Intraoperative pressure sore prevention: an analysis of bedding materials

Etiology and incidence of pressure ulcers in surgical patients

This experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive "usual perioperative care" or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only 2% developed stage II or IV ulcers. Patients with ulcers were statistically older, had diabetes, were smaller in body mass, had lower Braden Scale scores on admission, and used the new mattress overlay (P < .02). Pressure ulcers that presented as "burns" or ecchymosis did not deteriorate to stage III or IV ulcers during the study. The mattress overlay was not effective in preventing pressure ulcer development.

Pressure sore formation in the operating theatre: 1

While theatre nurses strive to master increasingly sophisticated equipment and techniques they must also endeavour to ensure that the quality of fundamental nursing care has positive outcomes for the patient. According to Land (1995), pressure area care is such a fundamental nursing activity that many health professionals do not recognize the importance of keeping abreast of new developments. A review of the literature concerning pressure sore formation suggests that, far from being a ward-based problem, all surgical patients experience a critical period during which they are most susceptible to pressure injury--the time spent on the operating table. This article, the first of two parts, outlines the pathophysiology of pressure sores and the contributory factors present within the operating theatre. The second part suggests nursing interventions to reduce the incidence of pressure sore formation during the perioperative phase.

Effects of truss mattress upon sleep and bed climate

The purpose of this study was to examine the effects of a truss mattress upon sleep and bed climate. The truss mattress which has been designed to decrease the pressure and bed climate humidity was tested. Six healthy female volunteers with a mean age of 23.3 years, served as subjects. The experiment was carried out under two conditions: a truss mattress (T) and a futon (F) (Japanese bedding). The ambient temperature and relative humidity were controlled at 19-20 degrees C, and RH 50-60% respectively. Sleep was monitored by an EEG machine and the rectal temperature, skin temperature and bed climate were also measured continuously. Subjective evaluations of bed and sleep were obtained before and after the recording sessions. No significant difference was observed in the sleep parameters and time spent in each sleep stage. Rectal temperature was significantly lower in T than F. Although there was no significant difference in bed climate over the T/F, the temperature under T/F was significantly higher in T. No significant difference was observed in subjective sleep evaluation. The subjective feeling of the mattress was significantly warmer in F than T before sleep. These results suggest that although T does not disturb the sleep parameters and the bed climate is maintained at the same level as with F, it may affect rectal temperature which can be due to low thermal insulation.

A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores

Four hundred and forty-six general, vascular and gynaecological surgical patients were recruited to a two centre, double triangular sequential randomised controlled trial to compare the post-operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco-elastic polymer pad (Action Products Inc.). Two hundred and twenty two patients were randomised to the experimental group and 224 to the standard mattress. The main endpoint failure rate (a pressure sore) was found to be 11% (22/205) for patients allocated to the dry visco-elastic polymer pad and 20% (43/211) for patients allocated to the standard operating table mattress. There was a significant reduction in the odds of developing a pressure sore on the dry visco-elastic polymer pad as compared to the standard, [symbol see text] = 0.46 with 95% confidence interval of (0.26, 0.82), P = 0.010. The adjusted point estimates of the probability of developing a pressure sore on the dry visco-elastic polymer pad and the standard operating table mattress were 0.11 and 0.21 respectively.

Skin injury in the operating room

Skin injury occurring in the operating room may occur as a result of electrical current, thermal injury, chemical irritation and mechanical stress. Between 1 December 1996 and 28 February 1997, 19 cases of skin injury from a total of 3657 operations were noted in our hospital. These injuries tend to be ignored because of their early spontaneous healing. We suggest that medical staff should pay more attention to this complication and prevent it from occurring.

The effects of a newly designed air mattress upon sleep and bed climate

In our previous study, an air mattress with three series of air cells with inflation pressure, that was increased/decreased in time interval of 20 min, did not affect sleep quality and quantity, although the relative and absolute humidity inside the bedding was kept significantly higher than that of a Futon. The purpose of this study was to confirm the effects of a newly designed air mattress upon sleep and bed climate. In this newly designed air mattress, the cell series and time interval was reduced. Six healthy female volunteers, aged 18-22, served as subjects. The experiment was carried out under two conditions: using a regular Futon (Futon), and a newly-designed air mattress with the timer and pump activated (Airmat). The room temperature and relative humidity were controlled at 22-23 degrees C and RH 50-60%, respectively. The subjects' sleep was monitored by using an EEG machine and their skin temperatures and bed climates were also measured continuously. Subjective evaluations of bed comfort and sleep were obtained before and after the recording sessions. Sleep onset latency, wake after sleep onset and the sleep efficiency index showed no significant differences between the two conditions. A significant difference was observed in the bed climate of the waist area. The temperature of the waist was lower overall under the Airmat than the Futon, while relative humidity was higher under the Airmat. Absolute humidity also tended to be higher in the Airmat. Sleep evaluation and comfort sensation were good under both conditions. Although sleep was not disturbed and subjective sleep evaluation tended to be better in Airmat, our results indicate that changing the time intervals and cell series until this air mattress level is not effective in decreasing the bed climate humidity.

The effects of air mattress upon sleep and bed climate

The purpose of this study was to investigate the effects of an air mattress upon sleep and bed climate. This air mattress, which employs a pump and timer to increase or decrease the inflation pressure in order to cure and prevent decubitus was tested. Six healthy female volunteers, aged 18 to 23, served as subjects. The experiments were carried out under three conditions: using regular Futon (Futon), the air mattress with pump and timer activated (Air+) and the same mattress without pump and timer activated (Air-). Room temperature and relative humidity were controlled at 22-23 degrees C and RH 50-60% respectively. Subjects' sleep was monitored by using EEG machine throughout the night, and subject's body temperature and bed climate were also continuously checked. Subjective estimation of bed and sleep were obtained before and after the recording sessions. Sleep onset latency and wake after sleep onset tended to be reduced in Air+ compared to Futon and Air-. The time and percentage of Stage 3 was increased significantly in the middle one third of the night in Air+. A significant difference was observed in bed climate of the waist area. Temperature tended to be higher in Futon than in Air+ and Air-, while relative and absolute humidity were significantly higher in Air+ and Air-. Significant difference between Air+ and Air- was observed only during one hour after sleep recordings started. Thermal sensation in the morning was cooler and comfort sensation tended to be better in Air+ and Air-. Subjective sleep estimation was somewhat good under all conditions. These results suggest that although these air mattresses do not affect sleep, we have to be cautious in using these mattresses as relative and absolute humidity were kept higher than with Futon. Further study on materials and construction of these air mattresses to decrease the humidity is needed.

Intraoperative positioning of surgical patients

All perioperative team members are responsible for the safe positioning of surgical patients. Circulating nurses coordinate the positioning of patients during intraoperative periods of care. Skilled perioperative nursing interventions afford patients safe and comfortable positioning during surgery, ensure optimal exposures of surgical sites, and prevent postoperative complications (e.g., pressure injuries, neuropathies, cardiovascular and respiratory compromises). Perioperative nurses should have a working knowledge of anatomy and physiology, patient risk factors, injury mechanisms, potential complications, and positioning devices before placing patients in required perioperative positions.