S
pine surgery patients placed in the
prone position can develop pressure
injuries on areas of their bodies with-
out much natural protection.
Fortunately, there are plenty of prod-
ucts and practices that can help keep their skin
intact during complex cases that typically last
longer than two hours.
Efforts to prevent pressure injuries begin with
pre-op assessments of the patient's skin integrity.
Everyone's body habitus is different, however, so
examine patients for potential trouble spots in pre-
op. Also make sure they don't have some kind of
chest deformity, a prominent set of ribs or have had
a mastectomy traits that can increase the risk of
pressure injures. Pad these areas as appropriate. In
general, focus on protecting a patient's face, chest,
chin and ribs.
When assessing patients in pre-op, use the Scott
or Munro trigger scales, which help to predict pres-
sure injuries in surgical patients. In addition to these
results, the biggest risk factor for pressure injury is
the duration of the surgery. Any procedure lasting
longer than 2.5 hours increases the likelihood of skin
breakdown. Of course, patients with ASA scores of
3s and 4s have a higher risk than those with 1s or 2s
— and there's a huge jump in risk between scores of
2 and 3. Operations are often longer for patients with
higher ASA scores due to the need for additional
time to manage their underlying diseases. In addition,
patients who have more comorbid disease often have
surgical conditions in later stages requiring more
5 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 2 0
Joyce Black, PhD, RN, CWCN, FAAN | Omaha, Neb.
Prevent Spine Surgery Pressure Injuries
Tables, padding, pressure sensors and skin
assessments protect prone patients during lengthy procedures.
PRONE TO INJURY Patients who are face-down for spine procedures are at risk for chin ulcers and other surgical-acquired pressure injuries.
Joyce
Black,
PhD,
RN,
CWCN,
FAAN
