The prone position—lying face down—is used in both neonatal and pediatric care for respiratory support, developmental positioning, and pressure relief. While it offers several physiological benefits, it must be applied with strict safety protocols, especially in infants.
Definition
Changing position of a patient (anesthetized or diagnosed with acute respiratory distress syndrome, or paralysis), from supine to prone position.
Purposes
- To improve oxygenation.
- To promote respiratory mechanics.
- To offer relief on pressure points in supine position.
- To improve clearance of secretions.
Procedure
| Nursing actions | Rationale | |
| 1 | Confirm the orders for giving a prone position to the patient. | Knowledge of what to expect would reduce anxiety and help in executing the maneuver with ease |
| 2 | Identify and understand the responsibility of each team member. (The physician defines the need for performing the prone maneuver and, together with the nurse and physiotherapist, determines the time of the maneuver and identifies the members of the prone team by name. The team usually comprises of six members: a physician, a physical therapist, a nurse, two technicians, and a physical therapist or nurse or technician responsible for reading and checking all checklist items. The person responsible for reading the tool should not participate in the procedure. In the case of patients with a chest drain, the team should include one more member, who is responsible for taking care of the drain and bottle.) | |
| 3 | Prepare or provide cushions to support the face, chest, pelvis, wrists and anterior leg region. | This prevents the risk of pressure sores. |
| 4 | During procedure Perform the pre-maneuver care which is checked in the presence of all team members and includes: Nutritional care: Suspend feeding; open Naso enteric tube 2 hours before Prev the procedure Material care: Provide cushions; place the crash cart and intubation unit close by; test aspiration equipment and bag-valve mask device. General care: Provide eye and skin care; review the placement of invasive and curative devices; suspend continuous hemodialysis. Airway care: Suction airway; check fixation of cord; record mouth corners and cuff pressure of ETT; preoxygenate for 10 minutes as ordered. Analgesia and sedation care: assess the need for increased sedation. | Prevents risk of injury and complications. Prompt management of adverse events during the procedure can be ensured. Maintains skin integrity and prevent complications. |
| 5 | Confirm the presence of all team members and their correct position (physician at the headboard and the other group members distributed along the two sides of the bed) and that everyone knows the envelope maneuver and the three turning points. | Pain during the procedure can be avoided |
| 6 | Counter check and ensure that the premaneuver care is performed using a checklist or appropriate tool as per the hospital policy. | Easy and hassle-free execution of the maneuver. |
| 7 | Ensure that the steps of the procedure are followed in sequence (procedure checklist can be read out loud by the assigned team member) Place head in a flat position and align limbs. Position the pelvis and chest cushions, and suspend and disconnect infusions. Perform the envelope maneuver, i.e., position the top sheet over the lower sheet. Place drains, tubes and invasive pressure transducer inside the envelope. The three-point turn is performed on the physician’s command. (The patient must be moved to the side of the bed opposite the mechanical ventilator, placed in lateral position, and then turned to the prone position). | |
| 8 | After procedure Perform post maneuver care. Check the position of ETT. mouth corners and tube cuff pressure. Check the position of the pelvis and anterior chest cushions, ensuring that the abdomen is free, and to check the positioning of the other cushions: Face (avoiding eye and ear injuries and breakage of the endotracheal tube), hand, and anterior leg region.The invasive arterial pressure transducer and electrodes on the patient’s chest must be repositioned.The upper limb is raised into the swimmer’s position and alternated every 2 hours to avoid injury to the brachial plexus. |
Special Consideration
Never pull the patient across the bed when the patient is in a prone position as it may injure a woman’s breast or a man’s genitals.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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