Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper

Advances in Skin and Wound Care - Tập 32 Số 9 - Trang 394-408 - 2019
Barbara Delmore1,2,3,4,5, Michelle Deppisch1,2,6,4,5, Cynthia Sylvia1,2,7,4,5, Crystal Luna-Anderson1,2,4,5, Ann Marie Nie1,2,8,4,5
1Acknowledgments: The authors thank Caroline Portoghese and Sharon Sonenblum for their significant contributions to this article. The authors, faculty, staff, and planners, including spouses/partners (if any), in any position to control the content of this CME/CNE activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies relevant to this educational activity.
2All tests are now online only
3Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU • Senior Nurse Scientist • Center for Innovations in the Advancement of Care • Clinical Assistant Professor • Hansjörg Wyss Department of Plastic Surgery • NYU Langone Health • New York, New York
4To earn CME credit, you must read the CME article and complete the quiz online, answering at least 13 of the 18 questions correctly.
5take the test at http://cme.lww.com for physicians and www.nursingcenter.com for nurses. Complete CE/CME information is on the last page of this article.
6Michelle Deppisch, PT, CWS, FACCWS • Wound Care Regional Clinical Specialist • Mölnlycke Health Care • Norcross, Georgia
7Cynthia Sylvia, DNurs, MSc, MA, RN, CWCN • Managing Member • Cynthia Sylvia LLC • Charles Town, West Virginia
8Ann Marie Nie, MSN, RN, FNP-BC, CWOCN • Wound, Ostomy Care Nurse Practitioner • Children’s Minnesota • Minneapolis, Minnesota

Tóm tắt

ABSTRACT Pediatric patients, especially neonates and infants, are vulnerable to pressure injury formation. Clinicians are steadily realizing that, compared with adults and other specific populations, pediatric patients require special consideration, protocols, guidelines, and standardized approaches to pressure injury prevention. This National Pressure Advisory Panel white paper reviews this history and the science of why pediatric patients are vulnerable to pressure injury formation. Successful pediatric pressure injury prevention and treatment can be achieved through the standardized and concentrated efforts of interprofessional teams. GENERAL PURPOSE To review what is known about pediatric pressure injuries (PIs) and the specific factors that make neonates and children vulnerable. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to: 1. Identify the scope of the problem and recall pediatric anatomy and physiology as it relates to PI formation. 2. Differentiate currently available PI risk assessment instruments. 3. Outline current recommendations for pediatric PI prevention and treatment.

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Tài liệu tham khảo

2017, Impact of a pressure injury prevention bundle in the Solutions for Patient Safety Network, Pediatr Qual Saf, 2, e013, 10.1097/pq9.0000000000000013

2018, Predicting pressure injury risk in pediatric patients: the Braden QD scale, J Pediatr, 192, 189, 10.1016/j.jpeds.2017.09.045

2015, Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer, Pediatrics, 136, 432, 10.1542/peds.2015-1386

2002, Incidence and prevalence of pressure ulcers in children, Adv Skin Wound Care, 15, 121, 10.1097/00129334-200205000-00007

1997, Fourth national pressure ulcer prevalence survey, Adv Wound Care, 10, 18

2005, Pediatric pressure ulcer prevalence—one hospital’s experience, Ostomy Wound Manage, 51, 44

2004, The prevalence of pressure ulcers in a tertiary care pediatric and adult hospital, J Wound Ostomy Continence Nurs, 31, 108, 10.1097/00152192-200405000-00004

2004, The 2003 National Pediatric Pressure Ulcer and Skin Breakdown Prevalence Survey: a multisite study, J Wound Ostomy Continence Nurs, 31, 168, 10.1097/00152192-200407000-00004

2006, Skin integrity in hospitalized infants and children. A prevalence survey, J Pediatr Nurs, 21, 445, 10.1016/j.pedn.2006.07.002

2011, Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care, Am J Crit Care, 20, 26, 10.4037/ajcc2011754

2009, The prevalence of pressure ulcers in four paediatric institutions, J Clin Nurs, 18, 3244, 10.1111/j.1365-2702.2009.02951.x

2014, Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age, J Spec Pediatr Nurs, 1, 80

