Preventing Pressure Ulcers In The Operating Room
Pressure sore, decubitus ulcer, and pressure ulcer are all terms used interchangeably to describe localized injuries to the skin and/or underlying tissue that usually occur over a bony prominence as a result of pressure, or pressure in combination with shear and/or friction.
What Is A Pressure Ulcer?
The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as an area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis.
According to a 2009 article, Prevention of Pressure Ulcers in the Surgical Patient, in the AORN Journal; “pressure ulcers (PUs) are a serious health care problem, and it is crucial to assess how patients acquire pressure ulcers after admission to a health care facility. In the OR, factors related to positioning, anesthesia, and the duration of the surgery, in addition to patient-related factors, all can affect PU development¹. . . All surgical patients should be considered at-risk for pressure ulcer development; therefore, preoperative departments should develop and implement strategic plans for pressure ulcer prevention.”
Quick Facts [ www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/puover.html ]
Did you know?
Number of patients affected by pressure ulcers: 2.5 million per year
Cost
- Pressure ulcers cost $9.1-$11.6 billion per year in the U.S.
- Cost of individual patient care ranges from $20,900 to $151,700 per pressure ulcer.
- Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay.
Pressure Ulcer Management
In 2008, The Centers for Medicare & Medicaid Services (CMS) included hospital acquired pressure ulcers (HAPU’s) as a “Never Event” which marked a turning point for most facilities. “Pressure ulcer management has become a standard part of every modern hospital’s protocol¹.”
Four Major Factors Contributing To Pressure Ulcers¹ [ www.actionproducts.com/media/files/Action-OR-Catalog-08-2012_low-res.pdf ]
- Uneven weight distribution
- Pressure
- Shear
- Heat and humidity build up
“Pressure ulcers are a costly, debilitating, and avoidable complication of surgery².”
The National Pressure Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) created the Pressure Ulcer Prevention: Quick Reference Guide outlining risk factors for patients in the operating room. [ www.npuap.org/wp-content/uploads/2012/02/Final_Quick_Prevention_for_web_2010.pdf ]
1. The following factors increase the risk the patient developing a pressure ulcer during a surgical procedure include:
a)Length of the operation
b)Increased hypotensive episodes intraoperatively
c)Low core temperature during surgery
d)Reduced mobility on day one of postoperatively
2. Use a pressure-redistributing mattress on the O.R. table for all individuals identified as being at risk of pressure ulcer development.
Action Products manufactures O.R. overlays that are cited by AORN best practices for Pressure Ulcer Prevention. The O.R. overlays, available in standard and custom sizes, provide pressure redistribution and reduce shear effects across the entire table surface. The low profile, simple design of the 1/2 inch Akton poymer O.R. overlay maximizes effectiveness and minimizes patient movement.
3. Position the patient in such a way as to reduce the risk of pressure ulcer development during surgery.
4. Elevate the heels completely (offload them) in such a way as to distribute the weight of the leg along the calf without putting all the pressure on the Achilles tendon.
The heel support gel positioner by Action is designed to secure and protect the heel area as well as cradle the patient’s Achilles tendon area.
5. Pay attention to pressure redistribution prior to and after surgery.
a) Place patient on pressure-distributing mattress prior to and after surgery.
b) Position the patient in a different posture preoperatively and postoperatively than the posture adopted during surgery.
Types of Gel Positioners
Head & Neck Gel Positioners help protect and cradle the patient’s head and neck by stabilizing the head movement and assists in the prevention of neck overextension.
- Lateral Head Pad with Center Dish
- Donut Head Pads
- Prone Headrests
- Horseshoe Head Pads
- Contoured Head Pad
- Ophthalmic Headrests
- Ophthalmic Cradle Headrests
Extremity Gel Positioners protect the patient’s arms and legs during procedures.
- Contoured Armboard Pads
- Armboard Pads
- Hand/Wrist Support
- Foot Pad
- Heel Support
- Stirrup Pad Set
Torso & Hip Gel Positioners provide support for the torso and upper body by providing increased stability.
- Flat-Bottomed Chest Rolls
- Contoured Chest Rolls
- Chest Gel Positioners
- Trapezoid Gel Positioner
- Dome-Shaped Gel Positioner
Proper patient positioning and cushioning of all pressure points is a priority and using the correct padding can protect the patient from pressure ulcers.
“Procedures longer than 2 1/2 hours to 3 hours significantly the risk of pressure ulcer formation. Positioning problems can result in significant injuries and successful lawsuits.” ~ [ tulane.edu/som/departments/surgery/medical-education/medical-students/upload/PATIENT-POSITIONING-2.ppt ]
AORN recommends “Classifying all surgical patients as “at risk” for PU development is an appropriate preoperative intervention to successfully reduce the incidence of possible PU development.” The uncontrollable length of surgeries and effects of anesthesia are two of the main contributing factors leading to the development of pressure ulcers. Although it is impossible to eliminate the risk of patients developing pressure ulcers during surgical procedures – some patients will develop pressure ulcers from skin breakdown regardless of preventative measures. It is important to be aware of the causes of pressure ulcers and what steps you can take to minimize the risk.
Additional Information:
- [ www.epuap.org/stop-pressure-ulcer-day/ ]
References:
- Pressure Ulcer
- Retrospective review of predisposing factors for intraoperative pressure ulcer development.
- You Have The Power To Prevent Pressure Ulcers-Outpatient Surgery
- Pressure Ulcer Prevention: Quick Reference Guide
- tulane.edu/som/departments/surgery/medical-education/medical-students/upload/PATIENT-POSITIONING-2.ppt
- [ www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/putool1.html ]
What is your recommendation on how to use gel rolls for positioning? For example, is it advisable to wrap our axillary rolls and torso gel rolls? I was taught not to do this since it defeats the purpose of even distribution of pressure. These products are disinfected after use anyway and placing a cloth over it would inadvertently create folds when the patient lays on it. Please advice. Thank you.