Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care

Schindler, Christine A.; Mikhailov, Theresa A.; Kuhn, Evelyn M.; Christopher, Jean; Conway, Pat; Ridling, Debra; Scott, Annette; Simpson, Vickie S.

doi:10.4037/ajcc2011754

Cited by 110 publications

(130 citation statements)

References 19 publications

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“…Pressure ulcers are common in hospitalized neonates, infants, and children, with estimates of point prevalence ranging from 10% to 35%, and they are most common in patients requiring management in an intensive care unit. 18,22,23 The most common sites for the development of pressure ulcers in neonates and children related to immobility are the sacrum/coccyx (most common site in children), occiput (most common site in infants), and heels. 24 More than 50% of pressure ulcers in hospitalized children are related to pressure from devices and equipment, including blood pressure cuffs; tracheostomy cannulas, connectors, and tubing; oxygen delivery devices such as nasal prongs, noninvasive positive pressure ventilation interfaces, and continuous positive airway pressure masks; and cutaneous oximetry probes.…”

Section: Wound Management Issues In Pediatricsmentioning

confidence: 99%

“…16 There are currently only a limited number of published clinical guidelines for the evaluation and management of wounds in the neonatal and pediatric populations. 2,13,[17][18][19][20][21] None of these have undergone the rigorous assessment required for the generation of evidence-based guidelines. As such, wound care practices and selection of wound care products tend to reflect provider experience and preference.…”

Section: Overview Of Wound Care In Pediatricsmentioning

confidence: 99%

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Dressings and Products in Pediatric Wound Care

King

Stellar

Blevins

et al. 2014

Advances in Wound Care

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Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moistureassociated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations. SCOPE AND SIGNIFICANCEGiven the lack of consensus on the optimal strategies for common wound care management issues in the neonatal and pediatric populations and the large number of wound care products on the market today, it can be challenging to make informed decisions regarding wound care in these populations. A comprehensive review of the literature on the following specific areas of focus: pressure ulcers, surgical wounds, epidermal stripping, intravenous extravasation injuries, moisture-associated skin damage (MASD), and use of negative-pressure wound therapy (NPWT) is presented, along with management recommendations based on the clinical experience of the authors.

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Section: Wound Management Issues In Pediatricsmentioning

confidence: 99%

Section: Overview Of Wound Care In Pediatricsmentioning

confidence: 99%

Dressings and Products in Pediatric Wound Care

King

Stellar

Blevins

et al. 2014

Advances in Wound Care

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“…We now know that pressure ulcers do occur in these patients [2][3][4] ; the reported incidence is 4% to 27%. [5][6][7][8][9] Despite the growing awareness of pressure ulcers in infants and children, little is known about the nuances of risk in this age group.…”

mentioning

confidence: 99%

Factors Associated With Occipital Pressure Ulcers in Hospitalized Infants and Children

Manning¹,

Gauvreau²,

Curley³

2015

American Journal of Critical Care

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Background The occiput is a common location for development of pressure ulcers in hospitalized infants and young children. However, risk factors associated with occurrence of the ulcers have not been fully described. Objective To identify factors associated with development of occipital pressure ulcers in acutely ill infants and children. Methods Charts of all patients with occipital pressure ulcers reported in a computerized safety event reporting system since its implementation in 2005 and of any patients with such ulcers recalled by members of the skin care special interest group were reviewed retrospectively. Results During a 4-year period, 60 cases of occipital pressure ulcers were identified: 40% stage I, 12% stage II, 30% unstageable, and 18% deep tissue Injury. The median age of the sample was 12 months. Among the patients, 86% were in the intensive care unit with cardiovascular or pulmonary problems. A total of 68% had comorbid conditions. Most of the patients were less than 1 year old; were critically ill, requiring high-risk therapies; and had multiple medical devices in place. Patients with the ulcers were commonly treated with mechanical ventilation (83%) and sedation (74%) and were described as agitated (42%). Many of these patients were receiving vasoactive medications (50%) and had vascular access devices in the neck that restricted head movement (45%). When documented, the median Braden Q score was 16. Conclusions Infants and children at risk for occipital pressure ulcers can be prospectively identified, allowing implementation of nursing interventions to prevent these ulcers.

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“…Elsevier does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Elsevier. 8 from pressure points (Baharestani andRatcliff, 2007 andSchindler et al, 2011).…”

Section: What Are Evidence-based Practices For the Treatment Of A Ktu?mentioning

confidence: 99%