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Guo Y, Zhao K, Zhao T, Li Y, Yu Y, Kuang W. The effectiveness of curvilinear supine position on the incidence of pressure injuries and interface pressure among surgical patients. J Tissue Viability 2019; 28:81-86. [PMID: 30878174 DOI: 10.1016/j.jtv.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/18/2019] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Intraoperative pressure injury is still a major problem of perioperative nursing. Reducing the peak interface pressure is a valid clinical intervention for reducing the incidence of intraoperative pressure injuries. However, studies of repositioning and pressure-redistributing for surgical patients are still lacking. In this context we aimed to evaluate the effect of a curvilinear supine position on incidence of pressure injury with surgical patients in a hospital setting. METHODS This was a prospective, randomized, controlled study, carried out from May to December 2016, included 104 surgical patients from a university hospital in China (experimental group, n = 52; control group, n = 52). Incidence of pressure injury, interface pressure, comfort and satisfaction scores from surgeons, anesthesiologists, OR nurses were recorded. Mann-Whitney U Chi-square test was used for difference of pressure injury's incidence and mixed linear model was used for interface pressure. RESULTS Overall the intervention group had significant fewer intraoperative pressure injuries than the control group (0 patients [0%] vs. 9 patients [17.65%], p = 0.002). Compared with control group, the experimental group had significantly lower interface pressures in the sacrum and heel regions (F = 23.81, p < 0.001; F = 60.71, p < 0.001). The subjects felt comfortable in two groups were 40(80%) vs. 3(5.88%) (experimental group vs. control group), respectively (p < 0.001). CONCLUSIONS Curvilinear supine position could significantly decrease the incidence of perioperative pressure injuries in surgical patients with surgery duration more than three hours. Considering these results, we recommend that curvilinear supine position use as effective interventions to inform perioperative care delivery, reducing perioperative pressure injuries. These findings may serve to guide the application of pressure redistribution in the surgical positioning of patients during prolonged surgery.
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Affiliation(s)
- Yue Guo
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
| | - Kuaile Zhao
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
| | - Tiyu Zhao
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
| | - Yan Li
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
| | - Yunhong Yu
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
| | - Wan Kuang
- TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, China.
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Peixoto CDA, Ferreira MBG, Felix MMDS, Pires PDS, Barichello E, Barbosa MH. Risk assessment for perioperative pressure injuries. Rev Lat Am Enfermagem 2019; 27:e3117. [PMID: 30698218 PMCID: PMC6336361 DOI: 10.1590/1518-8345.2677-3117] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/22/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives: to evaluate and classify patients according to the Risk Assessment Scale for Perioperative Pressure Injuries; verify the association between sociodemographic and clinical variables and the risk score; and identify the occurrence of pressure injuries due to surgical positioning. Method: observational, longitudinal, prospective and quantitative study carried out in a teaching hospital with 278 patients submitted to elective surgeries. A sociodemographic and clinical characterization questionnaire and the Risk Assessment Scale for Perioperative Pressure Injuries were used. Descriptive, bivariate and logistic regression analyses were applied. Results: the majority of patients (56.5%) presented a high risk for perioperative pressure injury. Female sex, elderly group, and altered body mass index values were statistically significant (p < 0.05) for a higher risk of pressure injuries. In 77% of the patients, there were perioperative pressure injuries. Conclusion: most of the participants presented a high risk for development of perioperative decubitus ulcers. The female sex, elderly group, and altered body mass index were significant factors for increased risk. The Risk Assessment Scale for Perioperative Pressure Injuries allows the early identification of risk of injury, subsidizing the adoption of preventive strategies to ensure the quality of perioperative care.
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Affiliation(s)
- Camila de Assunção Peixoto
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil.,Prefeitura Municipal de Uberaba, Secretaria Municipal de Saúde, Uberaba, MG, Brazil
| | | | | | - Patrícia da Silva Pires
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil
| | - Elizabeth Barichello
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil
| | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Instituto de Ciências da Saúde, Uberaba, MG, Brazil
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Joyce P, Moore ZEH, Christie J. Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2018; 12:CD012132. [PMID: 30536917 PMCID: PMC6516850 DOI: 10.1002/14651858.cd012132.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services. Research is needed to demonstrate clearly the effect of different provider-orientated approaches to pressure ulcer prevention and treatment. OBJECTIVES To assess the effects of different provider-orientated interventions targeted at the organisation of health services, on the prevention and treatment of pressure ulcers. SEARCH METHODS In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, non-RCTs, controlled before-and-after studies and interrupted time series, which enrolled people at risk of, or people with existing pressure ulcers, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS The search yielded a total of 3172 citations and, following screening and application of the inclusion and exclusion criteria, we deemed four studies eligible for inclusion. These studies reported the primary outcome of pressure ulcer incidence or pressure ulcer healing, or both.One controlled before-and-after study explored the impact of transmural care (a care model that provided activities to support patients and their family/partners and activities to promote continuity of care), among 62 participants with spinal cord injury. It is unclear whether transmural care leads to a difference in pressure ulcer incidence compared with usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.53 to 1.64; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).One RCT explored the impact of hospital-in-the-home care, among 100 older adults. It is unclear whether hospital-in-the-home care leads to a difference in pressure ulcer incidence risk compared with hospital admission (RR 0.32, 95% CI 0.03 to 2.98; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).A third study (cluster-randomised stepped-wedge trial), explored the impact of being cared for by enhanced multidisciplinary teams (EMDT), among 161 long-term-care residents. The analyses of the primary outcome used measurements of 201 pressure ulcers from 119 residents. It is unclear if EMDT reduces the pressure ulcer incidence rate compared with usual care (hazard ratio (HR) 1.12, 95% CI 0.74 to 1.68; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the number of wounds healed (RR 1.69, 95% CI 1.00 to 2.87; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the reduction in surface area, with and without EMDT, (healing rate 1.006; 95% CI 0.99 to 1.03; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if EMDT leads to a difference in time to complete healing (HR 1.48, 95% CI 0.79 to 2.78, very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).The final study (quasi-experimental cluster trial), explored the impact of multidisciplinary wound care among 176 nursing home residents. It is unclear whether there is a difference in the number of pressure ulcers healed between multidisciplinary care, or usual care (RR 1.18, 95% CI 0.98 to 1.42; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if this type of care leads to a difference in time to complete healing compared with usual care (HR 1.73, 95% CI 1.20 to 2.50; very low-certainty evidence; downgraded twice for very serious study limitations and twice for very serious imprecision).In all studies the certainty of the evidence is very low due to high risk of bias and imprecision. We downgraded the evidence due to study limitations, which included selection and attrition bias, and sample size. Secondary outcomes, such as adverse events were not reported in all studies. Where they were reported it was unclear if there was a difference as the certainty of evidence was very low. AUTHORS' CONCLUSIONS Evidence for the impact of organisation of health services for preventing and treating pressure ulcers remains unclear. Overall, GRADE assessments of the evidence resulted in judgements of very low-certainty evidence. The studies were at high risk of bias, and outcome measures were imprecise due to wide confidence intervals and small sample sizes, meaning that additional research is required to confirm these results. The secondary outcomes reported varied across the studies and some were not reported. We judged the evidence from those that were reported (including adverse events), to be of very low certainty.
