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Critical Care Nursing Clinics of North... Dec 2020Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide... (Review)
Review
Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide appropriate dressing and treatment selection. The interprofessional team, patient, and family should collaborate to create a plan of care for wound healing.
Topics: Bandages; Exudates and Transudates; Humans; Patient Care Team; Practice Guidelines as Topic; Pressure Ulcer; Wound Healing
PubMed: 33129410
DOI: 10.1016/j.cnc.2020.08.002 -
Journal of Wound Care Jul 2023Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk...
OBJECTIVE
Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs.
METHOD
This study used a cohort design. The data were collected at Acıbadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data.
RESULTS
Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001).
CONCLUSION
Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Pressure Ulcer; Operating Rooms; Risk Factors; Risk Assessment; Skin
PubMed: 37405971
DOI: 10.12968/jowc.2023.32.Sup7a.cxxviii -
Critical Care Nursing Clinics of North... Dec 2014The prevention of hospital-acquired pressure ulcers remains a top priority for health care facilities worldwide. This article discusses a process improvement in an... (Review)
Review
The prevention of hospital-acquired pressure ulcers remains a top priority for health care facilities worldwide. This article discusses a process improvement in an intensive care unit where the unit-acquired pressure ulcer rate was dropped from 30% to 0% by front-line staff nurses. The key areas addressed by the staff were education, creating a process for turning patients during bedside report, and the creation of a documentation tool for accurate skin/wound assessment. Involving front-line staff in the prevention methodology creates a process that is quickly adopted by staff, peer-to-peer accountability in accurate skin/wound assessment, and positive outcomes.
Topics: Humans; Intensive Care Units; Nursing Assessment; Nursing Staff, Hospital; Pressure Ulcer; Risk Factors; Skin Care
PubMed: 25438897
DOI: 10.1016/j.ccell.2014.08.011 -
Neonatal Network : NN 2015The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic,...
The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described.
Topics: Humans; Infant Care; Infant, Newborn; Intensive Care Units, Neonatal; Neonatal Nursing; Pressure Ulcer; Risk Assessment; Risk Factors; Skin Care; Soft Tissue Infections; Wound Healing
PubMed: 26803094
DOI: 10.1891/0730-0832.34.2.126 -
Revista Da Escola de Enfermagem Da U S P 2023Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. (Review)
Review
OBJECTIVE
Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.
METHOD
Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.
RESULTS
15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.
CONCLUSION
Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.
Topics: Humans; Pressure Ulcer; Systematic Reviews as Topic
PubMed: 38133528
DOI: 10.1590/1980-220X-REEUSP-2023-0039en -
JAAPA : Official Journal of the... Apr 2018Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk... (Review)
Review
Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk mechanisms factor into the development of pressure injuries. The timely recognition of these injuries is imperative. Many treatments exist for pressure injuries but the focus of patient management should be on preventing injury-related complications.
Topics: Bandages; Debridement; Friction; Humans; Negative-Pressure Wound Therapy; Nutritional Status; Nutritional Support; Pressure Ulcer; Risk Assessment; Risk Factors; Skin; Wound Healing
PubMed: 29517618
DOI: 10.1097/01.JAA.0000531043.87845.9e -
Advances in Skin & Wound Care Sep 2023To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries. (Review)
Review
GENERAL PURPOSE
To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries.
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 will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates.
Topics: Humans; Pressure Ulcer; Crush Injuries; Education, Continuing; Nurse Practitioners; Physicians
PubMed: 37603315
DOI: 10.1097/ASW.0000000000000025 -
Journal of Tissue Viability Feb 2020Negative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action...
AIM OF THE STUDY
Negative pressure wound therapy is thought to improve wound healing by altering capillary perfusion. However, despite many theories, the underlying mechanism of action remains controversial. Recent evidence suggests an increased tissue pressure and a temporary decreased microvascular blood flow as the main reasons for the good clinical results [1]. In an attempt to further explain the mechanism of action, we investigated the pressure distribution on the foam interface, and the influence on perfusion in a pre-experimental design.
MATERIALS AND METHODS
Pressure distribution was measured using a sensor based on a capacitive dielectric elastomer with flexible electrodes. In vitro flow measurements were done with vessel imitations in a block of 300 bloom ballistic gel to simulate soft tissue.
RESULTS
A peak pressure of up to 187 mmHg (255 g/cm2) within the foam interface, as well as decreased perfusion, were found using a standard negative pressure wound therapy setup. In conclusion, negative pressure wound therapy applies positive pressure to adjacent tissue and decreases local flow. The amount of suction applied is proportional to the pressure on the foam interface and reduction in flow.
CONCLUSION
In line with previous studies investigating the underlying mechanism of action, these findings may contribute to possible alterations in the use of negative pressure wound therapy, e.g. lowering suction pressure in patients with diminished peripheral blood flow.
Topics: Biomechanical Phenomena; Humans; Negative-Pressure Wound Therapy; Pressure; Pressure Ulcer; Regional Blood Flow; Wound Healing
PubMed: 31899070
DOI: 10.1016/j.jtv.2019.12.004 -
International Journal of Molecular... Dec 2020Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they... (Review)
Review
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
Topics: Animals; Apoptosis; Disease Management; Disease Susceptibility; Extracellular Matrix; Gene Expression Regulation; Gene Regulatory Networks; Humans; Immunity; MicroRNAs; Oxidative Stress; Pressure Ulcer; RNA Interference; Reperfusion Injury; Signal Transduction; Wound Healing
PubMed: 33374656
DOI: 10.3390/ijms22010064 -
British Journal of Nursing (Mark Allen... Aug 2016Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in... (Review)
Review
Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in order to accurately assess the pressure ulcer risk of vulnerable patients, and to subsequently reduce patient harm. The majority of pressure ulcers are avoidable, however, a variety of intrinsic and extrinsic factors can contribute towards the development of deep tissue injury. Understanding the body's internal responses to external pressure will enable nurses to recognise that a visual assessment alone may not necessarily identify patients at risk of deep tissue damage. This article reviews the evidence for the internal causative mechanisms of deep tissue injury, while linking to clinical practice and pressure ulcer prevention.
Topics: Humans; Nursing Care; Practice Guidelines as Topic; Pressure Ulcer; Risk Assessment; Skin; Time Factors
PubMed: 27523755
DOI: 10.12968/bjon.2016.25.15.840