Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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medication prescribed to her not for her jaw pain, but for the pain in her buttocks. If this healthy young woman with perfect skin integrity can suffer an injury like this, you better believe older patients with comorbidities are at risk as well. Research has demonstrated that a pressure injury can develop within minutes due to the cascade of events associated with cell deformation. In clinical practice, we have found that surgical patients immobilized for more than three hours are at risk for the development of a pressure injury. Take note, because the last thing you want is for one of your patients to visit their surgeon with a Stage 4 pressure injury on their heel, tailbone or occiput that happened when they entered the operating room for an elective proce- dure. Here are several ways to make sure these injuries don't happen at your facility. 1. Check every mattress Examine the status and integrity of every mattress in your ORs. They should be at least four-inches thick. Many older tables, and some newer ones, come with smaller two-inch pads that are insufficient to protect patients and can cause skin damage. Some compa- nies simply don't have skin protection in mind when they manufacture these two-inch mattresses. When purchasing new mattresses, manufacturers should be able to provide information about their pressure- relieving capabilities. Also, vinyl surfaces should be avoided. All your mattresses should be covered with one of several skin-safe fabrics on the market. 2. Position properly The days of using rolled-up towels and blankets or IV bags to help properly position patients are gone — or they should be. These methods are physiologi- cally incompatible with safe skin. Instead, use evi- dence-based gel or foam pads and positioning straps. Medical device-related pressure injuries are every bit as serious as those caused by a patient lay- ing in the same position for hours during surgery. 3. Protect vulnerable areas Once you've upgraded your mattresses and posi- tioning devices, you need to protect the areas of the patient's body that are most vulnerable to pressure injuries. For patients in the supine position, that's the heels, the sacrum and the occiput. Anyone who is going to be under anesthesia in that position for three hours or more should have their heels floated, their sacrum protected with a prophylactic five- layer foam dressing and the occiput lying on a flu- idized positioner. The area of the body a prophylactic dressing is applied depends on the surgical position. The prone position puts the forehead, chin, shoulders, breasts, anterior iliac crests, knees and dorsal foot surfacers at risk. The lithotomy position places stress and strain on the sacrum and heels; while lateral side- lying causes additional pressure on the opposite ear, shoulder, hip, knee and malleolus. In the prone position, manage moisture, shift the head from side to side every two hours and take care of the eyes by applying drops if appropriate. The patient's tongue should remain in the mouth, using a small bite block to do so if necessary. For torso protection, tubing should be secured away from the skin and tubing channels should be creat- ed with positioning devices. Using a combination of 3 0 • S U P P L E M E N T T O 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 • O C T O B E R 2 0 2 0 HEADACHE SUFFERER Patients who lay in the prone position for hours can develop deep-tissue skin injuries on their foreheads.