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Difficult Airways - April 2015 - Outpatient Surgery Magazine

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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1. Pressure ulcers A 78-year-old man — who was 6-foot-2 and 250 lbs. — with Parkinson's disease was placed in supine position for a cholecystectomy. His Parkinson's, along with his large and heavy legs, made movement difficult. After surgery, he developed blisters on his heels that pro- gressed to full-thickness wounds. After a delayed discharge from the hospital, the man was sent to a wound care center for 4 months until the pressure ulcers healed. "The simple answer is his heels should have been elevated," says Sharon A. Van Wicklin, MSN, RN, CNOR, CRNFA, CPSN-R, PLNC, a perioperative nursing specialist for AORN. But it often takes more than that to prevent pressure ulcers. Prevention requires a multi-fac- tor approach, she says, including a skin assessment and proper use of positioning devices to prevent skin breakdown. Brent Klev, MBA, BSN, RN, surgical services nurse manager for South Jordan Health Center at the University of Utah, says every patient at your facility — even those undergoing short procedures — should have a pre-op skin assessment. The assessment should use the Braden Scale and look at such risk factors as an age older than 70, vascular disease or diabetes, an operation longer than 4 hours, or a patient who is thin or malnourished. If a patient is found to be at risk, Mr. Klev says staff should pad all bony surfaces, including floating the patient's heels. For those deemed high-risk, Mr. Klev suggests using a fluid mattress overlay on the OR bed and placing a foam sacral dressing on patients. Ms. Van Wicklin recommends using gel positioning devices, which dis- tribute pressure better. 2. Perioperative vision loss An obese man was scheduled to undergo back surgery. He was placed in the prone posi- tion and under general anesthesia for the procedure, which unexpectedly lasted 9 hours. When the man awoke from surgery, he had lost his vision. The man sued, eventually win- ning a $21.8 million verdict. 1 0 9 A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T

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