Five medical procedures you can perform on a prone patient

Medicine is full of what we often call “sacred cows”—practices passed down through generations because “that’s how it’s always been done,” even when evidence evolves. A classic example is the routine checking of gastric residual volumes to assess enteral feeding tolerance. As literature advanced, we learned this was not the best indicator, and practice changed accordingly.

So why are we still clinging to sacred cows when it comes to prone therapy?

Too often we hear, “We can’t do that while the patient is prone.” In many cases, that simply isn’t true. We can perform far more procedures in the prone position than many realize.

Here are five procedures that can be performed while prone

1. Vascular Access
Central venous access can be safely achieved in multiple locations while the patient remains prone, including:

• Internal jugular (IJ)
• Femoral
• Popliteal
• Saphenous
• Posterior tibial veins

PICC lines may be placed via the posterior upper arm, and hemodialysis catheters can be inserted in the IJ or femoral vein. These procedures can be performed while the patient is manually proned or supported on an automated turning system such as the Pronova® by Turn Medical.

2. Cardiac Catheterization
A right heart catheterization can be performed with the patient in the prone position via subclavian vein access, again feasible both manually and on automated turning platforms.

3. Chest Tube Placement
Yes—chest tubes can be placed while the patient is prone. This includes patients who are manually proned as well as those supported on automated prone therapy systems.

4. Bronchoscopy

Patients with ARDS often develop a significant secretion burden that requires bronchoscopy to improve oxygenation. While most bronchoscopies are traditionally performed in the supine position, some patients are simply too unstable to tolerate repositioning. In these cases, bronchoscopy can be safely performed while the patient remains prone—either manually or on an automated prone therapy system.

Prone positioning may offer additional advantages during bronchoscopy and bronchoalveolar lavage (BAL). During BAL, saline is instilled into the distal airways to collect diagnostic samples. When performed in the prone position, gravity may facilitate more effective drainage of lavage fluid and mobilized secretions, rather than allowing fluid to pool dependently in the posterior lungs as can occur in the supine position. Clinically, this can result in more efficient secretion clearance while preserving the oxygenation benefits of prone therapy.

5. The Take-Home Message

Patients in the prone position do not have to sacrifice access to critical procedures. With appropriate expertise and planning, prone patients can continue to receive comprehensive, high-quality care while still benefiting from the physiologic advantages of prone therapy.

It’s time to put the sacred cows of prone therapy out to pasture.