Cath Lab Digest

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Index: Ostomy Wound Manage. 2013;59(2):44–48.

Abstract

  Deep tissue injury (DTI) can rapidly evolve into a higher stage pressure ulcer. Use of pressure-redistribution surfaces is a widely accepted practice for the prevention of pressure ulcers in acute care patients, particularly in departments where care processes limit mobility. A 15-year-old patient developed a sacral DTI 24 hours after completion of a lengthy (12-hour) electrophysiology (EP) study and catheter ablation. A root cause analysis (RCA) conducted to investigate the origin of the hospital-acquired suspected DTI prompted a small investigation to evaluate the pressure-distribution properties of the EP lab surface and an OR table pad. Five healthy adult employee volunteers were evaluated in the supine position by placing a sensing mat between the volunteer and the test surface. Interface pressures (on a scale of 0 mm Hg to 100 mm Hg) were captured after a “settling in” time of 4 minutes, and the number of sensors registering very high pressures (above 90 mm Hg) across the surface were recorded. On the OR table pad, zero to six sensors registered >90 mm Hg compared to two to 20 sensors on the EP lab surface. These data, combined with the acquired DTI, initiated a change in EP lab surfaces. Although interface pressure measurements only provide information about one potential support surface characteristic, it can be helpful during an RCA. Studies to compare the effect of support surfaces in all hospital units on patient outcomes are needed.

Keywords: deep tissue injury, pressure redistribution, support surface, in vivo testing

Potential Conflicts of Interest: none disclosed

Introduction

  According to the National Pressure Ulcer Advisory Panel1 (NPUAP), suspected deep tissue injuries (DTIs) are complex wounds that present as intact areas of purple or maroon skin discoloration as a result of underlying tissue damage. The category suspected deep tissue injury was incorporated into the NPUAP pressure ulcer staging system in 2007. DTIs are of particular concern to clinicians because they are often difficult to identify and can evolve rapidly to reveal damage and necrosis of deeper tissues.¹ In 2009, 36.8% of the pressure ulcers recorded in a survey of 86,932 acute care patients were facility-acquired, with 1% of these wounds documented as DTI.² A survey of Medicare statistics reveals that healthcare-associated pressure ulcers account for approximately $2.2 to $3.6 billion in healthcare costs each year.^3-5 A review⁶ of clinical evidence, animal studies, and in vitro models indicates that procedures lasting >3 hours are associated with increased rates of pressure ulcer formation in surgical patients; incidence continues to increase with extended duration thereafter.⁶

  Hospitals are continually evaluating ways to decrease hospital-acquired pressure ulcers (HAPUs), such as by utilizing pressure-redistributing mattresses. These surfaces are meant to either redistribute or reduce interface pressure, ideally to levels below 32 mm Hg, the average capillary closure pressure in human skin.⁷ Studies comparing the efficacy of various surfaces indicate that differences exist among them. For example, a randomized controlled trial8 evaluating 446 surgical patients showed the use of a dry viscoelastic polymer pad in the operating room (OR) resulted in significantly fewer postoperative pressure ulcers when compared to use of a standard surgical mattress (P = 0.010).