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Affiliation(s)
- Pauline Joyce
- Royal College of Surgeons in IrelandSchool of Medicine121 St. Stephens GreenDublinIreland2
| | - Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Janice Christie
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthOxford RoadManchesterLancashireUKM13 9PL
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Xiong C, Gao X, Ma Q, Yang Y, Wang Z, Yu W, Yu L. Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: A retrospective study. J Clin Nurs 2018; 28:1148-1155. [PMID: 30375697 DOI: 10.1111/jocn.14712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/20/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE To investigate the incidence of intraoperative blanchable erythema and pressure injuries in patients undergoing digestive surgery and to explore potential risk factors. BACKGROUND Pressure injuries pose significant economic and healthcare burden to patients and are used as one of the key indicators of nursing in the operation room with high incidence. DESIGN A retrospective observational study. METHODS Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hr by the information system. The clinical data were collected to analyse risk factors for intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. RESULTS Of 5,136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72-hr follow-up. Preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure were considered independent risk factors for intraoperative pressure injuries. CONCLUSION The incidence of pressure injuries in our study was lower than those reported in the previous studies. Accessing preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure was considered to be significant for preventing pressure injuries. RELEVANCE TO CLINICAL PRACTICE The findings suggest that preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure are associated with intraoperative pressure injuries in patients undergoing digestive surgery.
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Affiliation(s)
- Can Xiong
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinglian Gao
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Ma
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yang
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengyan Wang
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Yu
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Yu
- Operation Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Aloweni F, Ang SY, Fook-Chong S, Agus N, Yong P, Goh MM, Tucker-Kellogg L, Soh RC. A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score. Int Wound J 2018; 16:164-175. [PMID: 30289624 DOI: 10.1111/iwj.13007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.
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Affiliation(s)
- Fazila Aloweni
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Patricia Yong
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Meh Meh Goh
- Nursing Division, Singapore General Hospital (SGH), Singapore, Singapore
| | - Lisa Tucker-Kellogg
- Cancer & Stem Cell Biology, and Centre for Computational Biology Duke-NUS Medical School, Singapore, Singapore
| | - Rick Chai Soh
- Department of Anaesthesia, SGH, Singapore, Singapore
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Chello C, Lusini M, Schilirò D, Greco SM, Barbato R, Nenna A. Pressure ulcers in cardiac surgery: Few clinical studies, difficult risk assessment, and profound clinical implications. Int Wound J 2018; 16:9-12. [PMID: 30251323 DOI: 10.1111/iwj.12994] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 12/23/2022] Open
Abstract
Pressure ulcers (PUs) are a common complication after cardiac surgery, with almost one third of patients suffering from PUs during hospitalisation. Because of the burden that PUs exert on both the patients and the health care system, prevention is of utmost importance. The first step in successful prevention, however, includes the identification of the main features that render patients prone to PU development. Cardiac surgery population is not adequately addressed in current clinical trials and studies. Few studies focused specifically on cardiac surgery patients, but the majority included cardiac surgery patients within a heterogeneous population of acute or critical care patients. Therefore, additional research is warranted to understand the unique risk profile of patients undergoing cardiac surgery. Intraoperative risk factors that affect tissue tolerance have not been thoroughly investigated but are likely to play an important role, which might explain the epidemiology of a PU. Further research is also needed to better comprehend the risk of PUs among cardiac surgery patients and to design effective and tailored preventative measures with the help of newer tools for risk assessment.
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Affiliation(s)
- Camilla Chello
- Department of Dermatology, University of Rome "La Sapienza", Rome, Italy
| | - Mario Lusini
- Department of Cardiovascular Surgery, University "Campus Bio-Medico di Roma", Rome, Italy
| | - Davide Schilirò
- Department of Cardiovascular Surgery, University "Campus Bio-Medico di Roma", Rome, Italy
| | - Salvatore Matteo Greco
- Department of Cardiovascular Surgery, University "Campus Bio-Medico di Roma", Rome, Italy
| | - Raffaele Barbato
- Department of Cardiovascular Surgery, University "Campus Bio-Medico di Roma", Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, University "Campus Bio-Medico di Roma", Rome, Italy
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Kumta N, Coyer F, David M. Perioperative factors and pressure ulcer development in postoperative ICU patients: a retrospective review. J Wound Care 2018; 27:475-485. [PMID: 30086257 DOI: 10.12968/jowc.2018.27.8.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify variables during surgery that may contribute to the development of pressure ulcers (PUs) in postoperative, intensive care unit (ICU) patients within 72 hours of admission, as well as over their entire ICU admission. Furthermore, to investigate how these variables may impact on the number of PUs acquired. METHOD In a three-year retrospective audit, from 1 January 2014 to 31 December 2016, data from the electronic medical records of 3484 postoperative ICU patients in a major Australian metropolitan public hospital were retrieved and analysed to investigate associations between perioperative variables and PU occurrence. RESULTS A total of 69 ICU admissions (1.98%) out of 3484 resulted in at least one PU developing within the ICU. No specific variables were associated with the development of a PU within 72 hours of the patient's ICU admission. Multiple regression Cox analysis showed that length of time in the operating theatre (OT) (p=0.045), surgical specialty (p<0.001), 1-4 hypotensive episodes (p=0.017) and >5 hypotensive episodes (p<0.0005) were significantly associated with PU risk. Multivariable negative binomial regression demonstrated APACHE II score (p<0.01), OT time (p<0.01) and surgical specialty (p<0.01) were associated with PU number. CONCLUSION There are many risks to skin integrity at the perioperative period, and these risks may exert their effect well into the ICU admission period. It is imperative to identify and mitigate these factors in order to reduce PU incidence, morbidity and mortality.
