AORN Journal
Volume 84, Issue 1 , Pages 75-96 , July 2006

Prevention and Early Detection of Pressure Ulcers in Patients Undergoing Cardiac Surgery

  • Dennis Sewchuk, RN

      Affiliations

    • Dennis Sewchuk, RN, BS, CNOR, is a surgical services clinical educator at The Miriam Hospital, Providence, RI.
  • ,
  • Cynthia Padula, RN

      Affiliations

    • Cynthia Padula, RN, PhD, CS, is a research specialist, Center for Professional Practice Development, The Miriam Hospital, Providence, RI, and a professor, College of Nursing, University of Rhode Island, Kingston, RI.
  • ,
  • Evelyn Osborne, RN

      Affiliations

    • Evelyn Osborne, RN, MS, CWON, is a wound and ostomy clinical specialist, Center for Professional Practice Development, The Miriam Hospital, Providence, RI.

Notes 

  1. Duffy JR , Korniewicz DM . “Quality indicators,” American Nurses Association . http://nursingworld.org/mods/archive/mod72/ceomfull.htm (accessed 1 June 2006)
  2. In: “Recommended practices for positioning the patient in the perioperative practice setting,” in Standards, Recommended Practices, and Guidelines . Denver: AORN, Inc; 2006;p. 587–592
  3. In: “Pressure ulcers in adults: Prediction and prevention,” in Clinical Practice Guideline—Quick Reference Guide for Clinicians, Agency for Health Care Policy and Research . Rockville, Md: US Department of Health and Human Services; 1992;p. 1–15
  4. Lyder CH , et al.   “Quality of care for hospitalized Medicare patients at risk for pressure ulcers,” . Archives of Internal Medicine . June 25, 2001;161:1549–1554
  5. Allman RM , et al.   “Pressure ulcer risk factors among hospitalized patients with activity limitation,” . JAMA . March 15, 1995;273:865–870
  6. Jiricka MK , et al.   “Pressure ulcer risk factors in an ICU population,” . American Journal of Critical Care . September 1995;4:361–367
  7. Thomas DR , et al.   “Hospital-acquired pressure ulcers and risk of death,” . Journal of the American Geriatrics Society . December 1996;44:1435–1440
  8. Inman KJ , et al.   “Clinical utility and cost-effectiveness of an air suspension bed in the prevention of pressure ulcers,” . JAMA . March 3, 1993;269:1139–1143
  9. Lewicki LJ , et al.   “Patient risk factors for pressure ulcers during cardiac surgery,” . AORN Journal . May 1997;65:933–942
  10. Papantonio CT , Wallop JM , Kolodner KB . “Sacral ulcers following cardiac surgery: Incidence and risks,” . Advances in Wound Care . March 1994;7:24–36
  11. “NDNQI: National database of nursing quality indicators,” National Center for Nursing Quality . http://www.nursingquality.org (accessed 1 June 2006)
  12. Braden B , Bergstrom N . “A conceptual schema for the study of the etiology of pressure sores,” . Rehabilitation Nursing . January/February 1987;12:8–12
  13. Bergstrom N , et al.   “Diminished tissue tolerance: Influence on pressure sole development in the institutionalized elderly,” . Applied Nursing Research . August 1988;1:96
  14. Jesurum J , et al.   “Balloons, beds, and breakdown. Effects of low-air loss therapy on the development of pressure ulcers in cardiovascular surgical patients with intra-aortic balloon pump support,” . Critical Care Nursing Clinics of North America . December 1996;8:423–440
  15. Eachempati SR , Hydo LJ , Barie PS . “Factors influencing the development of decubitus ulcers in critically ill surgical patients,” . Critical Care Medicine . September 2001;29:1678–1682
  16. Starritt T , Ewing E . “Implementing good practice in the prevention and management of pressure sores,” . British Journal of Theatre Nursing . February 1999;9:60–63
  17. Gendron FG . Unexplained Patient Burns: Investigating Iatrogenic Injuries . Brea, Calif: Quest Publishing Co; 1988;
  18. Stotts NA . “Risk of pressure ulcer development in surgical patients: A review of the literature,” . Advances in Wound Care . April 1999;12:127–136
  19. Grous CA , Reilly NJ , Gift AG . “Skin integrity in patients undergoing prolonged operations,” . Journal of Wound, Ostomy, and Continence Nursing . March 1997;24:86–91
  20. Schoonhoven L , Defloor T , Grypdonck MH . “Incidence of pressure ulcers due to surgery,” . Journal of Clinical Nursing . July 2002;11:479–487
  21. Versluysen M . “How elderly patients with femoral fracture develop pressure sores in hospital,” . British Medical Journal . May 17, 1986;292:1311–1313
  22. Byers PH , Carta SG , Mayrovitz HN . “Pressure ulcer research issues in surgical patients,” . Advances in Skin & Wound Care . May/June 2000;13:115–121
  23. Aronovitch SA . “Intraoperatively acquired pressure ulcer prevalence: A national study,” . Journal of Wound, Ostomy, and Continence Nursing . May 1999;26:130–136
  24. Kemp MG , et al.   “Factors that contribute to pressure sores in surgical patients,” . Research in Nursing & Health . October 1990;13:293–301
  25. Campbell K . “Pressure point measures in the operating room,” . Journal of Enterostomal Therapy . May/June 1999;16:119–124
