Procedure: Initiating Continuous Lateral Rotation Therapy (CLRT)

Index:

1. Select Patient
2. Obtain Equipment
3. Prevent Nausea
4. Position Patient
5. Prepare Bed
6. Adjust Bed
7. Ensure Safety
8. Set Pause Times
9. Set Percentage of Rotation
10. Monitor Patient
11. Document
12. Maintain Standard for Skin Care
13. Re-evaluate

PROCEDURE

 1.

Select Patient

RN or Physiotherapist identifies appropriate patients for CLRT according to guidelines in the Standard for Nursing Care for CLRT.

 2.

Obtain Equipment

Obtain rotation module from the Charge Nurse. Install module into Sport^TM bed.  

 3.

Prevent Nausea/Motion Sickness

Consider administration of an anti-emetic prior to starting treatment if patient is awake or prone to nausea/vertigo. Although Gravol is no longer the preferred treatment for nausea, it is the first line treatment for motion sickness.

 5.

Position Patient

Position the patient into the centre of the bed. Ensure that the patient's shoulders are aligned with the label on the inside, upper siderail.

 6.

Prepare Bed

Weigh the patient.

 7.

Adjust Bed

Elevate the head of the bed as tolerated. The HOB must be < 40 degrees and foot of bed must be < 30 degrees. 

Some HOB elevation should be maintained at all times unless contraindicated.

8.

Ensure Safety

Ensure all siderails are up.

Scroll to Rotation/Perc./Vib. and press "Enter". Scroll to Rotation Therapy and press Enter. Now rotation settings can be entered.

9.

Set the Pause Time

Set the pause time to 2 minutes. This is the pause time goal.

If the patient does not tolerate turning well , increase the pause time. Select the lowest pause time duration that the patient is able to tolerate. As the patient adjusts to the bed rotation, gradually begin to decrease the pause time until the goal of 2 minutes is achieved.

The pause time is the duration of time that the bed rests in each position. For example, if the bed is set to rotate to the left and right side with a pause time of 2 minutes, the bed will rotate to the left, pausing for 2 minutes when the patient is fully rotated to the left. The bed will then rotate to the centre, pausing for 2 minutes with the patient in the supine position. Following rotation to the right, the bed will pause for 2 minutes at full right rotation, then complete the full cycle with a 2 minute pause following rotation to the centre again.

Intervals refer to the number of full cycles. One interval consists of rotation to the left, to the centre (supine), to the right and back to the centre again. The interval frequency is calculated automatically by the bed, and is based on the pause time and the time it takes for the bed to turn. The interval frequency will increase if the pause time is decreased.

Currently, the optimal treatment strategy has not been established. Hill-Rom recommends that patients rotate at least 18-20 hours out of every 24 hour period. This 18-20 hours refers to the total duration of time when the bed is in rotation mode. Hill-Rom recommends that the patient be given a rest period when the rotation is turned off for a period of at least one hour out of every 24 hour period. This one hour period may include times when nursing care is provided (e.g., baths, dressings) or procedures are performed (e.g., line insertions, xrays).

The bed always rotates to the right first.

10.

Set the Percentage of Rotation

Set the rotation at 20% for the right and left side.

Increase the degree of rotation by 10% each hour as tolerated, until the goal of 100% rotation is achieved. Monitor the patient after each rotation change.

The percentage rotation refers to the percentage of a 90 degree rotation being delivered. For example, setting the bed to a rotation of 100% to the left means that the bed will rotate to the left to 90 degrees. Setting the bed to rotate to 0% to the right means that the bed does not rotate to the right.

11.

Monitor Patient

Monitor the patient for signs of intolerance. Monitor for nausea, restlessness, decreased oxygen saturation, tachycardia, tachypnea or changes in blood pressure.

If signs of intolerance develop, return the patient to the previously tolerated rotation percentage.

If nausea develops, obtain an order for antiemetics. Consider sedatives to achieved desired VAMAAS score.

Monitor for asymmetrical intolerance, for example, desaturation during rotation on one side. Consider modifications to the percentage rotation on the affected side. Rotation may need to be modified to one side if rotation affects central lines or drainage tube placement.

The final goal for rotation is 100% rotation to the left and right sides. Some patients may experience nausea or vertigo. When a patient is turned to a position that puts their diseased lung down, increased blood flow to areas of decreased ventilation can worsen an existing shunt and cause the patient to desaturate.

12..

Document

Document the percentage of rotation (left and right) and the pause time in the Electronic Health Record. Document patient response q shift and prn.

13.

Maintain Standard for Skin Care

Continue to turn patient manually to inspect skin q2-4h.

Re-evaluate

Re-evaluate every 24 hours or when patient's condition changes.