2012, Pediatric pressure ulcer prevalence: a multicenter, cross-sectional, point prevalence study in Switzerland, Ostomy Wound Manage, 58, 18

2009, Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis, Ostomy Wound Manage, 39

1989, Risk factors associated with pressure ulcers in the pediatric patient following open-heart surgery, Prog Cardiovasc Nurs, 4, 99

2000, Pressure sores in children—the acute hospital perspective, J Tissue Viability, 10, 59, 10.1016/S0965-206X(00)80024-8

2013, A quality-improvement collaborative project to reduce pressure ulcers in PICUs, Pediatrics, 131, e1950, 10.1542/peds.2012-1626

2013, Under pressure: preventing pressure ulcers in critically ill infants, J Spec Pediatr Nurs, 18, 329, 10.1111/jspn.12043

1998, Skin breakdown in children and high-frequency oscillatory ventilation, Arch Phys Med Rehabil, 79, 1565, 10.1016/S0003-9993(98)90422-1

1996, Altered skin integrity in children admitted to a pediatric intensive care unit, J Nurs Care Qual, 62

2003, Pressure ulcers in pediatric intensive care: incidence and associated factors, Pediatr Crit Care Med, 4, 284, 10.1097/01.PCC.0000075559.55920.36

2014, Pressure ulcers in the hospitalized neonate: rates and risk factors, Sci Rep, 4, 7429, 10.1038/srep07429

2010, Incidence and risk factors of pressure ulcers in seven neonatal intensive care units in Japan: a multisite prospective cohort study, Int Wound J, 7, 323, 10.1111/j.1742-481X.2010.00688.x

2013, Pressure ulcer prevalence among hospitalized children in Jordan, Jordan Med J, 47, 241, 10.12816/0025819

2017, Pressure injury prevalence and the rate of hospital-acquired pressure injury among pediatric patients in acute care, J Wound Ostomy Continence Nurs, 44, 110, 10.1097/WON.0000000000000306

2015, Clinical nurse specialist collaboration to recognize, prevent, and treat pediatric pressure ulcers, Clin Nurse Spec, 29, 276, 10.1097/NUR.0000000000000135

2007, Pressure ulcers in neonates and children: an NPUAP white paper, Adv Skin Wound Care, 20, 208, 10.1097/01.ASW.0000266646.43159.99

2010, Frequency of pressure ulcers in the paediatric population: a literature review and new empirical data, Int J Nurs Stud, 47, 1330, 10.1016/j.ijnurstu.2010.07.006

2017, Airways and injuries: protecting our pediatric patients from respiratory device-related pressure injuries, Crit Care Nurs Clin N Am, 29, 187, 10.1016/j.cnc.2017.01.006

2009, Dilemmas in measuring and using pressure ulcer prevalence and incidence: an international consensus, Int Wound J, 6, 97, 10.1111/j.1742-481X.2009.00593.x

2017, Pressure injuries caused by medical devices and other objects: a clinical update, Am J Nurs, 117, 36, 10.1097/01.NAJ.0000527460.93222.31

1997, The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates, Issues Compr Pediatr Nurs, 20, 103, 10.3109/01460869709026881

2017, Early upper lip pressure ulcer in a preterm neonate, Pediatr Int, 1

2018, Recognizing congenital pressure injuries, J Wound Ostomy Continence Nurs, 46, 65

2010, Functional skin adaptation in infancy—almost complete but not fully competent, Exp Dermatol, 19, 483, 10.1111/j.1600-0625.2009.01023.x

2017, Age limit of pediatrics, Pediatrics, 140, e20172151, 10.1542/peds.2017-2151

1999, Neonatal skin care: the scientific basis for practice, Neonatal Netw, 18, 15, 10.1891/0730-0832.18.4.15

1998, Development of skin barrier function in premature infants, J Invest Dermatol, 111, 320, 10.1046/j.1523-1747.1998.00289.x

1983, Barrier properties of the newborn infant’s skin, J Pediatr, 102, 419, 10.1016/S0022-3476(83)80669-6

1986, Development of the epidermis in the newborn, Biol Neonate, 49, 74, 10.1159/000242513

1990, Transepidermal potassium ion, chloride ion, and water flux across delipidized and cellophane tape-stripped skin, Dermatology, 180, 66, 10.1159/000247992

