to reduce the chances
of a skin injury. For
instance, patients in
supine position
should have their
heels floated without
hyperextending the
knee. Foam dressings
should also be
applied to the heels
and sacrum, two
areas at risk for
injury.
Another interven-
tion I've seen make a major difference in PI reduction is using
molded foam inserts for the head of prone patients — as opposed
to regular square foam inserts. We were regularly seeing patients
coming out of surgery with PIs on their forehead and chin area
from lying in that prone position for several hours at a time. The
shearing forces caused by inserting hardware was obviously a fac-
tor, but the insert we used played a role, too. Once we switched
over to the molded foam, however, the forehead and chin PIs we
were seeing on a regular basis essentially disappeared.
You'll also need to gauge the patient's specific risk levels at every
stage of the surgical process. Remember, each phase of care carries
its own set of PI risks. For example, in pre-op there's the risk of a
delay and a patient just sitting there on a stretcher for two hours
waiting to go to surgery. Here, you'll want to intervene and offload
the patient's pressure point areas (we recommend this be done at
least every two hours during the case), encourage them to go to the
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 2 0
• UP IN THE AIR To avoid pressure injuries on patients in the supine position, float
the heels off the surface of the OR table without hyperextending the knee.
University
of
Nebraska
Medical
Center
