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operating room pressure ulcer

Pamela Clay, Casey Cruz, Keith Ayotte, Jeremy Jones, Susan B Fowler
PROBLEM: From 2014 to 2016, device related pressure injuries accounted for 62-81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients. METHODS: Collaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies...
January 31, 2018: Journal of Pediatric Nursing
Xiao-Qing Wei, Lei Song, Xue-Song Zhang, Kui-Yang Wang, Jie Wu
RATIONALE: Aortogastric fistula (AGF) is a rare but devastating clinical complication after esophagectomy. In a recent report, nearly all AGF patients died of massive hemorrhage or aspiration of massive hematemesis. Therefore, timely appropriate treatment of AGF remains a challenge.Herein, we report a case of AGF that resulted from peptic ulceration after esophagectomy and was successfully treated with endovascular stent graft placement. PATIENT CONCERNS: A 59-year-old man had undergone video-assisted thoracoscopic esophagectomy for squamous cell carcinoma and esophageal reconstruction using a gastric tube 14 months previously...
December 2017: Medicine (Baltimore)
Thomas R O'Toole, Natalie Jacobs, Brian Hondorp, Laura Crawford, Lisa R Boudreau, Jill Jeffe, Brian Stein, Phillip LoSavio
Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head...
April 2017: Otolaryngology—Head and Neck Surgery
Andréane Richard-Denis, Cynthia Thompson, Jean-Marc Mac-Thiong
Individuals with spinal cord injury are at risk of sacral pressure ulcers due to, among other reasons, prolonged immobilisation. The effectiveness of a multi-layer foam dressing installed pre-operatively in reducing sacral pressure ulcer occurrence in spinal cord injured patients was compared to that of using a gel mattress, and stratified analyses were performed on patients with complete tetraplegia and paraplegia. Socio-demographic and clinical data were collected from 315 patients admitted in a level-I trauma centre following a spinal cord injury between April 2010 and March 2016...
January 4, 2017: International Wound Journal
Mine Yoshimura, Norihiko Ohura, Junko Tanaka, Shoichi Ichimura, Yusuke Kasuya, Oruto Hotta, Yu Kagaya, Takuya Sekiyama, Mitsuko Tannba, Nao Suzuki
Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton-Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual-center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient...
December 7, 2016: International Wound Journal
P Rupert
OBJECTIVE: Diabetic ulcers are the most common foot injuries leading to lower-extremity amputation and the most common cause of non-traumatic lower extremity amputations in the industrialised world. Approximately 85% of all diabetes-related lower-extremity amputations are preceded by foot ulcers. When foot ulcers develop despite preventive measures, early and appropriate treatment should be initiated to help reduce the burden of diabetes-related amputations. Recent advances now offer these patients a regenerative process of restoring the wound with human integument by replacing damaged or missing tissue with similar tissue rather than scar formation...
April 2016: Journal of Wound Care
Allison Lipitz-Snyderman, Saul N Weingart, Christopher Anderson, Andrew S Epstein, Aileen Killen, David Classen, Camelia S Sima, Elizabeth Fortier, Coral L Atoria, David Pfister, Allison Lipitz-Snyderman, Saul N Weingart, Christopher Anderson, Andrew S Epstein, Aileen Killen, David Classen, Camelia S Sima, Elizabeth Fortier, Coral L Atoria, David Pfister
PURPOSE: Widespread consensus exists about the importance of addressing patient safety issues in oncology, yet our understanding of the frequency, spectrum, and preventability of adverse events (AEs) across cancer care is limited. METHODS: We developed a screening tool to detect AEs across cancer care settings through medical record review. Members of the study team reviewed the scientific literature and obtained structured input from an external multidisciplinary panel of clinicians by using a modified Delphi process...
February 2016: Journal of Oncology Practice
Yu-Ling Huang, Hui-Ling Lin, Fang Wang, Shu-Fang Vivienne Wu
Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the pe-riod of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan...
December 2015: Hu Li za Zhi the Journal of Nursing
Joan Webster, Carolyn Lister, Jean Corry, Michelle Holland, Kerrie Coleman, Louise Marquart
PURPOSE: To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. DESIGN: We used a prospective cohort study to investigate the research question. SUBJECTS AND SETTINGS: The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion...
March 2015: Journal of Wound, Ostomy, and Continence Nursing
Diane K Boyle, Emily Cramer, Catima Potter, Mary W Gatua, James X Stobinski
Specialty certification enhances patient safety in health care by validating that practice is consistent with standards of excellence. The purpose of this research was to explore the relationship between direct-care, specialty-certified nurses employed in perioperative units, surgical intensive care units (SICUs), and surgical units and nursing-sensitive patient outcomes in SICUs and surgical units. Lower rates of central-line-associated bloodstream infections in SICUs were significantly associated with higher rates of CPAN (certified postanesthesia nurse) (β = -0...
November 2014: AORN Journal
Angela B Echeverria, Bernardino C Branco, Kay R Goshima, John D Hughes, Joseph L Mills
BACKGROUND: Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience. METHODS: We retrospectively evaluated emergency descending thoracic aortic endovascular interventions performed at a single academic level 1 trauma center between January 2005 and August 2013 including all cases of traumatic aortic injury, ruptured descending thoracic aneurysm, penetrating atherosclerotic ulcer, aortoenteric fistula, and acute complicated type B dissection...
