Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 5 5 complex and lengthy procedures. However, don't be fooled into thinking that a young healthy person hav- ing a multilevel spinal fusion that will take several hours is not at risk — let the estimated time of sur- gery be your guide. Patients should be reexamined for pressure injuries in the PACU, even though most don't appear for about 48 hours after a procedure. During the post-op follow-up, you should always ask patients if any deep-tissue pressure injuries have formed. They appear as bruising or manifest as pain in areas of the body exposed to pressure during sur- gery, so be sure to ask about discomfort in the face, shoulders, ribs and lower legs. Added protection Adhesive dressings and egg crate foam adequately protect sensitive areas such as elbows and shoul- ders. Also consider fluidized positioning pillows that mold to the part of the body you want to pro- tect. The pillows hold their shape throughout the procedure and are a better option than regular pil- lows, which gradually compress during the case from the weight of the patient's body. The first and best thing to do to prevent pres- sure injuries is to properly pad the surface of the surgical table. Make sure the padding on whatever frame you use is still functional. There should be at least four inches of foam that still has its memo- ry and hasn't worn out. Test the condition of foam padding by pushing your hand into it. If the foam is functional, your handprint will quickly disap- pear. If the foam is old or worn, the handprint will remain for several minutes. There are a couple of different types of OR tables that work well for patients in the prone position. Any well-padded table that holds the patient in the jumping jack position allows surgeons to get as close as possible to the patient's spine as they work. Others are designed with an opening to free up space around the abdomen. These tables are need- ed — especially for individuals with high BMIs — to reduce pressure on the abdomen, blood vessels and liver, thereby making breathing easier for patients and reducing the risk of increased bleeding in the surgical space. The edges of the area in which the abdomen drops into create the potential for pres- sure injuries, so padding the patient's body where it meets these edges is crucial. You can also invest in gel pads to place atop your OR tables, mattresses that inflate and deflate during surgery to help relieve pressure from patients' abdominal area, as well as waffle mattresses that have small air pockets and vents in them that pre- vent moisture from forming on patients' skin to fur- ther reduce the risk of pressure injury. Pressure sensors, some the size of the entire OR table and some as small as four-by-four inches, are available to help you determine where patients are most susceptible for pressure injuries. When patients lay on top of the large device, or when a small one is slipped under them, interface pressure between the body and the surface is mapped on a computer. Hot spots appear as different colors on a TROUBLE SPOTS Protecting the chin, shoulders, elbows and ribs in pre-op or padding the parts of the table where they'll be resting can minimize the risk of pressure injuries. Joyce Black, PhD, RN, CWCN, FAAN