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White K, Fonseca MA, Petzoldt O, Cooper L. Evaluating the Effectiveness of an Alternating Pressure Overlay in Patients Undergoing Cardiothoracic Surgery. Am J Nurs 2024; 124:42-49. [PMID: 38386834 DOI: 10.1097/01.naj.0001008416.24563.5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
LOCAL PROBLEM In 2019 and the first half of 2020, our facility experienced an increase in the number and severity of hospital-acquired pressure injuries (HAPIs) among our cardiothoracic surgery population. Fifty percent of these HAPIs occurred within 72 hours of surgery. A review of the literature revealed that alternating pressure overlays (APOs) have been successfully used to prevent HAPIs in surgical patients. PURPOSE The primary purpose of our quality improvement (QI) project was to measure perioperative HAPI rates in cardiothoracic surgery patients after the addition of APOs to our HAPI prevention protocol. Our secondary purpose was to identify common factors among those patients who developed HAPIs. METHODS This QI project collected both pre- and postintervention data and compared the findings. A nurse-led team was responsible for measuring HAPI rates during the intervention-from July through October 2020-which involved placing an APO under cardiothoracic surgery patients during the 72-hour perioperative period. APOs were placed on all operating room (OR) tables and remained with the patients following surgery. Bed linens and skin care products were standardized for consistency. Lifts were used to reduce friction during repositioning. RESULTS During preintervention data collection, we identified 10 patients who developed HAPIs (seven out of 1,174 cardiothoracic surgery patients in 2019, for a HAPI rate of 0.6%, and three out of 333 patients in the first half of 2020, for a HAPI rate of 0.9%). During the four-month intervention period, in which APOs were used in 331 patients undergoing cardiothoracic surgery, no HAPIs developed. CONCLUSION Use of an APO in cardiothoracic ORs and critical care units may help reduce HAPI rates.
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Affiliation(s)
- Kristen White
- Kristen White is a clinical nurse specialist at Morristown Medical Center, Morristown, NJ, where Maria Alcina Fonseca is a nurse manager, Gagnon 5/CPACU/CVICU and inpatient cardiac rehabilitation, Olivia Petzoldt is a project manager, quality improvement, and Lise Cooper is a nurse researcher, Center for Nursing Innovation and Research. Contact author: Kristen White, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Kohta M, Yunoki S, Sugama J. Effect of prophylactic dressings to reduce pressure injuries: a polymer-based skin model. J Wound Care 2024; 33:S4-S9. [PMID: 38348862 DOI: 10.12968/jowc.2024.33.sup2.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE This study evaluated the effect of pressure injury (PI) prophylactic dressings used for patients at high risk of PI development to reduce friction, shear force and pressure, and their combined force, in an original polymer-based skin model. METHOD A low-friction outer-layer hydrocolloid (LFH) dressing and a multilayered silicone foam (MSF) dressing were used. Before application, compression and friction properties were measured. Our original experimental model-the 'simulated skin-shearing test'-consisted of: a weight; a polyurethane-based skin model containing a three-axis tactile sensor; dressings; a table covered with bedsheets; and a mechanical tester, by which the interface friction force, internal shear force and pressure were measured continuously during skin model movements. An estimated combined force generated by internal shear and pressure was represented as a vector. A model with no dressing was used as a control. RESULTS The LFH dressing had significantly higher compression strength versus the MSF dressing. In contrast, the dynamic coefficient of friction was lower for the LFH dressing versus the MSF dressing (p<0.05). In simulated skin-shearing test results, shear forces were 0.45N and 0.42N for LFH and MSF dressings, respectively, with no significant difference. The estimated combined force was lower for the MSF dressing compared with that of the LFH dressing and control. CONCLUSION The shear force-reducing effect in the skin model was equivalent between the LFH and MSF dressings. However, the MSF dressing significantly reduced the force generated by a combination of internal shear force and pressure compared with the LFH dressing.
