor for evidence of gastric regurgitation
 Used closed suction system to facilitate suction of ETT
 Laterally rotate the head 2-3 hours, placing it away from the elevated arm (if possible) and
avoiding neck extension
 Reposition the upper limbs every 2-3 hours.

 IN CASE OF EMERGENCY SITUATION SUCH AS CARDIAC ARREST, LOSS OF

AIRWAY RETURN THE PATIENT IN SUPINE POSITION.

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