Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices


Practice Alert

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This Practice Alert focuses on reducing the risk of harm to intubated adult ARDS patients and injury to nurses/caregivers when undertaking manual prone positioning.

Scope and Impact of the Problem

Prone positioning is a common treatment modality used in the management of moderate to severe acute respiratory distress syndrome (ARDS), although this intervention has some risks. The goal of prone positioning is to provide adequate oxygenation. However, because the risks associated with this position often outweigh the benefits, each patient should be evaluated before being placed in the prone position to determine whether there are any relative or absolute contraindications. Patient complications associated with prone positioning include pressure injuries, endotracheal tube obstruction, ocular and nerve injuries, and enteral nutrition intolerance, all of which require preventive interventions to reduce the risk of harm. Evidence supports the use of various nursing interventions to reduce the risk of complications.

During the COVID-19 pandemic, prone positioning became a customary treatment for patients with severe SARS-CoV-2 infections. Consequently, prone positioning was rapidly adopted by caregivers. Safely and effectively positioning the patient prone reduces risks of morbidity and mortality for the patient while reducing the risk of injury for the nurse and other caregivers.

This Practice Alert addresses reducing the risk of harm to intubated adult ARDS patients undergoing manual prone positioning for at least 12 to 16 hours per day. Continuous prone positioning has been found to increase the risk of complications. This article focuses on evidence-based strategies for preventing pressure injuries, major airway complications, ocular and nerve injuries, and enteral feeding complications while ensuring safe handling to promote caregiver safety.