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PRESSURE INJURIES
Pressure Injuries during Cardiac Surgery
Adriana Weaver
School of Nursing, Liberty University
Author Note
Adriana J. Weaver
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Adriana J. Weaver
Email: aweaver19@liberty.edu
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Pressure Injuries during Cardiac Surgery
Background
Pressure injuries (PIs) after surgery affect thousands of patients’ worldwide. During
surgery, patients are rendered acutely immobile which places cardiac surgery patients at
particular risk for the development of sacral pressure injuries. Their management is expensive, a
cost that can be reduced with proper preventive measures. Patients having surgery under general
anesthesia are at risk of developing PI, yet no specific tool has been developed to assess the risk
in these patients (Haisley et al., 2020).
The development of PI is a complex phenomenon, where both intrinsic and extrinsic
factors are of importance. The most important factor for the increased risk of development of PI
is reduced mobility. PI can occur at any time when tissue is compressed, and the compression
causes a breakdown of the skin and underlying tissue. The risk of PI increases when the
bodyweight is not evenly distributed on a supportive surface, or the tissue is poorly perfused.
Several areas of the body are most affected by PI. The most common sites after surgery are the
occipital area of the skull, the scapulae, the elbows, but particularly the sacral area and the heels.
The severity of PIs varies, from erythema on intact skin to tissue destruction, involving
subcutaneous tissue, muscle and bone (Haisley et al., 2020).
Numerous clinical guidelines have been developed to improve pressure ulcer prevention
and treatment. In 2007, the National Pressure Ulcer Advisory Panel (NPUAP) established a
system for categorizing pressure injuries. It defines a pressure injury as “localized damage to the
skin and underlying soft tissue usually over a bony prominence or related to a medical or other
device.” In 2016, the NPUAP and European Pressure Ulcer Advisory Panel expanded the
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definition of pressure ulcers to 6 different stages (Geller & Seng, 2020). Preventive measures to
avoid pressure ulcers include the use of support surfaces and pressure-relieving devices.
Significance
Pressure injuries result in pain, infection, substantial additional health care costs,
increased hospital length of stay, and in extreme situations, death. The incidence of patients who
developed pressure injuries (PIs) after undergoing cardiovascular surgery has been reported as
high risk as 29.5%. Accurately identifying patients, such as those having cardiovascular surgery,
who may be at high risk of developing PIs is the key to prevention in the hospital setting. Many
risk factors are associated with PI development in cardiovascular surgical patients including
older age, low body mass index, smoking tobacco, skin conditions, diabetes mellitus,
hypertension, hemoglobin level, operative time, use of medication such as vasopressors and
corticosteroids, hypothermia, and blood loss. Undergoing cardiopulmonary bypass (CPB) is also
posited to be associated with the development of PIs (Chen et al., 2020).
Several interventions have been proposed in past research studies to alleviate PIs. These
include pressure relief, infection control, debridement, and dressings (eg, gauze, alginate, foam,
hydrocolloid, hydrogel, silver-containing dressings, honey-coating dressings, transparent film
dressings, negative pressure wound therapy) (Geller & Seng, 2020). As the risk of PIs increases,
researchers are looking for better ways to decrease these incidences. Recent studies have
included gel pads, prophylactic silicone foam dressings, foam mattresses, and alternating
pressure mattresses being used for prevention of PIs.
Research Hypothesis
This research question guiding this proposal will be: “In cardiovascular surgical patients,
does initiation of pressure reducing surfaces (alternating pressure mattress/polyether mattress)
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reduce the incidence of sacral pressure injuries over standard gel pads placed on the operating
room table?” The purpose of this research question is to determine if sacral pressure injuries in
cardiovascular surgical patients can be reduced with the use of alternating pressure air overlays
instead of gel mattress pads placed on an operating room table. The anticipated outcome
includes:
Improve health outcomes in patients
Increase skin perfusion
Reduce risk of sacral pressure injuries
Variable of interest consist of improving the patient outcome by providing a safe environment,
effective care, and safety measures such as alternating pressure devices to decrease pressure on
loadbearing tissues by increasing skin perfusion and reducing the risk of sacral pressure injuries.
The hypothesis statement will be that adding the use of alternating pressure devices will
decrease the incidence of sacral pressure injuries. It is known that sacral pressure injuries happen
24 to 72 hours after periods of acute periods of immobility (Joseph et al., 2019). The outcome
will be measured by data from literature review. This quantitative study will use correlational
research. This type of research measures connections between ideas, and the direction (positive
or negative) and strength of those connections (Sutherland, 2017, p.86). “The Lord will guide
you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame.
You will be like a well-watered garden, like a spring whose waters never fail” (New International
Bible, 1973/2011, Isaiah 58:11).
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References
Chen, X., Liao, H., Gao, W., Chen, Y., Huang, J., & Wei, Y. (2020). Cardiopulmonary bypass
duration and the incidence of pressure injuries in patients undergoing cardiovascular
surgery. Journal of Wound, Ostomy & Continence Nursing, 47(4), 343-
348. https://doi.org/10.1097/won.0000000000000655
Geller, C. M., & Seng, S. S. (2020). How to keep patients un-HAPI: Cardiac surgery and sacral
pressure injuries: Invited expert opinion: hospital-acquired pressure injuries. The Journal
of Thoracic and Cardiovascular Surgery, 160(1), 158-
163. https://doi.org/10.1016/j.jtcvs.2019.12.108
Haisley, M., Sørensen, J. A., & Sollie, M. (2020). Postoperative pressure injuries in adults
having surgery under general anaesthesia: Systematic review of perioperative risk
factors. British Journal of Surgery, 107(4), 338-347. https://doi.org/10.1002/bjs.11448
Joseph, J., McLaughlin, D., Darian, V., Hayes, L., & Siddiqui, A. (2019). Alternating pressure
overlay for prevention of Intraoperative pressure injury. Journal of Wound, Ostomy and
Continence Nursing, 46(1), 13-17. https://doi.org/10.1097/won.0000000000000497
New International Bible. (2011). New International Version Online.
https://www.biblica.com/bible/ (Original work published in 1973)
Sutherland, S. (2017). Research problem and purpose. In J. Gray, S. K. Grove, & S.
Sutherland (Eds.), Burns and grove's the practice of nursing research: Appraisal,
synthesis, and generation of evidence (8th ed., pp. 76-97). Elsevier.
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