COVID-19 Proning for Self care

What is proning

• Proning is the process of turning a patient with precise, safe motions, from their back onto their abdomen (stomach), so the individual is lying face down.
• Proning is a medically accepted position to improve breathing comfort and oxygenation.
• It is extremely beneficial in COVID-19 patients with compromised breathing comfort, especially during home isolation. 

Importance of Prone lying

• Prone positioning improves ventilation, keeps alveolar units open and breathing easy.
• Proning is required only when the patient feels difficulty in breathing and the SpO₂ decreases below 94 (less than 94).
• Regular monitoring of SpO₂, along with other signs like temperature, blood pressure and blood sugar, is important during home isolation.
• Missing out on hypoxia (compromised Oxygen circulation) may lead to worsening of complications.
• Timely proning and maintaining good ventilation could save many lives.

Positioning of Pillow

• One pillow below the neck
• One or two pillows below the chest through upper thighs
• Two pillows below the shins

For Self-Proning

• You will need 4-5 Pillows.
• Regular alterations in lying position
• Best is to not spend more than 30 minutes in each position

Caution:

• Avoid proning for an hour after meals
• Maintain proning for only as much times as easily tolerable
• One may prone for up to 16 hours a day, in multiple cycles, as felt comfortable
• Pillows may be adjusted slightly to alter pressure areas and for comfort
• Keep a track of any pressure sores or injuries, especially , around bony prominences

Avoid Proning in conditions like

• Pregnancy
• Deep venous thrombosis (Treated in less than 48 hours)
• Major cardiac conditions
• Unstable spine, femur, or pelvic fractures

Non-self pronating patients (in emergency)

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

• Using a flat sheet, pull the patient to one side of the bed.
• Place the flat sheet around the arm that will pull through (the side you are turning toward).
• 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 center the patient. Discard the sheet that was used to place the patient in the supine position. Straighten lines and tubes.

Source : Ministry of Health & Family Welfare