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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1 2 6 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 4 3. Who is most at risk? To prevent pressure injuries, it's best to know something about the patient. That's why some form of skin care assessment should be a standard part of your pre-op nurses' patient care routines, especially among the patients who are most at risk. Elderly patients are at particularly high risk, since their skin is frail- er and there has been a decrease in subcutaneous tissue. Obese patients' bodies place more weight on their pressure points, so sup- port is essential. Patients with diabetes, high blood pressure or other comorbidities may already suffer from impaired perfusion, which could hinder circulation and result in pressure complications. Malnourished, dehydrated or atrophied patients may have weakened defenses, and previous wound sites or dressings may be especially sensitive areas. A pre-op skin assessment should take into account the type of surgery. How is the patient's body likely to be positioned to allow optimal access to the surgeon and anesthesia provider? The most important parts of the skin to spot check are the places where the patient is going to be posi- tioned. How long is the case expected to last? General anesthesia tends to dilate blood vessels, which may increase the risk of poor perfusion at pressure points. After conducting the assessment, you should know the areas that will require padding and special caution. Perioperative hypothermia and pressure injuries can go hand in hand. A decrease in tissue temperature is an indication that it is not being adequately perfused, so make sure you monitor core tempera- tures and maintain normothermia. If you have forced-air convective warming systems, make sure they're used routinely to keep the patient warm from their arrival in pre-op to their discharge. P A T I E N T S A F E T Y OSE_1406_part2_Layout 1 6/13/14 11:42 AM Page 126