of our plastic surgery cases can last more than 12 hours. Those ORs
got new mattresses right away. And eventually, over time, we replaced
them all.
Risk factors
Longer cases are one of the big challenges in preventing pressure
injuries, but the research from our WOC nurses also revealed which
patients tended to be higher-risk. We needed special precautions with
patients who:
• had BMIs of less than 19, or greater than 40;
• had previous or current pressure injuries;
• were 70 or older;
• were bed- or chair-bound; and
• had decreased sensation.
We also learned that while patients with mid-range BMIs were vul-
nerable to pressure injuries after about 3 hours on the OR table,
bariatric patients could develop injuries in half that time.
Furthermore, pressure injuries may not present themselves until 3
to 5 days after surgery, especially deep-tissue injuries, which again
pointed to important considerations that went well beyond the OR.
Who does what?
As I said, everyone has a role to play, starting with the pre-op nurses.
They began doing skin assessments on every patient, something they
hadn't always done previously, unless patients spoke up and said
they'd had pressure injuries in the past. Naturally, we don't want to
get dinged for existing injuries, but we also want to do what we can to
address any existing problems. Next, the pre-op nurses place preven-
tative foam dressing wherever it's needed — especially around the
sacral area and any other vulnerable bony areas.
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