Pressure Ulcer Development In Patients Research Articles

Skin integrity in patients undergoing prolonged operations

Objective: The purpose of this study was to identify risk factors contributing to pressure ulcer development in patients undergoing scheduled, prolonged operative procedures. Design: A descriptive study was conducted. Setting and subjects: A large university teaching facility provided the setting. Thirty-three subjects who underwent operative procedures lasting longer than 10 hours, as determined from the daily operating room schedule through a 6-month period, were included in the study. Instruments: Braden Scale for Predicting Pressure Sore Risk was used before the operation. Visual skin inspection, preoperative interventions, and demographic information were documented with a data-collection tool. Postoperative skin breakdown and its severity were assessed as stage I through IV according to the Pressure Ulcer Classification System recommended by the National Pressure Ulcer Advisory Panel. Methods: Visual preoperative skin assessment was performed and the Braden Scale was completed in the operating room holding area. Demographic information was collected from patient interviews and the medical record. Patient positioning and the placement of all positioning and thermal devices were observed and recorded in the operating room. Within 48 hours after the surgical procedure, the patients' skin was visually inspected. Pressure ulcers were noted, staged, and recorded. Main outcome measures: The χ 2 analyses compared those who did and those who did not acquire pressure ulcers for differences in gender, type of operation, position used in the operating room, and types of positioning devices. Student's t tests compared those who did and did not acquire pressure ulcers for differences in age. Braden Scale score, number of positioning devices, and length of operation. Results: Of the 33 patients studied, 15 (45%) were found to acquire stage I or II pressure ulcers within 48 hours after their procedure. Of the 15 patients who acquired pressure ulcers, 75% were placed on a warming blanket during the procedure. This was the only significant finding among the risk factors investigated in the comparison of those who did and did not acquire pressure ulcers ( χ 2 = 4.3, p < 0.05). Conclusions: Removal of the warming blanket from routine intraoperative use with patients undergoing prolonged operations is indicated. Continued follow-up of this patient population will help to determine whether avoidance of warming blankets is sufficient to lower the incidence of pressure ulcer formation.

Pressure ulcer incidence in an acute care setting

The purpose of this prospective study was to determine the incidence of pressure ulcers and to examine factors related to pressure ulcer development in patients in an acute care setting. Adult medical and surgical patients who were free of pressure ulcers at admission were assessed within 36 hours of admission and then three times per week for 2 weeks or until discharge. Instruments included a demographic data form, a skin assessment form, and the Braden Scale for Predicting Pressure Sore Risk. Most subjects had 46 assessments completed. The sample consisted of 149 subjects, with a pressure ulcer incidence rate of 13.4% ( n = 20). Subjects who acquired pressure ulcers had lower hemoglobin levels ( t = 2.17, p = 0.03), spent more time in bed ( t = 3.90, p = 0.0001), and spent less time in a chair ( t = 3.2, p = 0.002) than those who did not acquire pressure ulcers. A stepwise logistic regression analysis was used to calculate risk of pressure ulcer development. In the final model, hemoglobin level and hours spent in bed continued to be predictors of pressure ulcer development ( χ 2 = 9.306, df = 2, p = 0.0095). All 20 subjects who acquired pressure ulcers were further categorized into groups with stage I ( n = 12) or stage II ( n = 8) ulcers. Patients with stage I pressure ulcers were primarily receiving post-surgical care (67%), whereas patients who acquired stage II ulcers had medical conditions that affected tissue perfusion, such as respiratory diseases (50%) and diabetes mellitus (12%).