padded, even for a relatively short procedure.
Protect problem areas
Place foam or gel dressings over areas of concern. Heels are common
problem areas when patients are placed in the supine position and
need to be positioned off the table's surface. During cases when the
head is elevated — such as breast surgeries — skin break down can
occur on the sacrum. During GYN cases, break down can occur on
the lower part of the buttocks.
The pre-op nurse is best suited to pad potential problem areas, as the
patient is still conscious and able to move and shift to make padding
easier. She should communicate areas of specific concerns to the surgi-
cal team once the patient is moved into the OR.
When positioning patients in the OR, avoid using sand bags, rolled
towels or water bottles, which actually put tremendous pressure on
the areas you're trying to protect. If you use egg crates to pad boney
prominences, double the layers, as the valley of a single egg crate
doesn't add much protection.
Be aware of where Mayo stands and equipment cords are placed
around the patient, and never lean on the drapes during surgery. Even
the slightest additional pressure on the patient can increase the likeli-
hood of a skin injury. Monitor the patient throughout the procedure,
especially when the table is raised or tilted, to ensure skin surfaces
remain clear of additional forces.
Gel pads specifically designed to relieve pressure on bony promi-
nences work very well, especially if they're moldable to a patient's spe-
cific body shape. They're reusable, which is nice, but can also wear
out, so be sure to check that the gel hasn't separated. The devices must
be thick all the way through to offer the full protection they promise.
Also be sure to follow the manufacturers' instructions when applying
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