Strategies for prevention

References 1 . Aronovitch SA , Intraoperatively acquired pressure ulcers : Are there common risk factors ? Ostomy wound Manage . 2007 ; 53 ( 2 ): 57-69 . 2 . AORN Journal , March 2009 , Vol 89 , No 3 . Prevention of Pressure Ulcers in the Surgical Patient . Patina S . Walton-Geer , RN-BC , MSN , CWCN ,

CFCN Available at : http :// isgweb . aorn . org / ISGWeb / downloads / CEA09100-1115 . pdf . Accessed January 22 , 2015 . 3 . Data on file 4 . AORN Guidelines for Perioperative Practice , 2017 Edition

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• Thoracic vertebrae

• Dorsum of the feet

Buzzworthy

Best Practice

Take a “ position ” on pressure injury prevention

➊ Support surfaces- use pressure redistribution OR table

Assessment

pads and adequate padding devices

➋ Pressure points- assess and protect the common pressure points identified in each position

➌ Heel Protection- elevate heels or use heel offloading devices as needed

➍ MDRPI ’ s- assess skin and protect against common areas of medical device use

➎ MARSI- assess skin and protect against common areas of medical adhesives

Perioperative Pressure Injury Risk Factors 4

• Procedures exceeding 4 hours

• Impaired blood flow and hypotensive episodes

• Vascular , cardiac , thoracic or orthopedic surgery

• Specific positions ( lithotomy , lateral , supine )

• Use of standard operating room mattresses surfaces during surgery

• Thermoregulatory devices

Supine / reverse trendelenburg • Occiput

• General anesthesia

• Age > 70 years

• Poor nutritional status

• Thin stature

• Diabetes or vascular disease

• Preoperative Braden score < 20

Table position Areas at risk

• Assess all surgical patients for risk of pressure injury

• Use a pressure injury risk assessment tool

• Conduct thorough skin assessments

• Scapulae

• Arms

• Elbows

Interventions

Communication

Medical devices used in the perioperative setting

Medical Adhesive-Related Skin Injury — MARSI

• Substance applied to one surface of two separate surfaces that bind them together and resist their separation

• Adhesives can be used to cover and protect wounds , hold skin edges together , support an injured body part or to secure objects to the skin

Examples of Adhesives in the Perioperative area

• Tape

• Dressing

• Adhesive drape

• Catheter

• Implement measures to prevent pressure injury

• Identify perioperative pressure injuries

• Document

• Include in the hand-over communication to the next care provider the measures taken to prevent pressure injury development .

• Sequential compression devices ( SCDs )

• DVT sleeves

• TED hose

• Endotracheal tubes

• Securement devices

• Nasal cannulas

• Blood pressure cuff

• Electrode

• Pouch

• Patch

• Pulse oximetry

• Tourniquet

• Casts , splints and braces

• Urinary catheters

• Positioning straps

• Surgical trays , equipment ( placement on patient during surgery )

• Sacrum and coccyx

• Heels

Lateral / side lying • Dependent side of face and ear

• Dependent shoulder

• Dependent axilla

• Dependent hip

• Dependent knee

• Ankles

• Feet

Lithotomy • Occiput

• Shoulders

• Scapulae

• Hips

• Sacrum / coccyx

• Lateral aspect of the legs

• Heels

Prone / Jackknife • Forehead , nose , ears and chin

• Anterior shoulders

• Breasts

• Iliac crests

• Genitalia

• Knees

• Shins

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• Toes

• Cheeks

You know that proper turning and repositioning plays an important role in helping to prevent pressure injuries ( PIs ). But that ’ s not usually possible during operative or other invasive procedures . These are times when people are at high risk for PIs because they ’ re immobile and can ’ t typically sense pain or express feelings of pain . To help prevent pressure injuries during operative procedures , the Association of periOperative Registered Nurses recently updated its guidelines . Here are 3 key points :

Perioperative RNs

1 should be part of an interdisciplinary team that develops and oversees a holistic PI prevention program .

2

Along with a comprehensive patient assessment , use a validated and reliable tool such as the Munro Scale to assess specific OR risk factors . Note : the Braden Scale falls short when it comes to perioperative patients .

3

Help decrease PI risk in operative patients by using the right support surfaces such as high-specification or alternating air pressure .

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6 Healthy Skin