  26. Ramsay J . “Pressure ulcer risk factors in the operating room,” . Advances in Wound Care . May/June 1998;11:5–6
  27. Hoshowsky VM , Schramm CA . “Intraoperative pressure sore prevention: An analysis of bedding materials,” . Research in Nursing & Health . October 1994;17:333–339
  28. Tarpey A , et al.   “Evaluating support surfaces for patients in transit through the accident and emergency department,” . Journal of Clinical Nursing . March 2000;9:189–198
  29. Scott EM . “The prevention of pressure ulcers in the operating department,” . Journal of Wound Care . January 2000;9:18–21
  30. Scott EM , et al.   “Measurement of interface pressures in the evaluation of operating theatre mattresses,” . Journal of Wound Care . October 1999;8:437–441
  31. DeFloor T . “The effect of position and mattress on interface pressure,” . Applied Nursing Research . February 2000;13:2–11
  32. DeFloor T , De Schuijmer JD . “Preventing pressure ulcers: An evaluation of four operating-table mattresses,” . Applied Nursing Research . August 2003;13:134–141
  33. Schultz AA . “Study results: Prediction and prevention of pressure ulcers in surgical patients,” . Advances in Wound Care . May/June 1998;11:11
  34. Lindgren M , et al.   “Immobility—A major risk factor for development of pressure ulcers among adult hospitalized patients: A prospective study,” . Scandinavian Journal of Caring Sciences . March 2004;18:57–64
  35. Pokorny ME , Koldjeski D , Swanson M . “Skin care intervention for patients having cardiac surgery,” . American Journal of Critical Care . November 2003;12:535–544
  36. Vermillion C . “Operating room acquired pressure ulcers,” . Decubitus . February 1990;3:26–30
  37. Heizenroth PA . “Positioning the patient for surgery,” . In:  Meeker MH ,  Rothrock JC editor. Alexander's Care of the Patient in Surgery . 11th ed.. St Louis: Mosby; 1999;p. 153–172
  38. Wells JA , Karr D . “Interface pressure, wound healing, and satisfaction in the evaluation of a non-powered fluid mattress,” . Ostomy/Wound Management . February 1998;44:38–54
  39. Chalian AA , Kagan SH . “Backside first in head and neck surgery? Preventing pressure ulcers in extended length surgeries,” . Head & Neck . January 2001;23:25–28
  40. Nixon J , et al.   “A sequential randomized controlled trial comparing a dry visco-elastic polymer pad and standard operating bed mattress in the prevention of postoperative pressure sores,” . International Journal of Nursing Studies . August 1998;35:193–203
  41. Hardin JB , Cronin SN , Cahill K . “Comparison of the effectiveness of two pressure-relieving surfaces: Low-air-loss versus static fluid,” . Ostomy Wound Management . September 2000;46:50–56
  42. Ferrell BA , et al.   “Cost-effectiveness of low air-loss-beds for treatment of pressure ulcers,” . The Journals of Gerontology . May 1995;50:M141–M146 Series A
  43. Cullum N , et al.   “Support surfaces for pressure ulcer prevention,” . The Cochrane Database of Systematic Reviews, Issue 3 . 2004; Article No CD001735
  44. Glavis C , Barbour S . “Pressure ulcer prevention in critical care: State of the art,” . AACN Clinical Issues Critical Care Nursing . November 1990;1:602–613
  45. Bergstrom N , Braden BJ . The Braden Scale for Assessing Pressure Ulcer Risk . Omaha: Prevention Plus; 1999; Videotape
  46. Bergstrom N , et al.   “The Braden Scale for predicting pressure ulcer risk,” . Nursing Research . July/August 1987;36:205–210
  47. Bergstrom N , Demuth PJ , Braden BJ . “A clinical trial of the Braden Scale for predicting pressure sore risk,” . Nursing Clinics of North America . June 1987;22:417–428
  48. Braden BJ , Bergstrom N . “Clinical utility of the Braden Scale for predicting pressure sore risk,” . Decubitus . August 1989;2:44–51
  49. Carlson EV , Kemp MG , Shott S . “Predicting the risk of pressure ulcers in critically ill patients,” . American Journal of Critical Care . July 1999;8:262–269
  50. Halfens RJ , Van Achterberg T , Bal RM . “Validity and reliability of the Braden Scale and the influence of other risk factors: A multi-centre prospective study,” . International Journal of Nursing Studies . August 2000;37:313–319
  51. VandenBosch T , et al.   “Predictive value of the Braden Scale and nurse perception in identifying pressure ulcer risk,” . Applied Nursing Research . May 1999;9:80–86
  52. Bergstrom N , et al.   “Predicting pressure ulcer risk: A multisite study of the predictive validity of the Braden Scale,” . Nursing Research . September/October 1998;47:261–269
  53. In: “Recommended practices for skin preparation of patients,” in Standards, Recommended Practices, and Guidelines . Denver: AORN, Inc; 2006;p. 603–606

 Editor's notes: RIK® Fluid Operating Room table pads used for this study were provided by Kinetic Concepts, Inc (KCI, San Antonio, Tex). Investigative support also was provided by the nursing department at the Miriam Hospital, Providence, RI.

PII: S0001-2092(06)60100-2

doi: 10.1016/S0001-2092(06)60100-2

AORN Journal
Volume 84, Issue 1 , Pages 75-96 , July 2006