2000, Direct comparison of skin physiology in children and adults with bioengineering methods, Pediatr Dermatol, 17, 436, 10.1046/j.1525-1470.2000.01815.x

1997, Disruption of barrier function in neonatal skin associated with adhesive removal, J Pediatr, 131, 367, 10.1016/S0022-3476(97)80060-1

1999, Neonatal dermatology, Curr Opin Pediatr, 11, 471, 10.1097/00008480-199910000-00017

1978, Danger of iodine skin absorption in the neonate, J Pediatr, 93, 158, 10.1016/S0022-3476(78)80645-3

1981, Burn hazard of isopropyl alcohol in the neonate, Pediatrics, 98, 587

1966, Percutaneous absorption of hydrocortisone in children, Am J Dis Child, 112, 218

2009, Effect of chlorhexidine gluconate on the skin integrity at PICC line sites, J Perinatol, 29, 802, 10.1038/jp.2009.116

2012, Infant epidermal skin physiology: adaptation after birth, Br J Dermatol, 166, 483, 10.1111/j.1365-2133.2011.10659.x

1998, The timing of skin acidification in very low birth weight infants, J Perinatol, 18, 272

2015, Factors associated with occipital pressure ulcers in hospitalized infants and children, Am J Crit Care, 24, 342, 10.4037/ajcc2015349

2005, Skin breakdown in acute care pediatrics, Pediatr Nurs, 31, 132

2015, A Delphi study for the development of an infant skin breakdown risk assessment tool, Adv Neonatal Care, 15, 150, 10.1097/ANC.0000000000000104

2014, Pressure injuries to the skin in a neonatal unit: fact or fiction, J Neonatal Nurs, 20, 129, 10.1016/j.jnn.2013.08.006

2014, Nasal septum injury in preterm infants using nasal prongs, Rev Lat Am Enfermagem, 22, 826, 10.1590/0104-1169.3451.2486

2013, An integrative review of skin breakdown in the preterm infant associated with nasal continuous positive airway pressure, J Obstet Gynecol Neonatal Nurs, 42, 508, 10.1111/1552-6909.12233

2008, Barrier function and water-holding and transport properties of infant stratum corneum are different from adult and continue to develop through the first year of life, J Invest Dermatol, 128, 1728, 10.1038/sj.jid.5701239

2002, Biomedical assessment and instrumental evaluation of healthy infant skin, Pediatr Dermatol, 19, 473, 10.1046/j.1525-1470.2002.00214.x

2000, Changes in diapered and nondiapered infant skin over the first month of life, Pediatr Dermatol, 17, 45, 10.1046/j.1525-1470.2000.01711.x

1995, Skin care for high-risk neonates, J Wound Ostomy Continence Nurs, 22, 177, 10.1097/00152192-199507000-00008

2013, Validation and clinical impact of paediatric pressure ulcer risk assessment scales: a systematic review, Int J Nurs Stud, 50, 807, 10.1016/j.ijnurstu.2011.04.014

2003, Predicting pressure ulcer risk in pediatric patients: the Braden Q scale, Nurs Res, 52, 22, 10.1097/00006199-200301000-00004

2011, Using the Braden Q scale to predict pressure ulcer risk in pediatric patients, J Pediatr Nurs, 26, 566, 10.1016/j.pedn.2010.07.006

2009, The development of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale, J Wound Care, 18, 17, 10.12968/jowc.2009.18.1.32135

2015, Become PPUPET master: mastering pressure ulcer risk assessment with the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET), J Pediatr Nurs, 30, 598

2017, SIRA+P: development and testing, J Pediatr Nurs, 34, 65, 10.1016/j.pedn.2016.12.019

2017, WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): an executive summary, J Wound Ostomy Continence Nurs, 44, 241, 10.1097/WON.0000000000000321

2004, The use of a pressure ulcer risk assessment tool for children, Nurs Times, 100, 56

2015, Adjustability and adaptability are critical characteristics of pediatric support surfaces, Adv Wound Care, 4, 615, 10.1089/wound.2015.0639

2016, Device-related pressure ulcers from a biomechanical perspective, J Tissue Viability, 26, 57

