Archive March 2017 XVIII, No. 3

Prevent Pressure Ulcers

14 strategies to protect your patients from skin lesions caused by friction and unrelieved pressure.

Diane Stopyra

Diane Stopyra


pressure ulcers PRESSURE AND TIME Pressure ulcers can develop during shorter procedures, but the risk increases the longer anesthetized patients with unprotected bony prominences remain on the OR table.

Pressure ulcers are the painful, red reminders of unprotected bony prominences that remain on the OR table for too long. While no single precaution is 100% effective in preventing pressure ulcers — some patients will suffer skin breakdown no matter how hard you try to prevent it — the right positioning techniques and devices can go a long way toward reducing the risk. Here are 14 simple steps worth considering.

1. Stress good nutrition. Diet impacts risk for pressure ulcer development. Take time during the pre-operative meeting to discuss the importance of nutrition in the weeks leading up to surgery. "Advise patients to take a daily multivitamin, and to make sure they're incorporating protein into a balanced diet, because this helps prevent skin breakdown," says Denise Betcher, RN, MSN, CPHQ, nursing quality specialist at the Mayo Clinic in Scottsdale, Ariz. According to a 2015 report in the journal Advances in Skin and Wound Care, proper hydration can also help ward off pressure ulcers.

2. Keep skin moisturized. Dry skin is more susceptible to pressure ulcers. Advise patients with dry skin to use a moisturizing cream in the leadup to surgery, and to shower only every other day — showering can dry skin out more — and to use a soft sponge for gentle cleansing in the shower in the weeks leading up to surgery, as vigorous scrubbing can make skin more vulnerable to breakdown, according to leading pressure ulcer researcher Courtney Lyder, ND, ScD(H), FAAN, a professor of nursing at UCLA.

"While there's no clinical research on this, it's general knowledge in the field that having good moisture is one of the things that prevents skin breakdown," says Carlos Galeano-Rodriguez, MD, certified wound specialist physician with Vohra Post-Acute Physicians in Pittsburgh, Pa.

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