Against All Odds: Preventing Pressure Ulcers in High-Risk Cardiac Surgery Patients.

Abstract

The Virginia Commonwealth University Medical Center (VCUMC) is a quaternary urban academic medical center located in Richmond, Virginia. Our 865-bed facility is the only level I verified adult and pediatric trauma center in Richmond, hosting a state-of-the-art critical care tower, where our 14-bed cardiac surgery intensive care unit (CSICU) resides. We provide intensive care nursing for adult and geriatric patients who require surgical treatment of cardiac, thoracic, and vascular conditions. Our mechanical circulatory assist program serves as a referral center for patients in the region who require advanced cardiac and respiratory life support interventions. Patients with such complex problems are often transported to us by the VCUMC mobile intensive care unit (ICU) team. Patients in the CSICU are at high risk for development of hospitalacquired pressure ulcers as a result of their extensive cardiopulmonary bypass times, hemodynamic instability, and vasopressor requirements. Additionally, many cardiac surgery patients are difficult to turn because they have delayed sternal closures and large amounts of blood being rerouted outside of the body for cardiac and pulmonary support. Although our unit has routinely managed these high-risk patients aggressively, medical device–related pressure ulcers were increasing in frequency. The CSICU nursing staff implemented preventative measures to decrease rates of all hospital-acquired pressure ulcers, with a goal of 0 preventable pressure ulcers.