December 2014: American Journal of Surgery
Linda Minnich, Jason Bennett, Jennifer Mercer
Front line staff identified skin tears and stage one pressure ulcers on post-surgical patients undergoing surgical interventions lasting longer than 2 hours. Collaboration between unit-based councils from the operating room, post-anesthesia care unit, and post-surgical units established a new process for early identification and prevention of surgical acquired pressure ulcers (SAPUs). Interdepartmental collaboration was essential to identifying patient safety concerns and developing a new process of pre-evaluation, early identification, and prevention of SAPUs...
October 2014: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Rachel M Hayes, Marcia E Spear, Sheree I Lee, Buffy E Krauser Lupear, Richard A Benoit, Rainy Valerio, Roger R Dmochowski
The objective was to determine the relationship between time in the operating room (OR) and hospital-acquired pressure ulcers (HAPUs), controlling for temporality. The research team identified 931 HAPUs among surgical patients and matched them to 4 controls by hospital length of stay at the time the pressure ulcer (PU) was documented. A regression model estimated the relationship between OR time and HAPU after controlling for matching, age, sex, admission and current Braden score, weight, year, and American Society of Anesthesiologists physical status score...
November 2015: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Rohini Paul, Stacey Paris McCutcheon, Jenna Penelope Tregarthen, Lyn Thayer Denend, Stefanos A Zenios
\Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India (now known as the Narayana Institute of Cardiac Sciences), is one of the world's largest and busiest cardiac hospitals. In early 2009, NHCH experienced a sharp increase in the number of surgical procedures performed and a corresponding rise in hospital-acquired pressure ulcers. The hospital sought to reduce pressure ulcer prevalence by implementing a portfolio of quality improvement strategies. Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU)...
August 2014: American Journal of Nursing
R A Glennie, V K Noonan, N Fallah, S E Park, N P Thorogood, A Cheung, C G Fisher, M F Dvorak, J T Street
STUDY DESIGN: Test-retest analysis. OBJECTIVES: To determine the intra- and inter-rater reliability of the Spine Adverse Events Severity System for Spinal Cord Injury (SAVES-SCI) in patients with traumatic SCI. SETTING: Quaternary care spine program in Vancouver, Canada. METHODS: Ten hypothetical patient cases were developed. The cases were completed by 10 raters (seven physicians, one nurse, one physiotherapist and one researcher) who were asked to identify and grade the severity of adverse events using SAVES-SCI twice with 1-week interval...
October 2014: Spinal Cord
Nicolas Bonnaig, Steven Dailey, Michael Archdeacon
➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding...
July 2, 2014: Journal of Bone and Joint Surgery. American Volume
Joyce Black, Michael Clark, Carol Dealey, Christopher T Brindle, Paulo Alves, Nick Santamaria, Evan Call
The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR)...
August 2015: International Wound Journal
C Bălălău, S Stoian, I Motofei, B Popescu, F Popa, R V Scăunaşu
UNLABELLED: The most common complication of Zenker's diverticulum is aspiration pneumonia, compression of the trachea and esophageal obstruction with large diverticulum, and increased risk of development of carcinoma. Thus bleeding occurs rarely, can be massive and life threatening, with ulceration being the most common cause. MATERIAL AND METHODS: We describe a patient with sever upper gastrointestinal bleeding as a result of a Zenker's diverticulum. A 75 year-old woman was referred to the emergency room and hospitalized for hematemesis, melena, asthenia and total dysphagia...
April 2013: Revista Medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti Din Iaş̧i
Denise D O'Brien, Amy M Shanks, AkkeNeel Talsma, Phyllis S Brenner, Satya Krishna Ramachandran
OBJECTIVE: The risk for pressure ulcers is rarely identified in the perioperative period, and the influence of this period on risk factors has not been as rigorously studied as the postoperative period. We hypothesized that intraoperative risk factors exist, which increase the likelihood of a postoperative new-onset pressure ulcer. DESIGN: A retrospective observational study. SETTING: A large midwestern U.S. quaternary care institution. PATIENTS: A total of 2,695 adult surgical patients underwent operative procedures and received care in one of three ICUs using an electronic documentation application...
January 2014: Critical Care Medicine
Christine M Walden, Scott B Bankard, Bradford Cayer, William B Floyd, Herbert G Garrison, Todd Hickey, Linda D Holfer, Michael F Rotondo, Walter J Pories
OBJECTIVES AND BACKGROUND: Obese patients are difficult to transport between emergency departments, imaging facilities, operating rooms, intensive care units, acute care units, and rehabilitation facilities. Each move, along with turning, bathing, and access to bathrooms, poses risks of injury to patients and personnel. Similarly, inadequate mobilization raises the risk of pressure ulcers. The costs can be prohibitive. METHODS: On 6 pilot units, mobilization of patients was delegated to trained lift team technicians who covered the units in pairs, 24 hours per day, 7 days per week, to assist with moving and lifting of patients weighing 200 pounds or more, with a Braden Scale score of 18 or less and/or the presence of pressure ulcers...
October 2013: Annals of Surgery
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