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Affiliation(s)
- Neha Kumta
- Resident Medical Officer, Sunshine Coast University Hospital, Birtinya, QLD, Australia, University of Queensland, Brisbane, QLD, Australia
| | - Fiona Coyer
- Professor of Nursing; School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Michael David
- Biostatistical Consultant, Biostatistical Consultant, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Prevention of Pressure Injuries in the Operating Room: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2018. [PMID: 29521925 DOI: 10.1097/won.0000000000000410] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prevention of hospital-acquired pressure injuries (HAPIs) remains a crucial clinical challenge especially for those patients undergoing surgery. The purpose of this project was to examine whether a 5-layer silicone foam dressing applied to the sacrum of patients undergoing vascular surgery decreased the occurrence of sacral pressure injuries and to explore participant characteristics associated with the development of operating room (OR)-related pressure injuries. A pre-/postintervention design, quality improvement project in a convenience sample of 81 patients undergoing vascular surgery, in a 700-bed level I trauma acute care setting, in the Northeastern United States. Eighty-one patients undergoing vascular surgery participated in this project. Thirty-seven were in the preintervention group who were identified from the housewide pressure injury prevalence data from May and December 2010 and received standard pressure injury prevention while hospitalized. Forty-four patients in the intervention group were identified from a hospital-based outpatient vascular surgery office and preoperatively received the 5-layer silicone foam dressing in addition to standard care. Data were collected on the third and seventh postoperative days via the electronic medical record and paper medical records. Collected data included age, gender, comorbidities (diabetes, hypertension, peripheral vascular disease and, smoking status), presence of a 5-layer silicone sacral foam dressing, and pressure injury occurrence. Analysis included descriptive statistics, Fisher exact test to compare groups, and logistic regression to identify associated risk factors. More than 50% (n = 19) in the preintervention group developed a hospital-acquired pressure injury while only 1 subject (n = 2%) in the intervention group developed a hospital-acquired pressure injury (P = .000). Findings indicate that, after controlling for age, gender, and other comorbidities, application of a 5-layer silicone sacral foam dressing significantly reduced the likelihood of development of a new pressure injury (OR= 0.04, 95% confidence interval, 0.00-40; P = .006). This pre-/postquality improvement project, using a 5-layer silicone sacral foam dressing in addition to standard operating room pressure injury preventive interventions, for elective vascular surgical cases, resulted in a significant decrease in sacral operating room-related pressure injuries. These findings suggest the effectiveness of a 5-layer silicone foam dressing when added to standard preventive interventions. The findings warrant further investigation of additional preventative interventions in the OR specific to high-risk populations.
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Scientific and Clinical Abstracts From the WOCN® Society's 50th Annual Conference. J Wound Ostomy Continence Nurs 2018. [DOI: 10.1097/won.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dreyfus J, Gayle J, Trueman P, Delhougne G, Siddiqui A. Assessment of Risk Factors Associated With Hospital-Acquired Pressure Injuries and Impact on Health Care Utilization and Cost Outcomes in US Hospitals. Am J Med Qual 2017; 33:348-358. [DOI: 10.1177/1062860617746741] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospital-acquired pressure injuries (HAPI) are a societal burden and considered potentially preventable. Data on risk factors and HAPI burden are important for effective prevention initiatives. This study of the 2009-2014 US Premier Healthcare Database identified HAPI risk factors and compared outcomes after matching HAPI to non-HAPI patients. The cumulative incidence of HAPI was 0.28% (47 365 HAPI among 16 967 687 total adult inpatients). Among the matched sample of 110 808 patients (27 702 HAPI), the strongest risk factors for HAPI were prior PI (odds ratio [OR] = 12.52, 95% confidence interval [CI] = 11.93-13.15), prior diabetic foot ulcer (OR = 3.43, 95% CI = 3.20-3.68), and malnutrition (OR = 3.11, 95% CI = 3.02-3.20). HAPI patients had longer adjusted length of stay (3.7 days, P < .0001), higher total hospitalization cost ($8014, P < .0001), and greater odds of readmissions through 180 days (OR = 1.60, 95% CI = 1.55-1.65). This study demonstrates how big data may help quantify HAPI burden and improve internal hospital processes by identifying high-risk patients and informing best practices for prevention.
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Affiliation(s)
- Jill Dreyfus
- Premier Applied Sciences, Premier, Inc, Charlotte, NC
| | - Julie Gayle
- Premier Applied Sciences, Premier, Inc, Charlotte, NC
| | | | | | - Aamir Siddiqui
- Henry Ford Hospital, Wayne State University, Detroit, MI
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Prevalence and Predictors of Pressure Injuries From Spine Surgery in the Prone Position: Do Body Morphological Changes During Deformity Correction Increase the Risks? Spine (Phila Pa 1976) 2017; 42:1730-1736. [PMID: 28368987 DOI: 10.1097/brs.0000000000002177] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
MINI: Pressure injuries are prevalent in patients undergoing spine surgery while prone. Multiple risk factors exist and should be addressed. We found that patients undergoing spinal deformity correction surgery are at unique risk (odds ratio 3.31, P = 0.010) due to body morphological changes occurring secondary to intraoperative changes in spinal alignment. STUDY DESIGN Review of data and prospective study. OBJECTIVE To investigate the prevalence and predictive factors of pressure injuries in spine surgery performed in the prone position, and to determine whether morphological changes and truncal shifts occurring during deformity correction predispose to this complication. SUMMARY OF BACKGROUND DATA Spine surgery performed in the prone position presents the risk of developing pressure injuries. This risk is potentially increased in deformity correction, because it tends to involve more extensive procedures, with associated longer operating times. METHODS Cases of pressure injuries after spine surgery in the prone position were reviewed to ascertain prevalence and determine risk factors. Data including patient factors (age, sex, height, weight, body mass index, American Society of Anesthesiologists grade, comorbidities, Braden scale, neurological status, spinal pathology) and surgical factors (approach, procedure type, number of screws, operated levels, operative time) were collected. Independent risk factors were identified via multivariate analysis. A subsequent prospective analysis of all patients undergoing spinal deformity correction was conducted by performing intraoperative measurements of body morphological changes and shifts in truncal positions. Statistical correlation was performed to determine whether positional shifts cause pressure injuries. RESULTS The prevalence of pressure injuries was 23.0%. Previous skin problems (P = 0.034), myelopathy (P = 0.013), operative time >300 minutes (P = 0.005), and more than four operated levels (P = 0.006) were independent predictors of pressure injuries. Being a spinal deformity patient was also an independent risk factor for developing pressure injuries (odds ratio 3.31, P = 0.010). Significant changes in body measurements during deformity correction were predictive of pressure injuries. CONCLUSION Pressure injuries are prevalent in patients undergoing spine surgery while prone. Future studies should investigate strategies to prevent this complication based on the multiple risk factors identified in the present study. Patients undergoing spinal deformity correction surgery are particularly at risk due to intraoperative body morphological changes. Improved padding methods should be trialed in future studies. LEVEL OF EVIDENCE 3.
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Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients. J Wound Ostomy Continence Nurs 2017; 44:420-428. [PMID: 28671894 DOI: 10.1097/won.0000000000000349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013. Analysis is based on data from 6377 patients. METHODS Retrospective chart review was used to determine Braden Scale total and subscale scores, age, and incidence of pressure injury development. We used survival analysis to determine the hazards of developing a pressure injury associated with each subscale of the Braden Scale, with the lowest-risk category as a reference. In addition, we used time-dependent Cox regression with natural cubic splines to model the interaction between age and Braden Scale scores and subscale scores in pressure injury risk. RESULTS Of the 6377 ICU patients, 214 (4%) developed a pressure injury (stages 2-4, deep tissue injury, or unstageable) and 516 (8%) developed a hospital-acquired pressure injury of any stage. With the exception of the friction and shear subscales, regardless of age, individuals with scores in the intermediate-risk levels had the highest likelihood of developing pressure injury. CONCLUSION The relationship between age, Braden Scale subscale scores, and pressure injury development varied among subscales. Maximal preventive efforts should be extended to include individuals with intermediate Braden Scale subscale scores, and age should be considered along with the subscale scores as a factor in care planning.
