or vascular disease. Consider the patient's overall skin condition, fric-
tion and shearing risks during surgery and expected length of the case
when determining pressure injury risk reduction strategies.
• Positioning aids. Utilize effective positional aids by basing your
choices on evidence-based practice. Take the time to review
manufacturers' details on cleaning, usage and safety. Make sure you
have access to the latest instructions for use and staff and physician
competency information.
Don't rely on egg crate foam surfaces and traditional pillows, as
they do not distribute pressure effectively and tend to compress
quickly under the weight of the patient's body. If you are using these
types of materials, however, it's best to support low weight-bearing
areas, such as under the knees.
Finally, confirm that needed positioning aids are on hand and
ensure staff have the working knowledge, through in-servicing, of
how to use each device safely and effectively.
• Skin checks. Assess and document the patient's skin condition
before surgery. Reassess skin integrity during cases involving patients
who are in the supine or prone position for more than six hours and the
lithotomy or lateral decubitus position for more than three hours. Agree
upon times during lengthier cases when the surgical team will perform
skin assessments at pressure points, conduct range of motion exercises
and reposition the patient as needed.
It's also crucial to assess the patient's risk for a positioning complica-
tion. "Gain as much information as you can about their range of motion
status in pre-op," says Jenni Prevatt, MS, RN, CNOR, quality improve-
ment nurse analyst and surgical nurse reviewer at UC Davis Children's
Hospital in Sacramento, Calif. "Explain to the patient how they will be
positioned during surgery. That way, they'll be more likely to speak up if
they foresee a positioning issue based on their known range of motion
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