Practice Alert Provides Critical Care Nurses Safety Tips for Prone Positioning

By Jonathan Springston, Editor, Relias Media

Prone positioning was a key treatment tactic during the COVID-19 pandemic. Although the public health emergency is over, the technique remains a vital way to treat and manage acute respiratory distress syndrome (ARDS). Thus, the American Association of Critical-Care Nurses (AACN) has released a detailed practice alert to help ICU nurses caring for patients proning for extended periods.

“Many nurses proned their first patient during the pandemic, and as patients remain prone for longer stretches, the risk of complications grows. AACN developed this practice alert to provide a single place for clinicians to find best practices supported by published evidence,” explained Devin Bowers, MSN, RN, NE-BC, AACN’s director of practice excellence. “Standardizing the practices related to prone positioning helps minimize associated patient risks while maximizing care team safety.”

Patients struggling with breathing ailments can be placed on their stomachs to take pressure off the lungs and improve oxygenation. Those living with ARDS might be placed in this position for 12 hours or longer, which can lead to other complications. In its practice alert, the AACN built on existing evidence to detail tactics to monitor for and prevent these common complications: pressure injuries, airway obstruction and unplanned extubation, ocular and nerve injury, and enteral nutrition issues.

“Prone positioning poses significant risks for the patient, which can often outweigh the benefits,” said Lauren Morata, DNP, APRN-CNS, CCNS, CPHQ, one of the authors of the practice alert. “It’s important to evaluate each patient prior to their being placed in the prone position to determine whether there are any relative or absolute contraindications.”

Morata and colleagues encouraged organizations to use these practice alert principles to develop appropriate policies and procedures for proning, with education and review occurring at least once per year.

COVID-19 no longer is as serious as it was in 2020, but patients still do present with the virus and might need hospitalization. Researchers have published a paper about prone positioning vs. supine positioning for these patients, with other investigators raising questions about proning safety.

For more on this and related subjects, be sure to read the latest issues of Critical Care Alert and Emergency Medicine Reports.