Pressure Injuries in the

Operating Room

Catherine Steel

CNC Theatre

September 2012

National Pressure Ulcer Advisory

Panel (NPUAP 2007) Reposition every 2 hours

Consider postural alignment, distribution of weight, balance/stability

and redistribution

Written schedule

Pressure-redistributing devices in Operating Rooms for high risk

patients

Pad bony prominences; direct contact with other body parts, devices

and inspect regularly

Prophylactic Dressings

Intra operative management

Post operative assessment

New Evidence

Pressure injury and DVT

PAH Incidence of pressure injuries

Year Pressure Injuries

2010 19

2011 16

2012 42

Note: 2012 data range from Jan to August

2010 – 2012

Pressure Injuries by Position

Position 2010 2011 2012

Prone 13 9 26

Supine 5 4 11

Lithotomy 1 1 1

Unknown 0 2 1

Age of Patients with Perioperative Pressure

Injuries

0

2

4

6

8

10

12

14

1

>70

60 - 69

50-59

40-49

30-39

20-29

2012 patients only

Pressure Injuries by Specialty

Pressure Injuries per Surgical Specialty

B & E

Cardiac

ENT

General

Ophthalmology

Ortho

Urology

Neuro Surgery

Surgical Position Pressure Injuries

0

5

10

15

20

25

30

1

Prone

Beach chair

Lateral

Lithotomy

Supine

unknown

0

5

10

15

20

25

1 to 9 10 to 14 15 to 19 >20 Unknown

All

Prone

Waterlow/Patient Acuity

Length of Surgery

0

2

4

6

8

10

12

14

16

18

<1 1 to 2

hours

2-3 hours 3-4 hours 4-5 hours >5 hours

All Pressure Injuries

Prone Pressure Injuries only

Areas Affected by Pressure Injuries

0

5

10

15

20

25

30

35

Face

ches

thips

knee

sleg

back

heel

ear

thigh

groin

arm

shou

lder

butto

ck

abdo

men

All Pressure Injuries

Prone Pressure Injuries only

Prone Facial Injuries

Decompression L5S1

74 years

Waterlow 16

Surgery 3 ½ hours

Jackson table

Head cushion with

mirror

Pressure Injuries

Face 26/67 = 39%

Chest 8/67 = 12%

Hips 10/67 = 15%

almost 75% from prone positioning

29 patients sustained 1 PI

6 patients sustained 2 PIs

1 patient sustained 3 PIs

2 patients sustained 4 PIs

1 patient sustained 6 PIs

1 patient sustained 8 PIs

29

6

12

1 1 2

One

Two

Three

Four

Six

Eight

Unknown

Prone head positioning devices

Device 2010 2011 2012

Total

(32) %

Head

cushion

with

mirror 10 7 3 20 63

unknown 2 1 5 8 25

tongs 1 1 1 3 9

gel head

ring 0 0 1 1 3

Outcome Incidence Prone Pressure Injuries

0

1

2

3

4

5

6

Jan Feb March April May June July Aug

prone

State-wide Collaborative

Primary and Secondary care

Expert multidisciplinary membership

Local guidelines

Pan Pacific guidelines

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