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Affiliation(s)
- Masushi Kohta
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Shunji Yunoki
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan
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Pauly S, Mo P, Elliott J, Bleakney A, Pappu S, Jan Y. Effects of alternating pressure patterns on sacral skin blood flow responses in people with spinal cord injury. Int Wound J 2024; 21:e14792. [PMID: 38356253 PMCID: PMC10867481 DOI: 10.1111/iwj.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Alternating pressure support surface (APSS) is a common support surface for treating pressure injury in individuals with spinal cord injury (SCI). However, conflicting results on the effectiveness of APSS have been reported and may be associated with inappropriate configurations of APSS. The objectives of this study were to compare the different pressure amplitudes (75/5 mmHg [alternating between 75 and 5 mmHg] vs. 65/15 mmHg) and cycle periods (5 min [4 cycles] vs. 2.5 min [8 cycles]) of alternating pressure on sacral skin blood flow responses in 10 individuals with SCI. Sacral skin blood flow during and after loading of four alternating pressure protocols was assessed using laser Doppler flowmetry and was normalised to the value before loading (10-min baseline, 20-min loading and 10-min recovery). The results demonstrated that during the high-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (0.3658 ± 0.0688 for 75/5 mmHg and 0.1702 ± 0.0389 for 65/15 mmHg, p < 0.05); and during the low-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (1.7184 ± 0.262 for 75/5 mmHg and 0.5916 ± 0.1378 for 65/15 mmHg, p < 0.05). There were no differences between cycle periods in skin blood flow responses. No adverse events were reported. Our finding indicates that the pressure amplitude of alternating pressure is a significant factor affecting sacral skin blood flow responses. An appropriate configuration of alternating pressure is needed to effectively increase skin blood flow and tissue viability in individuals with SCI.
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Affiliation(s)
- Serah Pauly
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
| | - Pu‐Chun Mo
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jeannette Elliott
- Disability Resources and Educational ServicesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Adam Bleakney
- Disability Resources and Educational ServicesUniversity of Illinois at Urbana‐ChampaignChampaignIllinoisUSA
| | - Suguna Pappu
- Department of NeurosurgeryCarle Foundation HospitalUrbanaIllinoisUSA
| | - Yih‐Kuen Jan
- Department of Kinesiology and Community HealthUniversity of Illinois at Urbana‐ChampaignUrbanaIllinoisUSA
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Al-Majid S, Vuncanon B, Kiyohara M, Rakovski C. Using Continuous Intraoperative Pressure Mapping to Describe Patterns of Tissue Interface Pressure. AORN J 2022; 116:231-247. [PMID: 36005880 DOI: 10.1002/aorn.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/13/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to describe patterns of intraoperative tissue interface pressure, identify the amount of time during which the pressure at four anatomical locations exceeded 32 mm Hg, and examine associations between patient- and surgery-related variables and peak tissue interface pressure. We used a pressure mapping system to measure the intraoperative tissue interface pressure of 150 patients. We implemented linear mixed-effects models to assess trends in the mean and peak tissue interface pressure. The percentage of time during which the interface pressure exceeded 32 mm Hg at the scapulae, interscapular area, and sacral area was 70%, 70%, and 90%, respectively. Body mass index, length of surgery, and intraoperative position were major predictors of increased pressure. Understanding patterns of tissue interface pressure of patients during surgery may help perioperative nurses develop strategies to attenuate pressure and protect skin integrity.