2014, Dressings and products in pediatric wound care, Adv Wound Care (New Rochelle), 3, 324, 10.1089/wound.2013.0477

2004, Advantages and disadvantages of different nasal CPAP systems in newborns, Intensive Care Med, 30, 926, 10.1007/s00134-004-2267-8

2013, Prevention of pressure ulcers after pediatric tracheotomy using a Mepilex Ag dressing, Laryngoscope, 123, 3201, 10.1002/lary.24094

2014, The ontogeny of skin, Adv Wound Care, 3, 291, 10.1089/wound.2013.0467

2011, Pediatric tracheotomy wound complications, Arch Otolaryngol Neck Surg, 137, 363, 10.1001/archoto.2011.33

1996, Nasal deformities resulting from flow driver continuous positive airway pressure, Arch Dis Child Fetal Neonatal Ed, 75, F209, 10.1136/fn.75.3.F209

2005, Incidence of nasal trauma associated with nasal prong versus nasal mask during continuous positive airway pressure treatment in very low birthweight infants: a randomised control study, Arch Dis Child Fetal Neonatal Ed, 90, F480, 10.1136/adc.2004.069351

2008, Interface pressure comparison of healthy premature infants with various neonatal bed surfaces, Adv Neonatal Care, 8, 176, 10.1097/01.ANC.0000324342.32464.83

2017, Quality improvement of nasal continuous positive airway pressure therapy in neonatal intensive care unit, Pediatr Neonatol, 58, 229, 10.1016/j.pedneo.2016.04.005

2004, Risk factors associated with pressure ulcers in the pediatric intensive care unit, J Wound Ostomy Continence Nurs, 31, 179, 10.1097/00152192-200407000-00005

2013, Pressure ulcer treatment in pediatric patients, Adv Skin Wound Care, 26, 504, 10.1097/01.ASW.0000433103.55891.af

2017, Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study, Rev Bras Ter Intensiva, 29

2018, The impact of pediatric pressure injury prevention bundle on pediatric pressure injury rates: a secondary analysis, J Wound Ostomy Continence Nurs, 45, 209, 10.1097/WON.0000000000000439

2012, Prevention of tracheostomy-related pressure ulcers in children, Pediatrics, 129, e792, 10.1542/peds.2011-0649

2017, Pressure ulcer risk and prevention practices in pediatric patients: a secondary analysis of data from the National Database of Nursing Quality Indicators, Ostomy Wound Manage, 63, 26

2013, Medical device-related hospital-acquired pressure ulcers in children: an integrative review, J Pediatr Nurs, 28, 585, 10.1016/j.pedn.2013.05.004

2006, Support surface initiative: terms, definitions and patient care, Adv Skin Wound Care, 19, 487

2017, Reducing postsurgical wound complications: a critical review, Adv Skin Wound Care, 30, 272, 10.1097/01.ASW.0000516426.62418.48

2014, Little patients, big outcomes: the role of MEDIHONEY® in pediatric wound care, Ostomy Wound Manage, 60, 8

2015, Safety and efficacy of active Leptospermum honey in neonatal and paediatric wound debridement, J Wound Care, 24, 95, 10.12968/jowc.2015.24.3.95

2014, Neonatal case studies using active Leptospermum honey, J Wound Ostomy Continence Nurs, 41, 213, 10.1097/WON.0000000000000028

1997, Wound and skin care for the PICU, Crit Care Nurs Q, 20, 62, 10.1097/00002727-199705000-00007

2004, Validity and reliability of the Neonatal Skin Condition score, J Obstet Gynecol Neonatal Nurs, 33, 320, 10.1177/0884217504265174

2012, The Braden Q+P: a pediatric perioperative pressure ulcer risk assessment and intervention tool, AORN J, 96, 261, 10.1016/j.aorn.2012.05.010

1997, Taking the pressure off, Paediatr Nurs, 9, 25, 10.7748/paed.9.8.25.s20

1998, Paediatric pressure sore risk assessment, J Tissue Viability, 8, 30

1993, A tool to fill the gap: developing a wound risk assessment chart for children, Prof Nurse, 9, 112

1997, Pressure sore risk assessment in children, Paediatr Nurs, 9, 21, 10.7748/paed.9.6.21.s22

1998, Growing concern, Nurs Times, 94, 74