The Effects of a Positioning Program for Pressure Ulcer and Peripheral Nerve Injury Prevention during Surgery among the Older Patients Undergoing Urological Surgery
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Abstract
Purpose: The aim of this study was to compare the pressure ulcer scores and the incidence of peripheral nerve injury among those who received the positioning program for pressure ulcer and peripheral nerve injury prevention with routine care and those who received only routine positioning and care among the older patients during urological surgery in a lithotomy position.
Design: Two groups experimental research with pre- and post-test design.
Methods: Participants were randomized into intervention and control groups. Forty-two elders in the intervention group were assigned to participate in the positioning program with routine care and forty-two elders in the control group received only routine positioning and care. Data were collected using a demographic data questionnaire, the Bates-Jensen Wound Assessment tool (Thai version), peripheral nerve injury assessment form. The positioning program consisted of the guideline for lithotomy positioning together with the use of warm gel cushions on the arm boards and sacrum area and intermittent pneumatic compression. Data were analyzed using independent t-test, the Mann-Whitney U test, the chi-square test and Fisher’s exact test.
Main findings: The intervention group had statistically lower pressure ulcer scores, compared to the control group (p < .05). In addition, the incidence of peripheral nerve injury of the intervention group was significantly lower than that of the control group (p < .05).
Conclusion and recommendations: The outcomes of intervention program based on the guideline for positioning and equipment used including warm gel and intermittent pneumatic compression showed lower scores for pressure ulcers and incidences of peripheral nerve injury than those in the control group. Thus, using the positioning program is recommended as a routine practice for pressure ulcer and peripheral nerve injury prevention in urological surgery patients.
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References
Spruce L. Positioning the patient. AORN J. 2021;114(1):75-84. doi: 10.1002/aorn.13442.
Mizuno J, Takahashi T. Evaluation of external pressure to the sacral region in the lithotomy position using the noninvasive pressure distribution measurement system. Ther Clin Risk Manag. 2017;13:207-13. doi: 10.2147/tcrm.S122489.
Mizuno J, Takahashi T. Factors that increase external pressure to the fibular head region, but not medial region, during use of a knee-crutch/leg-holder system in the lithotomy position. Ther Clin Risk Manag. 2015;11:255-61. doi: 10.2147/tcrm.S72511.
Webster J, Lister C, Corry J, Holland M, Coleman K, Marquart L. Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators. J Wound Ostomy Continence Nurs. 2015;42(2):138-44. doi: 10.1097/won.0000000000000092.
Buli B, Diriba T, W/Yohannes M, Tesfaye B. Magnitude of position-related soft tissue injuries and associated factors among elective adult surgical patients at Tikur anbessa specialized hospital, Addis ababa, Ethiopia. Ann Med Surg (Lond). 2022;82:104592. doi: 10.1016/j.amsu.2022.104592.
Yılmaz E, Başlı AA. Assessment of pressure injuries following surgery: a descriptive study. Wound Manag Prev. 2021;67(6):27-40.
Hippalgaonkar AV, Bokil CV. A prospective observational study to find the incidence of position related injuries in patients undergoing urological procedures under anaesthesia. J Evol Med Dent Sci. 2020;9(13):1026-31. doi: 10.14260/jemds/2020/221.
Pham B, Teague L, Mahoney J, Goodman L, Paulden M, Poss J, et al. Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis. Surgery. 2011;150(1):122-32. doi: 10.1016/j.surg.2011.03.002.
Choi MA, Kim MS, Kim C. Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room. J Tissue Viability. 2021;30(3):331-8. doi: 10.1016/j.jtv.2021.06.006.
Peixoto CA, Ferreira MBG, Felix M, Pires PDS, Barichello E, Barbosa MH. Risk assessment for perioperative pressure injuries. Rev Lat Am Enfermagem. 2019;27:e3117. doi: 10.1590/1518-8345.2677-3117.
Guideline at a glance: positioning. AORN J. 2017;106(5):460-5. doi: 10.1016/s0001-2092(17)30919-5.
Xiong C, Gao X, Ma Q, Yang Y, Wang Z, Yu W, et al. Risk factors for intraoperative pressure injuries in patients undergoing digestive surgery: a retrospective study. J Clin Nurs. 2019;28(7-8):1148-55. doi: 10.1111/jocn.14712.