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Liang M, Chen Q, Zhang Y, He L, Wang J, Cai Y, Li L. Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies. Oncotarget 2017; 8:14516-14524. [PMID: 28036285 PMCID: PMC5362422 DOI: 10.18632/oncotarget.14312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023] Open
Abstract
Diabetes is a major cause of morbidity for patients undergoing surgery and can increase the incidence of some postoperative complications such as bedsores. We conducted a meta-analysis of observational studies to examine whether patients with diabetes undergoing surgery had high risk of bedsore. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library Central Register of Controlled Trials database from inception to November 2016. Studies were selected if they reported estimates of the relative risk (RR) for bedsore risk in postoperative diabetic patients compared with that of in non-diabetic patients. Random-effects meta-analysis was conducted to pool the estimates. A total of 16 studies with 24,112 individuals were included in our meta-analysis. The pooled RR of bedsore development for patients with diatetes was 1.77 (95% CI 1.45 to 2.16). The results of subgroup analyses were consistent when stratified by surgery type, study design, research region, sample size, inclusion period, analysis method and study quality. There was evidence of publication bias among studies and a sensitivity analysis using the Duval and Tweedie “trim-and-fill” method did not significantly alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This meta-analysis provides indications that diabetic patients undergoing surgery could have a higher risk of developing bedsores. Further large-scale prospective trials should be implemented to comfirm the association.
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Affiliation(s)
- Mining Liang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qiongni Chen
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
| | - Yang Zhang
- Nursing Teaching and Research Institute, Medical College of Guangxi University of Science and Technology, Liuzhou, Guangxi Province, China
| | - Li He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yiwen Cai
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lezhi Li
- Department of Nursing, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, China
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Al-Majid S, Vuncanon B, Carlson N, Rakovski C. The Effect of Offloading Heels on Sacral Pressure. AORN J 2017; 106:194-200. [DOI: 10.1016/j.aorn.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/17/2017] [Accepted: 07/06/2017] [Indexed: 10/18/2022]
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Magny E, Vallet H, Cohen-Bittan J, Raux M, Meziere A, Verny M, Riou B, Khiami F, Boddaert J. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 2017; 12:77. [PMID: 28852954 DOI: 10.1007/s11657-017-0365-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). INTRODUCTION Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. METHODS From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. RESULTS Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31-4.32, p = 0.044). CONCLUSION In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.
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Affiliation(s)
- Emmanuelle Magny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Helene Vallet
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Judith Cohen-Bittan
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Antony Meziere
- Department of Rehabilitation, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Marc Verny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Bruno Riou
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
- Department of Emergency Medicine and Surgery, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Jacques Boddaert
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France.
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France.
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Porcel-Gálvez AM, Romero-Castillo R, Fernández-García E, Barrientos-Trigo S. Psychometric Testing of INTEGRARE, an Instrument for the Assesment of Pressure Ulcer Risk in Inpatients. Int J Nurs Knowl 2017; 29:165-170. [PMID: 28834407 DOI: 10.1111/2047-3095.12173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study is to evaluate the psychometric properties of INTEGRARE, an instrument based on Nursing Outcome Classification. METHOD A multicenter, cross-sectional, methodological design was used. FINDINGS The study included 3,835 patients. Internal consistency α = 0.86. Confirmatory factor analysis demonstrated the unidimensionality of the scale, indicating a good model fit (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). CONCLUSIONS INTEGRARE is a valid and reliable instrument with high sensitivity, specificity, and diagnostic accuracy in measuring pressure ulcer (PU) risk in inpatients. IMPLICATIONS FOR NURSING PRACTICE This instrument allows us to know the effectiveness of nursing interventions, providing evidence for the validation of the diagnosis Risk for pressure ulcer (00249) as well as on health outcomes, due to the fact that PUs are nursing-sensitive outcomes. OBJETIVO Evaluar las propiedades psicométricas de INTEGRARE, un instrumento basado en la Clasificación de Resultados de Enfermería. MÉTODO: Se optó por un diseño transversal multicéntrico. RESULTADOS El estudio incluyó a 3,835 pacientes. Consistencia interna α = 0.86. El análisis factorial confirmatorio demostró la unidimensionalidad de la escala, indicando un buen ajuste del modelo (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). CONCLUSIONES INTEGRARE es un instrumento válido y fiable con alta sensibilidad, especificidad y precisión diagnóstica en la medición de riesgo de úlcera por presión (UPP) en pacientes hospitalizados. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Este instrumento nos permite conocer la efectividad de las intervenciones enfermeras, aportando evidencia para la validación del diagnóstico Riesgo de úlcera por presión (00249), así como sobre los resultados de salud, debido a que las UPP son resultados sensibles a la práctica enfermera.
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Risk Factors Associated With Pressure Ulcer Formation in Critically Ill Cardiac Surgery Patients: A Systematic Review. J Wound Ostomy Continence Nurs 2017; 43:242-7. [PMID: 26983066 DOI: 10.1097/won.0000000000000224] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac surgery patients are among those most at risk for developing pressure ulcers (PUs), with a reported incidence as high as 29.5%. Although numerous studies documenting PU risk factors and prevention strategies exist, the availability of literature examining risk factors specific to the cardiac surgery population is limited. AIM A systematic review was completed that aimed to identify the risk factors associated with PU development in critically ill, adult, cardiac surgery patients. METHODS The MEDLINE, CINAHL, and Cochrane databases were searched. Studies that focused on PU risk factors in critical care, surgical intensive care, or cardiac surgery populations and used PU occurrences as an outcome variable were included in the review. FINDINGS Twelve high-quality studies were retrieved and included in the review; they revealed 30 potential PU risk factors. Current evidence is limited in 2 important ways. First, the impact of intraoperative factors, such as cardiopulmonary bypass time or body temperature, appears to be underexplored. Second, a substantive discussion of the risk factors associated specifically with deep tissue injuries, a unique PU category, is absent. CONCLUSION The relatively high PU incidence among cardiac surgery patients suggests that typical PU prevention methods are insufficient for this population. Targeted prevention measures must be developed and implemented. Completion of this task required identification of risk factors unique to this population. Specific risk factors likely to increase risk among cardiac surgery patients include prolonged exposure to pressure during long surgical procedures, vascular disease, and/or vasopressor use postoperatively. Additional research concerning risk factors specific to this population is urgently needed.