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Prado CBC, Machado EAS, Mendes KDS, Silveira RCDCP, Galvão CM. Support surfaces for intraoperative pressure injury prevention: systematic review with meta-analysis. Rev Lat Am Enfermagem 2021; 29:e3493. [PMID: 34755774 PMCID: PMC8584934 DOI: 10.1590/1518-8345.5279.3493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/10/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE to evaluate evidence on effectiveness support surfaces for pressure injury prevention in the intraoperative period. METHOD systematic review. The search for primary studies was conducted in seven databases. The sample consisted of 10 studies. The synthesis of the results was carried out descriptively and through meta-analysis. RESULTS when comparing low-tech support surfaces with regular care (standard surgical table mattress), the meta-analysis showed that there is no statistically significant difference between the investigated interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The Higgins inconsistency test indicated considerable heterogeneity between studies (I2 = 83%). The assessment of the certainty of the evidence was very low. When comparing high-tech and low-tech support surfaces, the meta-analysis showed that there is a statistically significant difference between the interventions studied, with high-tech being the most effective (Relative Risk = 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified as not important (I2 = 0%). The assessment of certainty of evidence was moderate. CONCLUSION the use of high-tech support surfaces is an effective measure to prevent pressure injuries in the intraoperative period.
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Affiliation(s)
| | | | - Karina Dal Sasso Mendes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | | | - Cristina Maria Galvão
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico/Ministério da Ciência, Tecnologia e Inovações,
Brazil
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6
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Pittman J, Horvath D, Beeson T, Bailey K, Mills A, Kaiser L, Hall DK, Sweeney J. Pressure Injury Prevention for Complex Cardiovascular Patients in the Operating Room and Intensive Care Unit: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2021; 48:510-515. [PMID: 34591039 PMCID: PMC8601672 DOI: 10.1097/won.0000000000000815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of our project was to examine the effect of an alternating pressure (AP) overlay on hospital-acquired pressure injury (HAPI) in high-risk cardiovascular surgical patients. PARTICIPANTS AND SETTING This quality improvement (QI) initiative was conducted in a core group of 8 cardiovascular operating room (OR) suites and 1 cardiovascular surgical critical intensive care unit (ICU) in a large Indiana-based academic hospital. The sample comprised adult patients who underwent complex cardiovascular surgical procedures and those in the cardiovascular surgical ICU with extracorporeal membrane oxygenation (ECMO), ventricular assistive device (VAD), and undergoing heart and/or lung transplant, or open chest procedures. APPROACH The AP overlay was placed on OR cardiovascular foam surfaces and on selected ICU support surfaces for patients who met inclusion criteria. We used a pre/postcomparative QI design to assess outcomes including OR-related HAPI rates, ICU aggregate unit HAPI data, related costs, and staff satisfaction during the 3-month project period. OUTCOMES Operating room-related HAPIs were reduced from 8/71 (11%) preintervention to 0/147 (0%) postintervention (P = .008), resulting in a cost avoidance of $323,048 and positive staff satisfaction (mean = 3.85; 1- to 4-point Likert scale). No adverse outcomes occurred. Although not significant, ICU HAPI rates decreased from 10 to 7 pre/postintervention (P = .29), demonstrating a 14% HAPI reduction with a cost avoidance of $121,143. The ICU incidence density decreased from 3.57 to 3.24; however, there was no decrease in ICU monthly unit prevalence. Critical care staff satisfaction was positive (mean = 2.95; 1- to 4-point Likert scale) with most staff members preferring the AP overlay to a fluid immersion surface. A cost savings of 48% (AP overlay vs fluid immersion rental) was identified in the ICU. IMPLICATIONS FOR PRACTICE We achieved fewer HAPIs and reduced costs and observed positive staff satisfaction, along with no adverse events with the use of the AP overlay. Further research is needed to determine the safety and efficacy of this device for this pressure injury prevention option for immobile patients in both the OR and the ICU.
