BEST PRACTICES

What the NPIAP wants you to know about prone positioning and COVID-19 patients

When it comes to improving skin health outcomes, one of your most valuable resources is the 2019 National Pressure Injury Advisory Panel’s Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. If you’re currently caring for patients suffering from COVID-19, its evidence-based best practices are more important than ever.

One area to pay close attention to involves pressure injury prevention during prone positioning. Patients who are experiencing acute respiratory distress syndrome (ARDS) as a symptom of COVID-19 may be placed in the prone position for 12 hours or more.1 The goal of this strategy is to enhance oxygenation and perfusion rates; decrease strain on the lung tissue and lower risk of ventilator injury.2

However, along with its benefits, prone positioning can increase the risk of pressure injuries.3

Pressure points at risk

The NPIAP indicates areas where prone positioning can increase the risk of pressure injuries:2

NPIAP resource on prone positioning

To help you properly care for patients in the prone position, NPIAP created a focused, three-page document that you can download at no cost. It gathers recommendations from the Clinical Practice Guideline and offers information including:

  • Rationale for proning an ARDS patient
  • General guidelines for PIP with prone positioning
  • Specific recommendations for head, legs, torso, breasts and genitalia
  • Beds and positioning devices designed to support prone positioning
  • Repositioning principles
  • Recommendations regarding medical devices
  • Swimming position diagram

“It’s important that, as wound care nurses, we continue to bring evidence-based practice to our nurses and use the NPIAP guidelines on prone positioning to help reduce the risk for pressure injuries in patients suffering from acute respiratory distress syndrome due to COVID-19,” notes Medline clinician Kristin White, RN, BSN, CWON. “Our frontline nurses are working so hard to care for these patients, and they need to be armed with the right tools,” she stresses.

More tools to help you do the right thing

If you’re working longer hours and seeing a growing number of patients who require prone positioning, rely on your resources to provide consistent care. Combine NPIAP evidence-based best practices with the right products to strengthen your prevention and treatment efforts.

Product considerations for prone positioning pressure injury prevention protocol plan

  •  Apply soft silicone multilayered foam prophylactic dressings to pressure points on the face.
  •  Manage moisture and secretions with a liquid skin protectant or sealant on the face.
  • Apply thin foam dressings under medical devices, while avoiding multiple layers of dressings.
  • Follow the manufacturer’s guidelines when using beds, positioning devices, prophylactic dressings and other products.

Source: Medline clinician Patricia Turner, BSN, RN, CWOCN, CWS

Key takeaway

While prone positioning may help treat COVID-19 patients suffering from ARDS, it may also increase their risk of pressure injuries. To help prevent PIs, it’s important to follow evidence-based best practices and choose the right tools. Remember, this NPIAP resource, available for download now, can help inform your practice and improve skin health outcomes.