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Hobson DB, Chang TY, Aboagye JK, Lau BD, Shihab HM, Fisher B, Young S, Sujeta N, Shaffer DL, Popoola VO, Kraus PS, Knorr G, Farrow NE, Streiff MB, Haut ER. Prevalence of graduated compression stocking–associated pressure injuries in surgical intensive care units. J Crit Care 2017; 40:1-6. [DOI: 10.1016/j.jcrc.2017.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
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Kim JM, Lee H, Ha T, Na S. Perioperative factors associated with pressure ulcer development after major surgery. Korean J Anesthesiol 2017; 71:48-56. [PMID: 29441175 PMCID: PMC5809708 DOI: 10.4097/kjae.2018.71.1.48] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/30/2022] Open
Abstract
Background Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. Results The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05-0.82; P < 0.05) and high lactate levels (OR: 1.70, 95% CI: 1.07-2.71; P < 0.05) were independently associated with pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79-0.97; P < 0.001). Conclusions The present study revealed that preoperative low albumin levels and high lactate levels were significantly associated with pressure ulcer development after surgery.
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Affiliation(s)
- Jeong Min Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjeong Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Taehoon Ha
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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de Oliveira KF, Nascimento KG, Nicolussi AC, Chavaglia SRR, de Araújo CA, Barbosa MH. Support surfaces in the prevention of pressure ulcers in surgical patients: An integrative review. Int J Nurs Pract 2017. [PMID: 28643855 DOI: 10.1111/ijn.12553] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the scientific evidence about the types of support surfaces used in intraoperative surgical practice in the prevention of pressure ulcers due to surgical positioning. METHOD This is an integrative literature review. The electronic databases Cochrane, PubMed, Web of Science, Scopus, Lilacs, and CINAHL were used. The descriptors surgical patients, support surfaces, perioperative care, patient positioning, and pressure ulcer were used in the search strategy. Articles that addressed the use of support surfaces intraoperatively, published between 1990 and 2016, were selected. The PRISMA guidelines were used to structure the review. RESULTS Of 18 evaluated studies, most were in English, followed by Portuguese and Spanish; most were performed by nurses. The most commonly cited support surfaces were viscoelastic polymer, micropulse mattresses, gel based mattresses, and foam devices. CONCLUSION There are gaps in knowledge regarding the most efficient support surfaces and the specifications of the products used to prevent pressure ulcers due to surgical positioning.
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Alderden J, Rondinelli J, Pepper G, Cummins M, Whitney J. Risk factors for pressure injuries among critical care patients: A systematic review. Int J Nurs Stud 2017; 71:97-114. [PMID: 28384533 PMCID: PMC5485873 DOI: 10.1016/j.ijnurstu.2017.03.012] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To identify risk factors independently predictive of pressure injury (also known as pressure ulcer) development among critical-care patients. DESIGN We undertook a systematic review of primary research based on standardized criteria set forth by the Institute of Medicine. DATA SOURCES We searched the following databases: CINAHL (EBSCOhost), the Cochrane Library (Wilson), Dissertations & Theses Global (ProQuest), PubMed (National Library of Medicine), and Scopus. There was no language restriction. METHOD A research librarian coordinated the search strategy. Articles that potentially met inclusion criteria were screened by two investigators. Among the articles that met selection criteria, one investigator extracted data and a second investigator reviewed the data for accuracy. Based on a literature search, we developed a tool for assessing study quality using a combination of currently available tools and expert input. We used the method developed by Coleman et al. in 2014 to generate evidence tables and a summary narrative synthesis by domain and subdomain. RESULTS Of 1753 abstracts reviewed, 158 were identified as potentially eligible and 18 fulfilled eligibility criteria. Five studies were classified as high quality, two were moderate quality, nine were low quality, and two were of very low quality. Age, mobility/activity, perfusion, and vasopressor infusion emerged as important risk factors for pressure injury development, whereas results for risk categories that are theoretically important, including nutrition, and skin/pressure injury status, were mixed. Methodological limitations across studies limited the generalizability of the results, and future research is needed, particularly to evaluate risk conferred by altered nutrition and skin/pressure injury status, and to further elucidate the effects of perfusion-related variables. CONCLUSIONS Results underscore the importance of avoiding overinterpretation of a single study, and the importance of taking study quality into consideration when reviewing risk factors. Maximal pressure injury prevention efforts are particularly important among critical-care patients who are older, have altered mobility, experience poor perfusion, or who are receiving a vasopressor infusion.
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Affiliation(s)
- Jenny Alderden
- Boise State University, 1910 W University Drive, Boise, Idaho 83725, United States; University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT 84112, United States; St. Luke's Meridian Medical Center, 520 S Eagle Road, Meridian, Idaho 83642, United States.
| | - June Rondinelli
- Kaiser Permanente Southern California Health Services, 393 E Walnut Street 7th Floor, Pasadena, CA 91188, United States.
| | - Ginette Pepper
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT 84112, United States.
| | - Mollie Cummins
- University of Utah College of Nursing, 10 2000 E, Salt Lake City, UT 84112, United States.
| | - JoAnne Whitney
- University of Washington, Box 357266, 1959 NE Pacific St., Seattle, WA 98195, United States.
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Mehaffey JH, Politano AD, Bhamidipati CM, Tracci MC, Cherry KJ, Kern JA, Kron IL, Upchurch GR. Decubitus ulcers in patients undergoing vascular operations do not influence mortality but affect resource utilization. Surgery 2017; 161:1720-1727. [PMID: 28318554 DOI: 10.1016/j.surg.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. METHODS Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non-decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition. RESULTS A total of 538,808 cases were analyzed. Decubitus ulcers were most prevalent among Caucasian male Medicare beneficiaries (P < .001). Decubitus ulcer patients also underwent more nonelective vascular operations (P < .001). Wound, infectious, and procedural complications were more common in patients with decubitus ulcers (P < .001). Failure to rescue, defined as mortality after any complication, was more than doubled in decubitus ulcers (non-decubitus ulcers: 1.5%, decubitus ulcers: 3.2%, P < .001). Similarly, unadjusted mortality was also doubled in patients undergoing vascular operation with decubitus ulcers (non-decubitus ulcers: 3%, decubitus ulcers: 6%, P < .001). After risk adjustment among all patients, neither the presence of a decubitus ulcer nor specific ulcer staging increased the adjusted odds of death. Having a decubitus ulcer increased the adjusted odds of discharge to an intermediate care facility (odds ratio 2.9, P < .001). These patients also had 1.6 times the total charges compared to their non-decubitus ulcer cohort (non-decubitus ulcers: $49,460 ± $281 vs decubitus ulcers: $81,149 ± $5,855, P < .001). CONCLUSION Contrary to common perception, perioperative decubitus ulcer does not adversely affect mortality after vascular operation in patients proceeding to operative intervention. Patients with decubitus ulcers are, however, at higher risk for complications and incur sizeable additional charges.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Amani D Politano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | | | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Kenneth J Cherry
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - John A Kern
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Irving L Kron
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
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Mizuno J, Takahashi T. Evaluation of external pressure to the sacral region in the lithotomy position using the noninvasive pressure distribution measurement system. Ther Clin Risk Manag 2017; 13:207-213. [PMID: 28255240 PMCID: PMC5322810 DOI: 10.2147/tcrm.s122489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pressure ulcers (PUs) in the sacral region can be a complication of surgical procedures performed in the lithotomy position. Previous reports have noted a difference between men and women in PU development related to the supine position, and body weight and body mass index (BMI) have been also described as known risk factors in supine position-related PU development. The BIG-MAT® system is a noninvasive pressure distribution measurement device used to measure external pressure (EP). We used this system to investigate the relationship between EP to the sacral region in the lithotomy position and selected physical characteristics. METHODS We recruited 21 young, healthy volunteers (11 men and 10 women, aged 21.4±0.5 years). Using the BIG-MAT system, we measured four types of EP to the sacral region: box pressure, peak box pressure, contact pressure, and peak contact pressure. We analyzed the relationships between these dynamic parameters and physical characteristics of the participants. RESULTS There were no differences between men and women in the four types of EP, and no significant differences related to the participants' height, weight, or BMI. CONCLUSION An individual's height, weight, and BMI may not contribute to the risk of inducing lithotomy position-related PUs in the sacral region. The noninvasive pressure distribution measurement system BIG-MAT for patients in the lithotomy position during surgery could become a significant device when estimating EP at the sacral region.
