Etiology and Incidence of Pressure Ulcers in Surgical Patients

AORN Journal - Tập 70 - Trang 434 - 1999
Alyce A. Schultz, Maureen Bien, Karen Dumond, Kathleen Brown, Amanda Myers

Tóm tắt

ABSTRACTThis experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive “usual perioperative care” or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only 2% developed stage II or IV ulcers. Patients with ulcers were statistically older, had diabetes, were smaller in body mass, had lower Braden Scale scores on admission, and used the new mattress overlay (P < .02). Pressure ulcers that presented as “burns” or ecchymosis did not deteriorate to stage III or IV ulcers during the study. The mattress overlay was not effective in preventing pressure ulcer development. AORN J 70 (Sept 1999) 434–449.

Tài liệu tham khảo

10.1002/nur.4770130505 Vermillion C, 1990, “Operating room acquired pressure ulcers”, Decubitus, 3, 26 Wagner VD, 1994, “Intraoperatively acquired pressure ulcers”, Today's OR Nurse, 18 10.1097/00003465-199111000-00006 10.1002/nur.4770170504 10.1136/bmj.292.6531.1311 Papantonio CT, 1994, “Sacral ulcers following cardiac surgery: Incidence and risks”, Advances in Wound Care, 7, 24 Agency for Health Care Policy and ResearchPressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline publ no 92‐0047; 10.1097/00152192-199411000-00009 Agency for Health Care Policy and Research Pressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline publ no 92‐0047; National Pressure Ulcer Advisory Panel (NPUAP), 1989, “Pressure ulcers prevalence, cost, and risk assessment: Consensus development conference statement”, Decubitus, 2, 24 Agency of Health Care Policy and Research, 1994, Treatment of Pressure Ulcers, Clinical Practice Guideline Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36. Vermillion “Operating room acquired pressure ulcers ” 26–30; 10.1016/S0001-2092(07)68683-9 Koziak M, 1959, “Etiology and pathology of ischemic ulcers”, Archives of Physical Medicine Rehabilitation, 40, 242 Vermillion “Operating room acquired pressure ulcers ” 26–30; Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; Scott Mayhew Harris “Pressure ulcer development in the operating room: Nursing implications ” 242–250. Schultz AA, 1995, Outcomes: Six Months Post‐implementation of AHCPR Pressure Ulcer Guideline Ibid. 10.1002/j.2048-7940.1987.tb00541.x Agency for Health Care Policy and Research Pressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline publ no 92‐0047. Campbell K, 1989, “Pressure point measures in the operating room”, Journal of Enterostomal Therapy, 16, 119 Margolis DJ, 1995, “Definition of a pressure ulcer”, Advances in Wound Care, 8, 8 Kemp et al “Factors that contribute to pressure sores in surgical patients ” 293–301; Wagner “Intraoperatively acquired pressure ulcers ” 18–21; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Versluysen “How elderly patients with femoral fracture develop pressure sores in hospital ” 1311–1313; Stotts NA, 1988, “Predicting pressure ulcer development in surgical patients”, Heart & Lung, 17, 641 10.1046/j.1365-2648.1994.20020288.x Edwards “The rationale for the use of risk calculators in pressure sore prevention and the evidence of the reliability and validity of published scales ” 288–296. 10.1111/j.1532-5415.1979.tb06043.x Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Campbell “Pressure point measures in the operating room ” 119–124; 10.1001/archsurg.1973.01350220028007 Campbell. “Pressure point measures in the operating room ” 119–124. Stewart TP, 1988, “Burns or pressure ulcers in the surgical patient?”, Decubitus, 1, 36 Seiler Staheling “Skin oxygen tension as a function of imposed skin pressure: Implications for decubitus ulcer formation ” 298–301; Souther Carr Vistnes “Pressure tissue ischemia and operating table pads ” 544–537; Stewart Magnano “Burns or pressure ulcers in the surgical patient?” 36–40. Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Campbell “Pressure point measures in the operating room ” 119–124. Kemp et al “Factors that contribute to pressure sores in surgical patients ” 293–301; Marchette Arnell Redick “Skin ulcers of elderly surgical patients in critical care units ” 321–329; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339. Marchette Arnell Redick “Skin ulcers of elderly surgical patients in critical care units ” 321–329. K Campbell “Pressure point measures in the operating room ” 119–124. Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339. Vermillion “Operating room acquired pressure ulcers ” 26–30. Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; 10.1016/S0001-2092(06)62976-1 10.1016/S1071-5754(97)90077-2 Vermillion “Operating room acquired pressure ulcers ” 26–30; Marchette Arnell Redick “Skin ulcers of elderly surgical patients in critical care units ” 321–329; Versluysen “Hospital topics: How elderly patients with femoral fracture develop pressure sores in hospital ” 1311–1313; Campbell “Pressure point measures in the operating room ” 119–124; Kemp esct al “Factors that contribute to pressure sores in surgical patients ” 293–301; Wagner “Intraoperatively acquired pressure ulcers: The perioperative period is a critical time for nurses to predict and prevent the incidence of pressure ulcers in the surgical patient ” 18–21; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Stotts “Predicting pressure ulcer development in surgical patients ” 641–647; Schultz Outcomes: Six Months Post‐implementation of AHCPR Pressure Ulcer Guideline ; 10.1177/0148607187011003298 Kemp et al “Factors that contribute to pressure sores in surgical patients ” 293–301; Schultz Outcomes: Six Months Post‐implementation of AHCPR Pressure Ulcer Guideline ; Stotts “Nutritional parameters at hospital admission as predictors of pressure ulcer development in elective surgery ” 298–301; 10.7326/0003-4819-105-3-337 Kemp et al “Factors that contribute to pressure sores in surgical patients ” 293–301. Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; National Pressure Ulcer Advisory Panel (NPUAP) “Pressure ulcers prevalence cost and risk assessment: Consensus development conference statement ” 24–28. Wagner “Intraoperatively acquired pressure ulcers ” 18–21; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; Versluysen “How elderly patients with femoral fracture develop pressure sores in hospital ” 1311–1313; Braden Bergstrom “A conceptual schema for the study of the etiology of pressure sores ” 8–12; Scott Mayhew Harris “Pressure ulcer development in the operating room: Nursing implications ” 242–250; Stotts “Predicting pressure ulcer development in surgical patients ” 641–647; Campbell “Pressure point measures in the operating room ” 119–124. Wagner “Intraoperatively acquired pressure ulcers ” 18–21; Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; Braden Bergstrom “A conceptual schema for the study of the etiology of pressure sores ” 8–12; Stewart Magnano “Burns or pressure ulcers in the surgical patient ” 36–40; Versluysen “How elderly patients with femoral fracture develop pressure sores in hospital ” 1311–1313; Vermillion “Operating room acquired pressure ulcers ” 26–30; Schultz Outcomes: Six Months Post‐implementation of AHCPR Pressure Ulcer Guideline ; Allman “Pressure sores among hospitalized patients ” 337–342. Versluysen “How elderly patients with femoral fracture develop pressure sores in hospital ” 1311–1313; Vermillion “Operating room acquired pressure ulcers ” 26–30; Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; Scott Mayhew Harris “Pressure ulcer development in the operating room: Nursing implications ” 242–250; Allman et al “Pressure sores among hospitalized patients ” 337–342; M Koziak “Etiology and pathology of ischemic ulcers ” 242–250. Wagner “Intraoperatively acquired pressure ulcers: The perioperative period is a critical time for nurses to predict and prevent the incidence of pressure ulcers in the surgical patient ” 18–21; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Scott Mayhew Harris “Pressure ulcer development in the operating room: Nursing implications ” 242–250; Campbell “Pressure point measures in the operating room ” 119–124. Braden Bergstrom “A conceptual schema for the study of the etiology of pressure sores ” 8–12; Agency for Health Care Policy and Research Pressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline publ no 92‐0047. Lewicki et al “Patient risk factors for pressure ulcers during cardiac surgery ” 933–942. OR Acquired Pressure Ulcers First Annual Symposium Atlanta Ga 8–9 March 1998. Braden Bergstrom “A conceptual schema for the study of the etiology of pressure sores ” 8–12; Agency of Health Care Policy and Research Pressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline publ no 92‐0047. Grous Reilly Gift “Skin integrity in patients undergoing prolonged operations ” 86–91; Lewicki et al “Patient risk factors for pressure ulcers during cardiac surgery ” 933–942. Seiler Stahelin “Skin oxygen tension as a function of imposed skin pressure: Implications for decubitus ulcer formation ” 298–301; Souther Carr Vistnes “Pressure tissue ischemia and operating table pads ” 544–547; Stewart Magnano “Burns or pressure ulcers in the surgical patient ” 36–40; Hoshowsky Schramm “Intraoperative pressure sore prevention: An analysis of bedding materials ” 333–339; Campbell “Pressure point measures in the operating room ” 119–124. Lewicki et al “Patient risk factors for pressure ulcers during cardiac surgery ” 933–942; Papantonio Wallop Kolodner “Sacral ulcers following cardiac surgery: Incidence and risks ” 24–36; National Pressure Ulcer Advisory Panel (NPUAP) “Pressure ulcers prevalence cost and risk assessment: Consensus development conference statement ” 24–28.