Prone Position: When to Use This Position?

The prone position is a patient positioning technique used to improve the patient's access to specific body areas. This position is often used in healthcare settings, such as surgery or Covid treatment.

A patient position is a specific way a patient should be positioned during a medical procedure. There are many reasons a patient might need to be placed in a certain way, such as to improve the doctor's access to a particular area or reduce the risk of complications.

Patient positioning also plays a vital role in comfort: patients positioned correctly are less likely to experience pain or discomfort during a procedure.

Countless medical procedures require specific positioning, and there are several categories of positions, such as the supine, prone, lateral, and Trendelenburg patient position.

This guide will discuss the prone position, when it is used, and provide tips for healthcare professionals on placing patients safely in it.

What is The Prone Position?

When a patient is in the prone patient position, they are flat on their stomach and lying with their backs facing up. The head is bent sideways, with minimal hip and neck flexion.

This position is frequently used in the medical field, particularly during procedures or operations requiring access to the back or spine. It is also possible to use it for various physical therapy exercises.

In general, the prone patient position is flexible and can offer various benefits for various objectives, including medical and non-medical ones.

A patient lying prone can have additional support by placing a small pillow under their head and another pillow under their legs.

When to Use the Prone Patient Positioning?

The prone patient position is frequently used when a patient's back or spine needs to be accessed for a medical operation or treatment.

Some specific examples of when the prone position might be used include:

●      Surgery on the back

●      Brain or brainstem surgeries

●      Spinal surgeries

●      Rectal or buttock surgeries

●      Surgical procedures on the back of the arms or legs

●      Physical therapy for back pain

●      Massage therapy

Benefits and Risks of Prone Position

The prone position grants access to the dorsal region of the patient’s body, such as the shoulders, neck, and spine.

One benefit of the prone position is that it helps to improve respiratory function.

When an individual lies on their stomach, their lungs have more room to expand, which allows for better airflow.

The prone posture may help prevent the need for a ventilator in some cases. It can also boost the survival chances of individuals who have been placed on a respirator and are being withdrawn from it.

While the prone position has many benefits, it also comes with several risks. Some of the main dangers are increased abdominal pressure and increased bleeding.

Cardiovascular compromise can also occur, as the heart may not be able to pump blood effectively when in a prone position.

Additionally, abdominal compartment syndrome can occur, impairing not only visceral organs but also the cardiovascular and pulmonary systems; it may also cause a decrease in cerebral perfusion pressure.

Another risk associated with the prone position is venous air embolism, which occurs when gas bubbles enter the bloodstream and block blood flow.

Finally, ocular injuries can occur when a patient is positioned prone.

While these risks are serious, they can often be mitigated by taking precautions and using proper techniques when performing medical procedures in prone positions. The prone position can be used safely and effectively with careful planning and execution to improve patient outcomes.

The Prone Position During Surgery And its Complications

The prone positioning is a common position used by surgeons because when the patient is in the prone position, the dorsal surface of the body is more easily accessible.

The posterior cerebral fossa surgery, the buttock and perirectal procedures, the posterior spine surgery, and the operations on the lower extremities' rear components are standard procedures performed in the prone position. In addition, endoscopic retrograde cholangiopancreatography (ERCP) operations are typically carried out with the patient in a modified prone position.

As noted earlier, the prone position is associated with various complications. These complications are often caused by increased pressure on anterior structures.

Intraoperative pressure sores have a prevalence rate of between 5% and 66%, resulting in higher hospital stays and healthcare expenditures.

Loss of vision after surgery can be caused by significant orbital pressure, and this problem may result in permanent disability.

Abdominal ischemia and organ failure can occur when there is excessive pressure on vital abdominal structures, causing them to become ischemic and fail.

Pressure sores on the chest are linked to prolonged operations in the prone position. Large breasts are subjected to more direct pressure. Furthermore, patients with breast implants risk rupturing and developing breast necrosis due to the direct pressure applied when lying face down.

There are, however, some safety precautions that can be put n place to mitigate the risk associated with this position.

●      Tape the patients' eyes before placing them prone.

●      Patients with large breasts should have their breasts placed medially because lateral placement might be uncomfortable.

●      Avoid excessive flexion, extension, or neck rotation that is unnecessary for enough surgical exposure.

●      Properly position the head and neck and continuously check throughout the surgery to prevent spinal cord and brachial plexus nerve injuries.

The Prone Position for COVID19 Treatment

Although additional research needs to be done, medical professionals have discovered that the prone posture benefits patients suffering from severe COVID-19.

The patient's back lungs can fully expand when positioned in the prone position. It may also assist the individual in coughing up more of the fluid in their lungs and may enhance how oxygen is distributed throughout their body. This may generally result in improved breathing.

When patients are placed in prone position, they are subject to close observation. The patient will remain in the prone position for a predetermined time before the medical staff will move them back to the supine position for a few hours.

If the patient is experiencing an improvement in their breathing and can tolerate the treatment, the process may be repeated over several days. People have been able to avoid having to be intubated and placed on ventilators in the intensive care unit because of this in some cases.

Patients in the COVID-19 study treated with ventilators have also benefited from lying in the prone position. It has been demonstrated that increasing the time ventilated patients spend in the prone position can improve their chances of survival.

FAQ

Why Does the Prone Position Improve Oxygenation?

The prone position improves oxygenation mainly because it helps open up the alveoli in the lungs. When a person is lying on their back, the weight of their body can compress the alveoli and make it difficult for them to expand. This can lead to a decrease in oxygen levels in the blood. However, when a person is in the prone position, the alveoli can expand more fully, and this helps to increase oxygen levels in the blood.

What Is the Benefit of Putting a Patient Prone?

There are many benefits associated with placing a patient prone. Some of the most common advantages include improved oxygenation, enhanced breathing, and better drainage of secretions produced in diseased lungs.

Is Prone Position Good for COVID?

The prone position is often used in treating covid patients.

This is because it has been shown to improve patients' oxygenation compared to other positions. It is also shown that it can prevent lung injuries caused by mechanical ventilators.

What Is the Difference Between Supine and Prone?

The main difference between supine and prone is that supine is the position in which a person lies on their back with their face up, while prone is the position in which a person lies on their stomach with their face down.

Why Is the Prone Position Used for ARDS?

Doctors often use the prone position for ARDS because research indicates that it leads to better ventilation of the dorsal lung areas affected by the alveolar failure, improvement in ventilation/perfusion matching, and a reduction in mortality rate.

Conclusion

The prone position is one that medical practitioners often use because it has many benefits for patients suffering from respiratory problems. It can improve oxygenation, help to clear secretions from the lungs and prevent injuries caused by mechanical ventilators. While more research needs to be done on the long-term effects of this treatment, it is a promising option for patients with severe respiratory problems.

Although considerable risks are involved with the position, taking adequate precautions and using enough supportive devices can be well-managed.