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Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja-shi, Okayama, Japan
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Engels D, Austin M, McNichol L, Fencl J, Gupta S, Kazi H. Pressure Ulcers: Factors Contributing to Their Development in the OR. AORN J 2016; 103:271-81. [PMID: 26924365 DOI: 10.1016/j.aorn.2016.01.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/09/2015] [Accepted: 01/14/2016] [Indexed: 12/26/2022]
Abstract
The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours. We performed a retrospective chart review to determine what factors contribute to the development of pressure ulcers in patients who undergo surgical procedures. The sample population included patients who acquired a pressure ulcer that was not present at admission and developed during their postoperative hospital stay. The project revealed consistent risk factors that may contribute to the development of pressure ulcers in patients who have undergone surgical procedures. These findings can drive the implementation of preventive measures to reduce the occurrence of HAPUs associated with surgical procedures.
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Meehan AJ, Beinlich NR, Hammonds TL. A Nurse-Initiated Perioperative Pressure Injury Risk Assessment and Prevention Protocol. AORN J 2016; 104:554-565. [DOI: 10.1016/j.aorn.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/15/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Shafipour V, Ramezanpour E, Gorji MAH, Moosazadeh M. Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis. Electron Physician 2016; 8:3170-3176. [PMID: 28070249 PMCID: PMC5217808 DOI: 10.19082/3170] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A pressure ulcer is a serious safety issue in healthcare systems. The patient's rate of infection with an ulcer, especially a postoperative ulcer, is critical, as it is dictated by factors such as being in a fixed position during surgery, the type of anesthesia used, the duration of surgery, and patient-related factors. The present study was conducted to carry out a systematic assessment of the prevalence of a postoperative pressure ulcer and to find its general prevalence using a meta-analysis. METHODS The researchers searched databases, including PubMed, Google Scholar, Scopus, Science Direct, the Thomson Reuters' Web of Science (WOS). For English articles published online between January 2000 and October 2015 on the subject of a pressure ulcer, a total of 19 articles were ultimately selected based on the study inclusion criteria. Then results were analyzed in Stata-11. RESULTS The 19 articles qualified for entering the meta-analysis examined a total of 9527 patients. The studies estimated the general prevalence of a postoperative pressure ulcer as 18.96% (CI 95%: 15.3-22.6); the prevalence by gender was reported as 10.1% (CI 95%: 7.2-13.01) in men and 12.8% (CI 95%: 8.3-17.2) in women. Stage 1 ulcer had a 17.02% prevalence (CI 95%: 11.04-22.9), stage 2 a 6.7% prevalence (CI 95%: 3.8-9.7), stage 3 a 0.9% prevalence (CI 95%: 0.2-1.6), and stage 4 a 0.4% (CI 95%: -0.05-0.8) prevalence. CONCLUSION The prevalence of a postoperative pressure ulcer is high among the entire population; however, it is still higher in women than in men. The prevalence of a stage 1 ulcer is higher than the prevalence of the other stages of an ulcer.
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Affiliation(s)
- Vida Shafipour
- Ph.D., Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ensieh Ramezanpour
- M.Sc. of Critical Care Nursing, Student's Research Committee, Nasibeh Nursing & Midwifery Faculty Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ali Heidari Gorji
- Ph.D., Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Ph.D. of Epidemiology, Assistant Professor, Health Science Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
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Tayyib N, Coyer F, Lewis P. Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study. Int Wound J 2016; 13:912-9. [PMID: 25662591 PMCID: PMC7949994 DOI: 10.1111/iwj.12406] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/09/2014] [Accepted: 12/04/2014] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.
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Affiliation(s)
- Nahla Tayyib
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Peter Lewis
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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79
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Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators. J Wound Ostomy Continence Nurs 2016; 42:138-44. [PMID: 25473881 DOI: 10.1097/won.0000000000000092] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. DESIGN We used a prospective cohort study to investigate the research question. SUBJECTS AND SETTINGS The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. METHODS Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. RESULTS Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. CONCLUSION Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.
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80
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Scientific and Clinical Abstracts From the 2016 WOCN® Society & CAET Joint Conference. J Wound Ostomy Continence Nurs 2016. [DOI: 10.1097/won.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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81
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Joyce P, Moore ZEH, Christie J, Dumville JC. Organisation of health services for preventing and treating pressure ulcers. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Pauline Joyce
- Royal College of Surgeons in Ireland; School of Medicine; 121 St. Stephens Green Dublin Ireland 2
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St. Stephen's Green Dublin Ireland D2
| | - Janice Christie
- University of Manchester; School of Nursing, Midwifery and Social Work; Oxford Road Manchester Lancashire UK M13 9PL
| | - Jo C Dumville
- University of Manchester; School of Nursing, Midwifery and Social Work; Oxford Road Manchester Lancashire UK M13 9PL
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Kirkland-Walsh H, Teleten O, Wilson M, Raingruber B. Pressure Mapping Comparison of Four OR Surfaces. AORN J 2016; 102:61.e1-9. [PMID: 26119617 DOI: 10.1016/j.aorn.2015.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/23/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022]
Abstract
Mortality and health care costs associated with hospital-acquired pressure ulcers (HAPUs) increase yearly. After four hours of surgery, the risk of developing a pressure ulcer increases by 33% for every 30 minutes of surgery. Prolonged immobility, lower blood pressures, and increased surface interface pressure may hinder the blood supply delivered to the skin, eventually leading to pressure ulcers. We measured and compared four different OR surfaces to identify the most effective pressure redistribution surface for prolonged OR procedures. The best surface attributes that provide efficient pressure redistribution should have the following properties: the lowest average interface pressure, the lowest peak interface pressure, and the highest skin contact area. Although all surfaces had similar average interface pressures, the air-inflated static seat cushion had the best pressure redistribution properties in the sacral region compared with the other surfaces tested.