Aloweni F, Ang SY, Fook-Chong S, Agus N, Yong P, Goh MM, et al. A prediction tool for hospital-acquired pressure ulcers among surgical patients: surgical pressure ulcer risk score. Int Wound J. 2019;16(1):164-75. doi: 10.1111/iwj.13007.
Oster KA, Oster CA. Special needs population: care of the geriatric patient population in the perioperative setting. AORN J. 2015;101(4):443-56; quiz 457-9. doi: 10.1016/j.aorn.2014.10.022.
Zhou F, Wu Z, Yu Y, Xu L. Establishment and application of pressure injury assessment module in operating room based on information management system. J Healthc Eng. 2022;2022:1463826. doi: 10.1155/2022/1463826.
Barrell K, Smith AG. Peripheral neuropathy. Med Clin North Am. 2019;103(2):383-97. doi: 10.1016/j.mcna.2018.10.006.
Joyce P, Moore ZE, Christie J. Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Syst Rev. 2018;12(12):CD012132. doi: 10.1002/14651858.CD012132.pub2.
Stanton C. Guideline for positioning the patient. AORN J. 2022;115(5):P5-P7. doi: 10.1002/aorn.13680.
Basic principles of patient positioning. AORN J. 2016;103(3):P10-2. doi: 10.1016/s0001-2092(16)00139-3.
Shakibamehr J, Rad M, Akrami R, Rad M. Effectiveness of tragacanth gel cushions in prevention of pressure ulcer in traumatic patients: a randomized controlled trial. J Caring Sci. 2019;8(1):45-9. doi: 10.15171/jcs.2019.007.
Preventing pressure injuries in patients placed on a spinal table. AORN J. 2019;109(5):P11-P13. doi: 10.1002/aorn.12706.
Guideline summary: positioning the patient. AORN J. 2017;106(3):238-47. doi: 10.1016/j.aorn.2017.07.006.
Link T. Guideline implementation: prevention of venous thromboembolism. AORN J. 2018;107(6):737-48. doi: 10.1002/aorn.12146.
Ren W, Duan Y, Jan YK, Li J, Liu W, Pu F, et al. Effect of intermittent pneumatic compression with different inflation pressures on the distal microvascular responses of the foot in people with type 2 diabetes mellitus. Int Wound J. 2022;19(5):968-77. doi: 10.1111/iwj.13693.
Guo Y, Zhao K, Zhao T, Li Y, Yu Y, Kuang W. The effectiveness of curvilinear supine position on the incidence of pressure injuries and interface pressure among surgical patients. J Tissue Viability. 2019;28(2):81-6. doi: 10.1016/j.jtv.2019.02.005.
Bates-Jensen BM, McCreath HE, Harputlu D, Patlan A. Reliability of the bates-jensen wound assessment tool for pressure injury assessment: the pressure ulcer detection study. Wound Repair Regen. 2019;27(4):386-95. doi: 10.1111/wrr.12714.
Prasungsit C. Tool to measure wound healing [Internet]. Mahidol University; 2016 [cited 2021 Feb 22]. Available from: http://www.si.mahidol.ac.th/th/Th/division/nuring/NDivision/N_APN/admin/download_files/8_100_1.pdf. (in Thai).
Ma L-Y, Chen H-L, Gu H-Y, Hua L, Gao X-M. Analysis of the clinical features and risk factors of device-related pressure injuries in the operating room. Int Wound J. 2023;20(3):706-15. doi: 10.1111/iwj.13912.
Fred C, Ford S, Wagner D, Vanbrackle L. Intraoperatively acquired pressure ulcers and perioperative normothermia: a look at relationships. AORN J. 2012;96(3):251-60. doi: 10.1016/j.aorn.2012.06.014.
Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia. 2018;73 Suppl 1:51-60. doi: 10.1111/anae.14140.
Prielipp RC, Morell RC, Butterworth J. Ulnar nerve injury and perioperative arm positioning. Anesthesiol Clin North Am. 2002;20(3):589-603. doi: 10.1016/s0889-8537(02)00009-3.
Harada Y, Tanaka JI, Umemoto T, Sekine RI, Wakabayashi T, Kijima K, et al. Toward standardized patient positioning to avoid peripheral nerve injury during laparoscopic colorectal surgery: application of a protocol and study of the resulting relationship between total rotation time and contact pressure at the shoulder. Asian J Endosc Surg. 2019;12(3):269-74. doi: 10.1111/ases.12645.