Perioperative Pressure Injuries
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Transcript of Perioperative Pressure Injuries
Pressure Injuries in the
Operating Room
Catherine Steel
CNC Theatre
September 2012
National Pressure Ulcer Advisory
Panel (NPUAP 2007) Reposition every 2 hours
Consider postural alignment, distribution of weight, balance/stability
and redistribution
Written schedule
Pressure-redistributing devices in Operating Rooms for high risk
patients
Pad bony prominences; direct contact with other body parts, devices
and inspect regularly
Prophylactic Dressings
Intra operative management
Post operative assessment
New Evidence
Pressure injury and DVT
PAH Incidence of pressure injuries
Year Pressure Injuries
2010 19
2011 16
2012 42
Note: 2012 data range from Jan to August
2010 – 2012
Pressure Injuries by Position
Position 2010 2011 2012
Prone 13 9 26
Supine 5 4 11
Lithotomy 1 1 1
Unknown 0 2 1
Age of Patients with Perioperative Pressure
Injuries
0
2
4
6
8
10
12
14
1
>70
60 - 69
50-59
40-49
30-39
20-29
2012 patients only
Pressure Injuries by Specialty
Pressure Injuries per Surgical Specialty
B & E
Cardiac
ENT
General
Ophthalmology
Ortho
Urology
Neuro Surgery
Surgical Position Pressure Injuries
0
5
10
15
20
25
30
1
Prone
Beach chair
Lateral
Lithotomy
Supine
unknown
0
5
10
15
20
25
1 to 9 10 to 14 15 to 19 >20 Unknown
All
Prone
Waterlow/Patient Acuity
Length of Surgery
0
2
4
6
8
10
12
14
16
18
<1 1 to 2
hours
2-3 hours 3-4 hours 4-5 hours >5 hours
All Pressure Injuries
Prone Pressure Injuries only
Areas Affected by Pressure Injuries
0
5
10
15
20
25
30
35
Face
ches
thips
knee
sleg
back
heel
ear
thigh
groin
arm
shou
lder
butto
ck
abdo
men
All Pressure Injuries
Prone Pressure Injuries only
Prone Facial Injuries
Decompression L5S1
74 years
Waterlow 16
Surgery 3 ½ hours
Jackson table
Head cushion with
mirror
Pressure Injuries
Face 26/67 = 39%
Chest 8/67 = 12%
Hips 10/67 = 15%
almost 75% from prone positioning
29 patients sustained 1 PI
6 patients sustained 2 PIs
1 patient sustained 3 PIs
2 patients sustained 4 PIs
1 patient sustained 6 PIs
1 patient sustained 8 PIs
29
6
12
1 1 2
One
Two
Three
Four
Six
Eight
Unknown
Prone head positioning devices
Device 2010 2011 2012
Total
(32) %
Head
cushion
with
mirror 10 7 3 20 63
unknown 2 1 5 8 25
tongs 1 1 1 3 9
gel head
ring 0 0 1 1 3
Outcome Incidence Prone Pressure Injuries
0
1
2
3
4
5
6
Jan Feb March April May June July Aug
prone
State-wide Collaborative
Primary and Secondary care
Expert multidisciplinary membership
Local guidelines
Pan Pacific guidelines
• Education
• Website
• Resources
• Documentation
• Benchmarking