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83
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Swafford K, Culpepper R, Dunn C. Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit. Am J Crit Care 2016; 25:152-5. [PMID: 26932917 DOI: 10.4037/ajcc2016963] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hospital-acquired pressure ulcers (HAPUs) are a costly and largely preventable complication occurring in a variety of acute care settings. Because they are considered preventable, stage III and IV HAPUs are not reimbursed by Medicare. OBJECTIVES To assess the effectiveness of a formal, year-long HAPU prevention program in an adult intensive care unit, with a goal of achieving at least a 50% reduction in 2013, compared with 2011. METHODS Planning for the prevention program began in 2012, and the program was rolled out in the first quarter of 2013. Program components included use of Braden scores, a revised skin care protocol, fluidized repositioners, and silicone gel adhesive dressings. Efforts were made to educate and motivate staff and encourage them to be more proactive in detecting patients at risk of HAPUs. RESULTS Incidence of HAPUs in the unit was reduced by 69% (n = 17; 3% of patients in 2013 vs n = 45, 10% of patients in 2011), despite a 22% increase in patient load. The potential cost saving as a result of this decrease was approximately $1 million. CONCLUSIONS A comprehensive, proactive, collaborative ulcer prevention program based on staff education and a focus on adherence to protocols for patient care can be an effective way to reduce the incidence of HAPUs in intensive care units.
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Affiliation(s)
- Katie Swafford
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
| | - Rachel Culpepper
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
| | - Christina Dunn
- Katie Swafford is a critical care clinical nurse specialist and Rachel Culpepper and Christina Dunn are staff nurses and shift coordinators in the critical care unit at Eskenazi Health, Indianapolis, Indiana
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Emeđi D, Skela-Savič B. Povezave med razjedo zaradi pritiska in ohranjanjem integritete kože pacienta v intenzivni zdravstveni obravnavi: pregled literature. OBZORNIK ZDRAVSTVENE NEGE 2015. [DOI: 10.14528/snr.2015.49.4.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Namen raziskave je prikazati večdimenzionalne potrebe in možne dejavnike tveganja za razjedo zaradi pritiska pri odraslih pacientih v intenzivni zdravstveni obravnavi.
Metode: Uporabili smo analizo in sintezo pregleda dokazov iz zbirke podatkov EMERALD, CINAHL, PubMed in ProQuest. Ključne iskalne besedne zveze so bile: »quality of care«, »pressure ulcer«, »prevention and treatment of pressure ulcers«, »skin integrity critical care patients«. Omejitveni kriteriji iskanja so bili: obdobje 2010 do 2013, celotno besedilo člankov v angleščini. Začetna merila je izpolnjevalo 280 zadetkov in 40 izbranih ustreznih prispevkov. Potek raziskave je prikazan v skladu z načeli Cochranove zbirke, ocena kakovosti dokazov pa v hierarhiji dokazov.
Rezultati: Identificiranih je 191 kod, ki so združene v 11 vsebinskih kategorij: okolje intenzivne terapije – značilnosti nekaterih dejavnikov tveganja, čas bivanja v enoti, vazoaktivne učinkovine, spol, starost, administrativno diagnostična kategorija, postelja, ležišče, lestvica Waterlow, razjeda zaradi pritiska in pomen prve stopnje razjede.
Diskusija in zaključek: Raziskava pokaže pomen uvedbe proaktivnih ukrepov za ohranjanje integritete kože pacienta. Osredotoča se na vitalnost tkiva in promocijo kakovostne zdravstvene oskrbe z vidika teorije. Potrebne so raziskave, ki bi za boljše razumevanje pojasnjevale številna druga tveganja in učinkovite programe za vitalnost kože.
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Predictors of pressure ulcer development in patients with vascular disease. JOURNAL OF VASCULAR NURSING 2015; 32:55-62. [PMID: 24944172 DOI: 10.1016/j.jvn.2013.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although pressure ulcer (PU) risk factors are well known in the general population, little research is available in hospitalized surgical patients admitted with vascular diseases. METHODS Using a retrospective medical records review, characteristics of hospitalized surgical patients with vascular diseases were assessed. Variables were based on literature review of PUs and availability of medical records and administrative data. Trained registered nurses collected data. Analyses included descriptive and comparative statistics, and multivariable modeling was used to determine predictors of PU. RESULTS In 849 adult admissions, 18.9% had a PU; 11.8% were hospital-acquired PU (HAPU). Patients were more likely to be elderly, male (n = 575; 67.7%), and Caucasian (n = 704; 83.3%). Common diagnoses were aneurysms/embolisms (43.2%) and atherosclerosis (31.2%). Patients with HAPU were more likely to be discharged to a skilled nursing or other facility compared with home (P < .001). In univariate analyses, 12 patient characteristics were associated with HAPU presence: Female gender, non-married status, current smoker, non-Caucasian race, non-intensive care unit (ICU) stay, primary diagnosis of atherosclerosis, higher analgesic use, higher right ankle brachial index (ABI), lower Braden score, higher blood urea nitrogen (BUN) higher serum creatinine and higher total protein levels. In multivariate analyses, nine factors predicted HAPU: Lower right ABI and Braden score, an ICU stay, low and high hematocrit values, female gender, non-White race, atherosclerosis history, and higher BUN and body mass index (BMI). The concordance index for the nine-item model was 0.854. CONCLUSION The rate of HAPU in hospitalized surgical patients with vascular diseases was greater than expected. Assessment of important HAPU factors and implementation of interventions are needed to decrease risk and improve clinical outcomes.
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86
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Cox J, Roche S. Vasopressors and development of pressure ulcers in adult critical care patients. Am J Crit Care 2015; 24:501-10. [PMID: 26523008 DOI: 10.4037/ajcc2015123] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. OBJECTIVE To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. METHODS A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. RESULTS Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. CONCLUSION The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.
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Affiliation(s)
- Jill Cox
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
| | - Sharon Roche
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
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87
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Santos CTD, Almeida MDA, Oliveira MC, Victor MADG, Lucena ADF. [Development of the nursing diagnosis risk for pressure ulcer]. ACTA ACUST UNITED AC 2015; 36:113-21. [PMID: 26334417 DOI: 10.1590/1983-1447.2015.02.49102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 04/28/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The study objective was to develop the definition and compile the risk factors for a new Nursing Diagnosis entitled "Risk for pressure ulcer". The process was guided using the research question, "What are the risk factors for development of a PU and what is its definition?" METHOD An integrative literature review was conducted of articles published in Portuguese, English or Spanish from 2002 to 2012 and indexed on the Lilacs/SCIELO, MEDLINE/PubMed Central and Web of Science databases. The final sample comprised 21 articles that provided answers to the research question. These articles were analyzed and summarized in charts. RESULTS A definition was constructed and 19 risk factors were selected for the new nursing diagnosis, "Risk for pressure ulcer". CONCLUSIONS Identification and definition of the components of the new nursing diagnosis should aid nurses to prevent pressure ulcer events.