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Affiliation(s)
- Joyce Pittman
- Correspondence: Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, 5721 USA Dr North, Room 3057, Mobile, AL 36688 ()
| | - Dawn Horvath
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Terrie Beeson
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Karrie Bailey
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Annie Mills
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Laura Kaiser
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Deborah K. Hall
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
| | - Jennifer Sweeney
- Joyce Pittman, PhD, ANP-BC, FNP-BC, CWOCN, FAAN, Health Sciences, College of Nursing, University of South Alabama, Mobile
- Dawn Horvath, MSN, RN, ACNS-BC, CNS-BC, Cardiovascular Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Surgical Intensive Care Unit, Indiana University Health University Hospital, Indianapolis
- Karrie Bailey, BSN, RN, CNOR, Perioperative Services, Indiana University Health Methodist Hospital, Indianapolis
- Annie Mills, MSN, RN, Cardiac Medical Critical Care, Indiana University Health Methodist Hospital, Indianapolis
- Laura Kaiser, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Deborah K. Hall, BSN, RN, CNOR, Indiana University Health Methodist Hospital, Indianapolis
- Jennifer Sweeney, MSN, RN, ACNS-BC, CDE, Allegany College of Maryland, Cumberland
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Santos CTD, Barbosa FM, Almeida TD, Vidor ID, Almeida MDA, Lucena ADF. Clinical evidence of the nursing diagnosis Adult pressure injury. Rev Esc Enferm USP 2021; 55:e20210106. [PMID: 34617953 DOI: 10.1590/1980-220x-reeusp-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify clinical evidence of the nursing diagnosis Adult pressure injury. METHOD Cross-sectional study with 138 adult patients, with community-acquired or hospital-acquired pressure injuries, admitted to clinical, surgical, and intensive care units. Data collected from Electronic health records (EHR) and from the clinical assessment of patients at the bedside, analyzed through descriptive statistics. RESULTS The partial thickness loss of dermis presenting as a shallow open ulcer, intact or open/ruptured blister, consistent with a stage II pressure injury, was the significant defining characteristic. Significant related factors were pressure on bony prominence, friction surface, shear forces, and incontinence. The population at significant risk was that at age extremes (≥60 years). Significant associated conditions were pharmacological agent, physical immobilization, anemia, decreased tissue perfusion, and impaired circulation. CONCLUSION The clinical indicators assessed in the patients showed evidence of the nursing diagnosis Adult pressure Injury, with significant lesions consistent with stage II, resulting from pressure, especially in elderly individuals, and in those on various medications.
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Affiliation(s)
- Cássia Teixeira Dos Santos
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, RS, Brazil
| | | | - Thayná de Almeida
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Isabella Duarte Vidor
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | | | - Amália de Fátima Lucena
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, RS, Brazil
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Kohta M, Nakamura Y, Yunoki S. The Effectiveness of Topical Aid Sliding Sheet Potentially Used for Pressure Injury Treatment. CHRONIC WOUND CARE MANAGEMENT AND RESEARCH 2021. [DOI: 10.2147/cwcmr.s284180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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A 10-Year Prevalence Survey and Clinical Features Analysis of Pressure Injury in a Tertiary Hospital in China, 2009-2018. Adv Skin Wound Care 2021; 34:150-156. [PMID: 33587476 DOI: 10.1097/01.asw.0000732740.92841.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe the 10-year prevalence of pressure injury (PI) in a tertiary hospital in China and determine the clinical characteristics of inpatients with PI. METHODS The authors performed a retrospective analysis of PI cases extracted from the electronic health record of a tertiary hospital. The trend of PI prevalence over 10 years was described by estimating the average percent change (EAPC). Comorbidities were described with the Charlson Comorbidity Index (CCI). The clinical characteristics of PI were described using the number of cases and composition ratio. RESULTS The overall prevalence of PI was 0.59% (5,838/986,404). From 2009 to 2018, the rate increased from 0.19% to 1.00% (EAPC = 22.46%). When stage I PIs were excluded, the prevalence of PI ranged from 0.15% to 0.79% (EAPC = 21.90%). The prevalence of hospital-acquired PI was 0.13%. Prevalence increased with age (Ptrend < .001) and was significantly higher in men than women (P < .001). Patients with PI were more widely distributed in the ICU (20.58%), vasculocardiology department (11.73%), gastroenterology department (10.18%), and OR (8.29%). Of patients with PI, 71.3% had a CCI score 4 or higher. CONCLUSIONS The PI prevalence in the study facility increased rapidly over the study period. Pressure injuries among patients in the gastroenterology department and in the community deserve more attention. The CCI may be a good indicator for PI risk assessment.
