What is Proning, Importance of Proning and precautions to take while Proning

What is Proning, Importance of Proning and precautions to take while Proning: -

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In these tough times of the Second Wave of COVID-19 where hospitals are running out with beds, ventilators, medicines, oxygen concentrators and most importantly oxygen cylinders, the Ministry of Health and Family Welfare (MoHFW) advised proning and stated that it is beneficial for self-care for the patients who tested COVID-19 positive. By using proning, a significant improvement in oxygen levels have been seen. Let’s check out what is proning and how to use it and precautions to take.

About Proning: -

Proning is a position in which a patient is made to sleep on their stomach from their back. This position is medically accepted since it improves breathing comfort and oxygenation.

As per MoHFW, this position is very useful for COVID-19 patients who have trouble breathing, especially during home isolation.

Importance of Proning: -

  • A prone position used for better breathing improves ventilation and keep alveolar units of the lungs open which makes breathing easy.
  • Proning technique is used for the patient when their breathing becomes difficult for them and blood oxygen level i.e., SpO2 decreases below 94 or less than 94.
  • When a COVID-19 positive patient is home isolated then is necessary to check or monitor SpO2 level, temperature, blood pressure and blood sugar levels at regular intervals. If a patient’s Oxygen circulation compromised (Hypoxia) then the situation may become worse and will increase the complications.
  • If proning is done on time with maintaining good ventilation can help to save many patients lives.

How to use a pillow in Proning: -

  • In Proning one pillow will be placed below the neck.
  • In Proning 1-2 pillows will be placed below the chest through upper thighs.
  • In Proning two pillows will be placed below the shins.

How to do Self-Proning: -

  • For self proning a patient will need 4-5 pillows.
  • Regular alterations in Lying positions also required.
  • In each proning position is it advised not to spent more than 30 minutes. A patient can lie in the below-mentioned positions as per MoHFW-
  1. First Position- 30 Minutes-2 Hours: Laying on your belly
  2. Second Position- 30 Minutes-2 Hours: Laying on your right side
  3. Third Positions- 30 Minutes-2 Hours: Sitting up
  4. Fourth Position- 30 Minutes-2 Hours: Laying on your left side
  5. After this repeat this process again.

Precautions to take while Proning: -

  • Maintain proning position as many times as easily tolerable.
  • Always avoid proning for an hour after meals.
  • In Proning positions Pillows may be adjusted slightly to alter pressure areas and for comfort purpose.
  • Always keep track of any kind of pressure sores or injuries, mainly around bony prominences.
  • Avoid proning if a patient has an unstable spine, femur or if you have any pelvic fractures
  • Avoid Proning if a patient has any major cardiac conditions.
  • Avoid Proning if a patient is pregnant.
  • Avoid Proning if a patient has Deep venous thrombosis (Treated in less than 48 hours)

How to do Non-self-pronating for patients in an emergency: -

Here is a five-step method to place a patient in the prone position using a regular bed, flat sheet and family members-

  • Pull the patient to one side of the bed using the flat sheet.
  • Place the flat sheet around the arm that will pull through (the side you are turning towards)
  • A second flat sheet is placed on the bed and tucked under the patient. This sheet will pull through as you are turning the patient.
  • Using the sheet, turn the patient over and position the patient prone. The arm and sheet will pull across the bed.
  • Pull and centre the patient. Discard the sheet that was used to place the patient in the supine position. Straighten lines and tubes.

 Source: Ministry of Health and Family Welfare and news portals.

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