ACTIVE LEARNING TEMPLATE: Therapeutic Procedure

Tommie A Waiters
STUDENT NAME______________________________________
Proning therapy
PROCEDURE NAME_____________________________________________________________________ REVIEW MODULE CHAPTER____________

Description of Procedure
Prone ventilation is ventilation that is delivered with the patient lying in the prone position. Prone ventilation may
be used for the treatment of acute respiratory distress syndrome (ARDS) mostly as a strategy to improve
oxygenation when more traditional modes of ventilation fail (eg, lung protective ventilation).

Indications CONSIDERATIONS

severe ARDS with life threatening, refractory

Nursing Interventions (pre, intra, post)
hypoxaemia
prone positioning may also be used for Pre: assemble sufficient trained staff to coordinate
patients with posterior wounds, burns and positioning safely
Intra: provide padding and support for potential
skin flaps pressure areas (face, upper chest, pelvis, knees)
turn patient prone
Post: abdomen should hang between two pillows/
supports
duration varies among protocols (e.g. 6-16 hours a
day for up to 10 days)

Outcomes/Evaluation
- Obtain baseline vital signs and physical
assessment in the prone position in order to
assess for adverse or positive outcomes
- Best outcomes reported when prone positioning is
used in combination with both low tidal volume
ventilation (6 cc/kg) and neuromuscular blockade
- Mortality at day 28 was significantly lower in the
prone group than in the supine group
- warranted to ascertain the potential benefit of this
technique in improving final respiratory and global
outcomes
Client Education
- Explain to the patient and family, as appropriate, the
rationale for pronation therapy,
- Explain what the sedation, paralytics, and
mechanical ventilation.
- Explain the procedure, including
positioning, the demonstrated benefit, frequency of
assessments, expected response,
and parameters for discontinuing therapy

Potential Complications Nursing Interventions

- decreased enteral nutrition Prior to prone positioning, perform any
- ETT obstruction or dislodgement;
- chest tube and abdominal drain dislodgement
nursing interventions that require access to
- increased intrabdominal pressure the anterior body
i- ncreased intracranial pressure surface (e.g., oral care, suctioning, wound
- difficulty monitoring (e.g. ECG lead placement)
- labour intensive
dressings, emptying of ostomy bags, etc.) to
- difficult to perform procedures or reintubate minimize the
may delay referral to other potentially life-saving measures - need to return patient to a supine position.
such as ECMO-
facial oedema
pressure trauma

ACTIVE LEARNING TEMPLATES