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Neo TG, Koo SH, Chew STH, Png GK, Lacuesta MJ, Wu MYL, Tay RYC, Singh PA, Chandran R. A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery. J Tissue Viability 2021; 30:222-230. [PMID: 33612359 DOI: 10.1016/j.jtv.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.
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Affiliation(s)
- Tze Guan Neo
- Department of Nursing, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | | | - Gek Kheng Png
- Department of Nursing, Changi General Hospital, Singapore
| | | | | | | | - Prit Anand Singh
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore
| | - Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care Changi General Hospital, Singapore.
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Kohta M, Ohura T, Okada K, Nakamura Y, Kumagai E, Kataoka H, Kitagawa T, Kameda Y, Kitte T. Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales. J Multidiscip Healthc 2021; 14:207-217. [PMID: 33564237 PMCID: PMC7866919 DOI: 10.2147/jmdh.s294734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home) was developed to predict pressure injury risk in geriatric individuals requiring long-term care in home settings. This study aimed to compare the convergent validity of the PPRA-Home to that of the two other standardized pressure injury prevention scales: the Braden and Ohura-Hotta (OH) scales. Methods A multicenter, cross-sectional study was conducted with 34 home-based geriatric support service providers located in five Japanese districts. The study included 69 participants (30 had a pressure injury and 39 did not) who were at classified at care levels of 1 through 5 under Japan’s long-term care insurance system. Care managers served as assessors for the PPRA-Home, while physicians or certified expert nurses served as assessors for the Braden and OH scales. Convergent validity was investigated by examining correlation coefficients between total scores on the PPRA-Home and the other two scales. Receiver operating curve analysis was used to quantify each scale’s accuracy for the two groups: those with and without a pressure injury. Results The PPRA-Home was found to be negatively correlated with the Braden scale (r=−0.79, p<0.05), and positively correlated with the OH scale (r=0.58, p<0.05). The area under the curve (AUC) for the PPRA-Home, Braden scale, and OH scale were 0.737, 0.814, and 0.794, respectively. A PPRA-Home cutoff score of 4 had a sensitivity of 63.3% and specificity of 81.6%. Conclusion The AUC for the PPRA-Home as scored by care managers was similar to those of the Braden and OH scales as scored by physicians or expert nurses. More research on the PPRA-Home’s content and predictive validity is required.
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Affiliation(s)
- Masushi Kohta
- Medical Engineering Laboratory, ALCARE Co. Ltd., Tokyo, Japan
| | - Takehiko Ohura
- Pressure Ulcers and Wound Healing Research Center, Sapporo, Japan
| | - Katsuyuki Okada
- Department of Dermatology, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Yoshinori Nakamura
- Department of Medical Home Healthcare Center, Tenri Hospital Shirakawa Branch, Tenri, Japan
| | | | - Hitomi Kataoka
- Department of Nursing, Yamagata University, Yamagata, Japan
| | - Tomomi Kitagawa
- Department of Nursing, Hikone Municipal Hospital, Hikone, Japan
| | - Yuki Kameda
- Wound Care Marketing Division, ALCARE Co Ltd., Tokyo, Japan
| | - Toshihiro Kitte
- Department of Health Care Policy, Shiga Government Office, Otsu, Japan
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12
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Lupiáñez-Pérez I, Gómez-González AJ, Marfil-Gómez RM, Morales-Asencio JM, García-Mayor S, León-Campos Á, Kaknani-Uttumchandani S, Moya-Suárez AB, Aranda-Gallardo M, Morilla-Herrera JC. Tissue temperature, flux and oxygen of sacral and trochanteric area under pressure of healthy subjects: A quasi-experimental study. J Tissue Viability 2021; 30:207-215. [PMID: 33487523 DOI: 10.1016/j.jtv.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h. METHODS Quasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements. RESULTS The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant. CONCLUSION Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries.
