Archive May 2018 XIX, No. 5

Prevent Pressure Ulcers

7 practical pearls to protect your patients' skin.

JoEllen McBride

JoEllen McBride, PhD


Hands On
HANDS ON The dynamics of the operating room — prolonged pressure on bony prominences, friction and shearing — are conducive to skin breakdown and pressure ulcer formation.

You know that surgery makes patients more vulnerable to pressure ulcers, but you might not realize just how big the problem is. It's estimated that up to 45% of the 1.6 billion healthcare associated pressure ulcers that patients develop each year originate in the OR. And 23% are acquired intraoperatively during surgeries that last more than 3 hours. What makes the OR a likely place for skin breakdown and pressure ulcer formation? Prolonged pressure, friction and shearing — the perfect storm for decubitus ulcers (from Latin decumbere, "to lie down").

And the longer patients are lying down for surgery, the greater their chance of acquiring pressure ulcers on the skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone. Studies have shown that nearly 1 out of every 10 patients who undergoes surgical procedures that last more than 3 hours will develop a pressure ulcer. Here are a 7 ways you can offload the pressure of pressure injuries. Remember, like most things, it's more cost-effective to prevent pressure ulcers than to treat them.

1. Identify high-risk patients

Float the Heels
FLOAT THE HEELS Use a boot-like heel-suspension device to raise the patient's heels off the operating surface instead of a pad or piece of egg crate foam, per AORN guidelines.

You can reduce the number of pressure injuries by creating a standardized assessment and implementing specific interventions for patients at the most risk. Here are some of the patient-specific factors that increase the likelihood a patient will develop a pressure injury:

  • over 65 years old
  • taking certain medications such as corticosteroids or vasoactive agents
  • diagnosed with certain diseases such as cancer, cardiovascular disease and diabetes mellitus
  • low hemoglobin and hematocrit levels, systemic blood pressure and BMI
  • poor nutrition
  • low albumin levels
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