Pressure injury prevention in the perioperative setting: An integrative review

Abstract

Background: Pressure injury (PI) has a significant impact on patients and their families, and is costly to health care institutions. Perioperative PI remains problematic, although little is reported about current perioperative pressure injury prevention (PIP) strategies. Aim: To identify the key perioperative PIP strategies, following a systematic review of published research, to describe existing gaps in the literature, and to inform the development of subsequent observational study. Design: An integrative literature review method developed by Whittemore and Knafl 1 was used. Method: Research inclusion and exclusion criteria were identified a priori. Six data bases were searched and search terms included pressure ulcer/sore prevention, perioperative, operating room. Two review authors evaluated the quality of the studies using a validated tool, and a third author arbitrated when there was a discrepancy. Agreement between the two rates was measured using an intraclass correlation coefficient (ICC). Findings: Based on the inclusion and exclusion criteria, 270 papers were screened and ten quantitative studies were included. Quality scores ranged from 29 per cent to 89 per cent, resulting in an ICC of 0.955 (95 per cent confidence interval, 0.821 to 0.989, p < 0.0001). Five key PIP strategies were identified, including skin inspection, support surfaces and positioning aids, thermoregulation, medical devices and/or equipment, and interprofessional communication. Conclusions: This review confirmed the scarcity of current evidence of perioperative PIP practice and identified five key perioperative PIP strategies. Most of the reviewed studies focused on one main PIP strategy, and no direct observational studies have been undertaken in relation to perioperative PIP.

Acute lumbar paraspinal compartment syndrome after radical cystectomy

“…Similarly to pressure injuries described in bedridden, sedated patients in an intensive care setting, for at-risk patients we suggest modifying the position slightly at least every 2 hours to relieve pressure on the lumbar area 7 19. Besides, reducing pressure with an interface between the body and the operating table could further improve outcomes, with specific surgical support surfaces like gel or foam overlays 20. Impact of periodic position changes and addition of support surfaces on the occurrence of LPCS should be explored in clinical trials.…”

“… 7 19 Besides, reducing pressure with an interface between the body and the operating table could further improve outcomes, with specific surgical support surfaces like gel or foam overlays. 20 Impact of periodic position changes and addition of support surfaces on the occurrence of LPCS should be explored in clinical trials.…”

Using pressure mapping intraoperatively to prevent pressure ulcers—A quasi‐experimental study

“… 17 Reaching consensus in the operating team is a key strategy in preventing the development of pressure ulcers. 26 Therefore, to increase patient safety, pressure mapping could be used as a tool to facilitate consensus in the operating room team regarding if and when micro repositioning needs to be performed. It has been argued that the patient's fragile situation during surgery implies that unnecessary interruptions should be avoided, but it is important to disseminate knowledge about how minute changes in a patient's position can lead to increased blood flow 27 and that international guidelines recommend micro repositioning during surgery.…”

“…The use of pressure mapping has previously been shown to facilitate teams in reaching consensus regarding if, and when, micro repositioning should be performed 17 . Reaching consensus in the operating team is a key strategy in preventing the development of pressure ulcers 26 . Therefore, to increase patient safety, pressure mapping could be used as a tool to facilitate consensus in the operating room team regarding if and when micro repositioning needs to be performed.…”

Cerrahi Hemşirelerin Basınç Yaralanması, Risk Faktörleri ve Önlenmeye İlişkin Bilgilerin İncelenmesi

“…Bir metaanaliz çalışmasında basınç yaralanmalarının genellikle kalp, genel/torasik, ortopedik ve vasküler cerrahi girişimler sonrasında daha sık gelişebileceği bildirilmiştir (24). Cerrahi hastalarında basınç yaralanması gelişimi ağrının artmasına, hastanede daha uzun süre kalmaya, hastaneye tekrar yatışlara, çoklu cerrahi girişimlere ve olası şekil bozukluğuna neden olabilmektedir (20,25). (30)(31)(32)(33).…”