pressure ulcers. Stay away from egg crates, which are commonly used
but have very tiny pockets of air that compress too easily. And avoid
using IV bags under the heel, another common practice, since these
also provide inadequate pressure relief. You can use static (non-elec-
tric) mattress overlays made of air, foam or gel to provide pressure
relief; the overlays can follow the patient into recovery.
9. Relieve pressure during surgery. While it's not always possi-
ble to reposition the patient during the case, consider assigning a
point person, such as the circulator, who can look for windows of
opportunity to make small adjustments, like repositioning tempera-
ture probes or a face mask, or making sure that the heels of a patient
in the supine position remain suspended off the table throughout sur-
gery to alleviate pressure. This person can make sure any foam or gel
cushioning under high-risk areas stays in place. Ask the anesthesia
provider to make micro adjustments to the head of a patient in the
supine position, if medically advisable, in order to prevent pressure
ulcers under the cervical collar.
10. Pay attention to tubing. If pressed against the skin, drainage
tubing, oxygen tubing, and catheter or fecal collection tubing can cause
pressure on the skin. "We've recently invested in oxygen tubing that's
made of a softer silicone, because it results in less pressure," says Ms.
Betcher. "And we will put little foam cylinders around this tubing so it's
not exerting so much pressure on the ears. It's also important to empty
incontinence devices frequently in the OR. The weight of a full bag will
tug on the tubing and create more pressure against the skin."
11. Never drag a patient from one surface to another. To
reduce the risk of skin shearing and bruising when transferring a
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