Q: Please give us the guidelines on turning and repositioning hemodynamically unstable patients, patients with an intra-aortic balloon pump, and patients receiving vasopressors.

A: Kathleen M. Vollman, RN, MSN, CCNS replies:

Specific studies that address the direct questions of how and with what frequency to turn and reposition critically ill patients with hemodynamic instability, whether the patients are receiving vasoactive medications or intra-aortic balloon pump therapy, have not been published. However, a body of evidence is available from which inferences can be made to develop recommendations for safely turning and repositioning hemodynamically unstable patients.

The evidence comes from 3 areas. The first area describes the impact of prolonged bed rest and/or space flight research where bed rest was used to simulate weightlessness and the effect that motion has on the cardiovascular system in healthy adults, elderly persons, and patients with diabetes.1–...

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