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The Association between Pre-existing Diabetes Mellitus and Pressure Ulcers in Patients Following Surgery: A Meta-analysis. Sci Rep 2015; 5:13007. [PMID: 26260124 PMCID: PMC4531331 DOI: 10.1038/srep13007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/13/2015] [Indexed: 12/30/2022] Open
Abstract
Uncertainty exists about the role of diabetes in the development of surgery-related pressure ulcers. Therefore, we conducted a meta-analysis to explore the association between pre-existing diabetes mellitus and pressure ulcers among patients after surgery. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random effects models. Thirteen eligible studies of 2367 patients in total and 12053 controls were included in the final analysis. Compared with patients without diabetes, the pooled odds ratio (OR) of the incidence of pressure ulcers in diabetic patients was 1.74 [95% confidence interval (CI) = 1.40–2.15, I2 = 51.1%]. Estimates by type of surgery suggested similar results in cardiac surgery [OR = 2.00, 95% CI = 1.42–2.82, I2 = 0%], in general surgery [OR = 1.75, 95% CI = 1.42–2.15, I2 = 0%], and in major lower limb amputations [OR = 1.65, 95% CI = 1.01–2.68, I2 = 0%] for diabetic patients versus non-diabetic controls. We did not find an increased incidence of pressure ulcers in diabetic patients undergoing hip surgery compared with non-diabetic controls [OR = 1.46, 95% CI = 0.62–3.47, I2 = 93.1%]. The excess risk of pressure ulcers associated with pre-existing diabetes was significantly higher in patients undergoing surgery, specifically in patients receiving cardiac surgery. Further studies should be conducted to examine these associations in other types of surgery.
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90
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Lupear SK, Overstreet M, Krau SD. Perioperative nurses' knowledge of indicators for pressure ulcer development in the surgical patient population. Nurs Clin North Am 2015; 50:411-35. [PMID: 25999080 DOI: 10.1016/j.cnur.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite focused attention to improve the quality and safety of patient care, and the financial impact pressure ulcers (PUs) can have on a health care provider or institution, evidence supports that PUs continue to occur in other patient populations during admission to the hospital. An example of a patient population in which evidence indicates that the development of PUs occurs, is patients who have a surgical procedure. The article discusses a project designed to identify potential knowledge deficits among perioperative nurses of indicators for PU development in the surgical patient population.
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Affiliation(s)
| | - Maria Overstreet
- Center for Clinical Simulation, Middle Tennessee School of Anesthesia, Madison, TN, USA; Vanderbilt School of Nursing, Nashville, TN, USA
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91
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Chou CL, Lee WR, Yeh CC, Shih CC, Chen TL, Liao CC. Adverse outcomes after major surgery in patients with pressure ulcer: a nationwide population-based retrospective cohort study. PLoS One 2015; 10:e0127731. [PMID: 26000606 PMCID: PMC4441478 DOI: 10.1371/journal.pone.0127731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 04/20/2015] [Indexed: 01/08/2023] Open
Abstract
Background Postoperative adverse outcomes in patients with pressure ulcer are not completely understood. This study evaluated the association between preoperative pressure ulcer and adverse events after major surgeries. Methods Using reimbursement claims from Taiwan’s National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of 17391 patients with preoperative pressure ulcer receiving major surgery in 2008-2010. With a propensity score matching procedure, 17391 surgical patients without pressure ulcer were selected for comparison. Eight major surgical postoperative complications and 30-day postoperative mortality were evaluated among patients with pressure ulcer of varying severity. Results Patients with preoperative pressure ulcer had significantly higher risk than controls for postoperative adverse outcomes, including septicemia, pneumonia, stroke, urinary tract infection, and acute renal failure. Surgical patients with pressure ulcer had approximately 1.83-fold risk (95% confidence interval 1.54-2.18) of 30-day postoperative mortality compared with control group. The most significant postoperative mortality was found in those with serious pressure ulcer, such as pressure ulcer with local infection, cellulitis, wound or treatment by change dressing, hospitalized care, debridement or antibiotics. Prolonged hospital or intensive care unit stay and increased medical expenditures were also associated with preoperative pressure ulcer. Conclusion This nationwide propensity score-matched retrospective cohort study showed increased postoperative complications and mortality in patients with preoperative pressure ulcer. Our findings suggest the urgency of preventing and managing preoperative pressure ulcer by a multidisciplinary medical team for this specific population.
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Affiliation(s)
- Chia-Lun Chou
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Woan-Ruoh Lee
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, United States of America
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
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Mehta C, George JV, Mehta Y, Wangmo N. Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set. J Tissue Viability 2015; 24:123-30. [PMID: 25981928 DOI: 10.1016/j.jtv.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. PURPOSE The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. DESIGN A cross sectional point prevalence study. INSTRUMENTS European Pressure Ulcer Advisory Panel (EPUAP) data collection form. METHODS Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. RESULTS The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). CONCLUSION The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers.
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Affiliation(s)
- Chitra Mehta
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
| | - Joby V George
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India.
| | - Yatin Mehta
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
| | - Namgyal Wangmo
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
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Kwak HR, Kang J. Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission. ACTA ACUST UNITED AC 2015. [DOI: 10.7475/kjan.2015.27.3.347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hye Ran Kwak
- Dong-A University Medical Center, CCU, Busan, Korea
| | - Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
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Hooper VD. Patient Experience as a Priority. J Perianesth Nurs 2014; 29:339-41. [DOI: 10.1016/j.jopan.2014.08.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meehan A, Beinlich N. Peer-to-peer learning/teaching: An effective strategy for changing practice and preventing pressure ulcers in the surgical patient. Int J Orthop Trauma Nurs 2014. [DOI: 10.1016/j.ijotn.2013.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bonnaig N, Dailey S, Archdeacon M. Proper Patient Positioning and Complication Prevention in Orthopaedic Surgery. J Bone Joint Surg Am 2014; 96:1135-1140. [PMID: 24990979 DOI: 10.2106/jbjs.m.01267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible.
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Affiliation(s)
| | - Steven Dailey
- UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:
| | - Michael Archdeacon
- UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:
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Intraoperative Risk Factors Associated With Postoperative Pressure Ulcers in Critically Ill Patients. Crit Care Med 2014; 42:40-7. [DOI: 10.1097/ccm.0b013e318298a849] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sprigle S, Sonenblum S, Conner-Kerr T. mobilityRERC state of the science conference: individualizing pressure ulcer risk and prevention strategies. Disabil Rehabil Assist Technol 2013; 8:454-61. [DOI: 10.3109/17483107.2013.823574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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