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Affiliation(s)
- Inmaculada Lupiáñez-Pérez
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain; District of Primary Health Care Malaga-Guadalhorce, Spain
| | - Alberto J Gómez-González
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
| | - Raquel M Marfil-Gómez
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
| | - José M Morales-Asencio
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain
| | - Silvia García-Mayor
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain.
| | - Álvaro León-Campos
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain
| | - Ana B Moya-Suárez
- Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain; Agencia Sanitaria Costa Del Sol, A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - Marta Aranda-Gallardo
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain; Agencia Sanitaria Costa Del Sol, A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - Juan C Morilla-Herrera
- University of Malaga, Faculty of Health Sciences, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), C/Dr. Miguel Díaz Recio, 28, 29010, Málaga, Spain; District of Primary Health Care Malaga-Guadalhorce, Spain
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13
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Wu FL, Zheng Z, Ma Y, Weng K, Liao F, Jan YK. Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses. J Tissue Viability 2020; 29:264-268. [PMID: 32978042 DOI: 10.1016/j.jtv.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF). AIM The specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols. METHODS Two studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant. RESULTS For the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant). CONCLUSION This study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.
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Affiliation(s)
- Fu-Lien Wu
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Zhi Zheng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yinyin Ma
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kaixiang Weng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Preventing Pressure Injuries in Nursing Home Residents Using a Low-Profile Alternating Pressure Overlay: A Point-of-Care Trial. Adv Skin Wound Care 2020; 33:533-539. [PMID: 32941227 DOI: 10.1097/01.asw.0000695756.80461.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pressure injuries (PIs) are a significant concern for patients with very limited mobility in skilled nursing facilities. Conflicting clinical guidelines and a lack of effectiveness data for the various support surfaces reduces the efficacy of PI prevention programs. OBJECTIVE To assess the preventive effectiveness (incidence of facility-acquired PIs) of a low-profile alternating pressure (AP) support surface plus facility-specific PI prevention programs in patients at high risk for PI. DESIGN AND SETTING Prospective, multicenter, point-of-care observational study in two for-profit nursing homes in the northeastern US. PATIENTS AND INTERVENTION A retrospective review of 101 residents was performed to determine baseline PI incidence. Then, a consecutive sample of 25 participants was selected based on the following eligibility criteria: high risk for PI, bedbound (20 hours or more per day), and stay in a mechanical ventilation unit for more than 5 days. The participants were placed on an AP overlay positioned above a facility-provided nonpowered reactive support surface. MAIN OUTCOME MEASURE The development of any new PI (stage 1-4), deep-tissue injury, or unstageable PI in participants using the AP overlay. The PI incidence for the AP group was compared with the retrospective baseline PI incidence from the same units in the two nursing homes. MAIN RESULTS The group using the AP overlay had a significantly lower PI incidence (0/25, 0%) compared with baseline (22/101, 21.8%; P < .001). Almost 80% of the study participants in the AP group were completely immobile, 100% of the participants were bowel- and bladder-incontinent, their average time on the AP overlay was 140.9 ± 94.1 days, and average length of stay in the facility was 633.9 ± 1,129.1 days. CONCLUSIONS The low-profile AP overlay was significantly more effective than facility-specific prevention programs alone in preventing PIs in a high-risk nursing home population over an extended period.
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Gefen A, Creehan S, Black J. Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review. Int Wound J 2020; 17:1405-1423. [PMID: 32496025 DOI: 10.1111/iwj.13408] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/30/2022] Open
Abstract
An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Sue Creehan
- Wound/Ostomy Program Team, VCU Health System, Richmond, Virginia, USA
| | - Joyce Black
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
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