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ST🚨Proning🚨
‼️I’ve had around 20 people ask me to discuss proning. I have no clue how to do that without real life scenarios so this is all I’ve got on this snow day lol.
❄️From the top:
✅Used for treatment in ARDS. You’ll likely see orders to prone for 8-12hrs.
✅In my experience we do this when we can’t oxygenate well enough on max ventilator settings. (P/F ratios)
✅I feel 4 staff MINIMUM is safe and gets the job done efficiently and effectively. In the video I used the 2 unicorns as staff opposite me and the brontosaurus as the RT. The triceratops is the ventilator in the corner.
✅You need RT at the head. Period.
✅I have never proned someone who wasn’t SUFFICIENTLY both Paralyzed AND Sedated.
✅First, choose a direction to turn towards. I suggest turning towards the ventilator so the airway is easily maintained.
🚨Remove all cardiac monitoring stickers from the patient’s chest and the patient’s gown.
🚨Place protective foam pads on knees and chest and shoulders to prevent pressure injury.
🚨Unhook any tubes and lines that can/will get crossed up. If they are critical lines like sedation and pressers leave them just be mindful. Often I even unhook ALine connections/tubing.
❄️Once proned you need to hook all tubes and lines back up that were unhooked. Zero your ALine.
‼️‼️The arm closest to the turn needs to be flat and tucked so when you turn it doesn’t break‼️‼️
‼️‼️Note: When replacing cardiac monitor stickers keep in mind they will need to be opposite!
🌨️There are pillows that fit perfectly under the patient’s chest to raise their upper chest/neck and head up from the bed so the ETT sits appropriately.
🧠Assess Sedation and paralysis (train of 4) post prone.
🫀🫁Also the turn and just being prone can and will often cause hemodynamic changes in rhythm HR/BP and sats.
🍼I’ve mostly done trickle feeds but have had some who were kept NPO
🚨With the face down you run the risk of pressure injury so a smal foam pillow keeping the face up and protected is really nice if available.
‼️Secretions won’t be pooling in the back of the mouth anymore they will pool on the bed sheet now so place a folded pad or pillow under the mouth. 👄
@strong_nurse_rebuild
