STANDARD OF CARE CONTINUOUS LATERAL ROTATION (CLRT)

Ensure that patient and health care provider safety standards are met during this procedure including: Risk assessment and appropriate PPE 4 Moments of Hand Hygiene Procedural Safety Pause is performed Two patient identification Safe patient handling practices Biomedical waste disposal policies
Select Patient Identify Clinical Indicators for Therapy Identify Contraindications Determine Therapy Goals Monitor Clinical Indicators of Tolerance Identify Indicators for Discontinuing CLRT Documentation
STANDARD OF NURSING CARE
1.	Select Patient CLRT use is only indicated for patients with impaired gas exchange due to pneumonia or atelectasis. Obesity alone is not an indication for use. Documentation in the AI record must include the reason for starting CLRT.
2.	Identify Clinical Indicators for Therapy Need/impending need for mechanical ventilation P/F ratio <200 Desaturation induced by nursing care Hemodynamic instability during manual turning Immobility with respiratory compromise
3.	Identify Contraindications to Therapy Therapy is contraindicated in patients with the following conditions: Unstable head injuries Uncleared cervical, thoracic or lumbar spine injuries Raised intracranial pressure Long bone or cervical traction Severe agitation Severe diarrhea Severe nausea/vertigo that fails to respond to medication Open abdominal wounds (evaluate with physician on a patient specific basis) Terminal illness (unless indicated to promote patient comfort and no patient with medically treatable indication in need of module)
4.	Determine Therapy Goals To improve oxygenation To decrease length of ventilator days To demonstrate resolution of pneumonia/atelectasis Currently, CLRT is not indicated for the treatment of skin breakdown. Ongoing skin integrity monitoring is important to ensure that CLRT use is not associated with adverse integumentary outcomes.
5.	Monitor Clinical Indicators of Tolerance Monitor the following clinical indicators and document in the graphic record q1H: Mechanical ventilation parameters Pulse oximeter reading HR and BP VAMASS Monitor the patient's position (e.g., left, right or supine) when changes in oxygen saturation are note, and document relationship in the AI record. Track tolerance and response Q1H. Monitor for nausea or vertigo and administer antiemetics if indicated. Reassess q4h and prn. P/F ratio should be calculated daily during ventilator rounds and prn. The goal for the P/F ratio is >200. If signs of intolerance are identified, adjust therapy to the previously tolerated settings. See Procedure for Initiating CLRT.
6.	Identify Indicators for Discontinuing CLRT Consider discontinuing CLRT when the following goals have been achieved: Improved chest xray Improved breath sounds Decreased secretions Increased patient mobility Hemodynamic stability during turning is achieved A change occurs in the patient's condition that contraindicates continued CLRT use Patient intolerance
7.	Document Document lateral rotation and percussion settings and patient response at the start of each shift and Q4H PRN. Document in the

References:

Ahrens, T. et al. (2004). Effect of kinetic therapy on pulmonary complications. American Journal of Critical Care, 13, 376-383.

Davis, K. et al. (2003). The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. http://ccforum.com/content/5/C81

Krishnagolpalan, S, et al (2002). Body positioning of intensive care patients: clinical practice versus standards. Critical Care Medicine, 30, 2588-2592.

Raoof, S, et al (1999). Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Clinical Investigations in Critical Care, 115, 1658-1666.

User Manual Total Care Bed System from Hill-Rom, 3rd. Edition 2003.

Developed by: Gina Case RN, Clinical Educator CCTC

Last Update: March 30, 2010, Revised January 20, 2017, Reviewed February 8, 2023