5 2 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 1 5
sive drugs also increase the hazard of improp-
er positioning, as do chilly ORs and the possi-
bility of hypothermia. The longer patients are
on the table, the higher their risk of injury,
especially as cases approach the 3-hour mark.
Improper positioning on the OR table for a
prolonged period of time adversely affects the
integrity of the skin and causes compression
of subcutaneous tissue and muscle. The dam-
age to surface or underlying tissue presents
over time as redness, bruising, blistering,
sloughing or necrosis, and any time there is
skin breakdown, the risk of infection is very
high.
Intrinsic risks include, but are not limited to, a patient's age (with elderly
patients more susceptible), lack of mobility, diabetes, recent weight loss, poor
nutritional status (which is often exacerbated by pre-surgical NPO restrictions),
and use of blood thinners.
Even though most patients who undergo surgery at outpatient facilities are
in good overall health, they can face the same risks, and while the signs of
positioning injuries may not appear for 2 to 4 days, they can originate from a
single stay on the OR table.
2. Assess the skin's condition
Check the skin condition of all surgical patients for intactness and risk of injury
during the pre-op and post-op periods. Communicate the findings at patient
handoffs using the Braden Scale for Predicting Pressure Sore Risk
(osmag.net/9wAgQA).
Hold regularly scheduled in-services, at which a perioperative nurse champion
and a wound-ostomy-continence nurse (who'll know about skin healing) can
z LIGHTEN THE LOAD Low-friction
lateral transfer devices can sidestep
the shear forces that hurt patients' skin.
Pamela
Bevelhymer,
RN,
BSN
