Turning and Positioning: Vital Steps for Pressure Redistribution

Repositioning should ensure optimal offloading of all bony prominences and maximum redistribution of pressure.

Importance of Turning and Positioning

No support surface can provide complete pressure relief, as pressure is always applied to some area of the skin. Therefore, turning and repositioning for pressure redistribution must occur regularly. The frequency of turning may vary with the pressure redistribution capacity of the support surface; however, the individual's response to pressure should always guide turning frequency. High-risk individuals with poor tissue tolerance may require more frequent turning. 

Considerations for Turning and Positioning: General Guidelines

1. Check Pressure Points: Ensure all pressure points are adequately offloaded by checking that pressure areas receive intended relief. In the lateral side-lying position, offload the sacrococcygeal area without placing pressure on the trochanter.
2. Self-Relief Education: Teach individuals who can provide some or all their own pressure relief to reposition correctly and perform 'pressure relief lifts' or other maneuvers.
3. Heel Care: Pay particular attention to the heels, which can be continuously exposed to pressure even with frequent repositioning. Refer to the guidelines on heel pressure injuries for specific recommendations.
4. Ventilated Patients: For sedated and ventilated individuals, particularly neonates and infants, frequently reposition the head.
5. Medical Devices: Avoid positioning the individual directly onto medical devices like tubes or drainage systems. Refer to guidelines on device-related pressure injuries for relevant recommendations.

Turning and Positioning for Individuals with Pressure Injuries

1. Existing Pressure Injuries: Avoid positioning the individual on bony prominences with existing non-blanchable erythema. 2. Preferred Positions: Use the 30° side-lying position instead of the 90° side-lying position. Encourage individuals who can reposition themselves to sleep in a 20° to 30° side-lying position or flat in bed if not contraindicated. 3. Head of Bed Elevation: To minimize pressure and shear, it's recommended to keep the head of the bed as flat as possible. Avoid elevating it beyond 30°, especially for critically ill individuals at high risk of pressure injuries, as higher elevations increase interface pressure at the trochanter and sacrum.  4. Shear Prevention: Prevent sliding down in the bed by flexing the knees and using pillows under the arms. This helps avoid shear forces and weight-bearing on the sacrum and/or coccyx. 5. Eating Positions: For individuals with a sacral and/or coccygeal pressure injury, sitting erect on the side of the bed while eating may be a better option. Ensure integrated bed systems that transform into a chair position do not place direct pressure on the injury.

1. Assessment: Before repositioning, assess the individual's current position and any pressure points.
2. Lift, Don’t Drag: When repositioning, lift the individual to avoid dragging, which can cause shear forces and increase the risk of skin damage.
3. Optimal Offloading: Position the individual to offload pressure from bony prominences and distribute pressure evenly.
4. Use Supportive Devices: Utilize pillows, wedges, and other supportive devices to maintain the new position and offload pressure areas.
5. Regular Monitoring: Frequently check the individual's skin condition and the effectiveness of the pressure redistribution. Adjust the frequency and method of repositioning as needed based on the individual's response.