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Archive January 2020 XXI, No. 1

Pressure Ulcers: Surgery's Sore Subject

Your OR team can prevent pressure injuries by following these 5 guidelines

Joyce Black

Joyce Black, PhD, RN, CWCN, FAAN


PRONE TO INJURY Patients who are face down for spine and other prone position surgeries are at risk for chin ulcers and other pressure injuries.

The elderly woman left your facility with a tiny incision in her back and a gaping wound on her chin — one the expected scar of spine surgery, the other the unwelcomed scab of a pressure ulcer. Your OR team could have avoided this gruesome outcome had they followed the 5 guidelines in “The Standardized Pressure Injury Prevention Protocol” ( I co-authored:

1. Pad the patient. The No. 1 way to prevent pressure injuries is to apply foam dressings or gel cushions and pads to where patients come into contact with the bed, especially to areas of risk such as the sacrum and the heels.

Next, take a look at the mattresses on your OR tables. Gel pads that are ½ to ¾ of an inch thick work well. There are also thinner pads, about 3⁄8 of an inch, that have parallel columns of air that inflate and deflate during the case to change the pressures against the patient’s skin. Inflatable waffle mattresses have little pockets of air with venting holes in between that let air flow and moisture vent to keep patients dry. Patients having surgery while in a prone, face-down position need dressings applied to their face, chest and chin. The front of the body doesn’t have a lot of padding and ulcerates very rapidly.

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