AMELİYATHANELERDE ÖNEMLİ BİR RİSK: BASINÇ YARALANMASI

Öz

Basınç yaralanması sağlık bakım maliyetlerini önemli ölçüde artırması, uzun bir tedavi süreci gerektirmesi ve hastanede kalış süresini uzatması nedeniyle önlenmesi ve tedavi edilmesi gereken küresel bir sorundur. Basınç yaralanması ağrıya, sosyal izolasyona ve iş kayıplarına neden olarak yaşam kalitesini olumsuz yönde etkiler. Cerrahi operasyon basınç yaralanması gelişimi için önemli bir risktir. Ameliyattan sonra ilk 48-72 saat içerisinde gelişen basınç yaralanmalarının ameliyata bağlı olduğu kabul edilir. Hastanın taşıma ya da pozisyon verme işlemlerinde basınç ve sürtünme kuvvetlerine maruz kalması, ameliyat tipine bağlı ameliyat süresinin uzaması, verilen anestezi etkisiyle duyusal algının bozulması ameliyat sırasında basınç yaralanmasına neden olan risk faktörleridir. Ayrıca bireysel risk faktörleri de ameliyata bağlı basınç yaralanma riskini artırır. Düşük ya da yüksek beden kütle indeksi, ileri yaş, komorbid hastalıklar ameliyattan önce değerlendirilmesi gereken bireysel risk faktörleridir. Kanıta dayalı geliştirilen rehberler ameliyata bağlı basınç yaralanmalarının önlenmesi için; perioperatif basınç yarası risk değerlendirmesinin yapılmasını, hastanın yeniden konumlandırılmasını, destek yüzeylerin kullanılmasını, topukların ameliyat masasıyla temasının kesilmesini, basıncın tüm bedene dengeli olarak dağıtılmasını önerir. Ameliyathane ekibinin önemli bir üyesi olan ameliyathane hemşireleri hastanın bireysel risk faktörlerini göz önünde bulundurarak ameliyat sırasında gelişebilecek basınç yaralanmaları konusunda dikkatli olmalı, cildin düzenli kontrolünü yapmalı ve riski önlemelidir.

Anahtar Kelimeler

• ameliyathane
• basınç yarası önleme
• basınç yarası risk faktörleri
• hemşirelik
• basınç yarası

AN IMPORTANT RISK TO PREVENT IN THE OPERATING ROOMS: PRESSURE INJURY

Öz

Pressure injury is a global problem that needs to be prevented and treated, as it significantly increases healthcare costs, requires a long treatment process and prolongs hospital stay. Pressure injury negatively affect the quality of life by causing pain, social isolation and job losses. Surgery is an important risk for pressure injury. Pressure injuries that develop within the first 48-72 hours after surgery are considered to be due to surgery. Exposure of the patient to pressure and friction force in carrying or positioning procedures, prolongation of the operation time depending on the type of surgery, deterioration of sensory perception with the effect of anesthesia are the risk factors that cause pressure injury during surgery. In addition, individual specific risk factors also increase the risk of pressure injury due to surgery. Low or high body mass index, advanced age, comorbid diseases are individual risk factors that should be evaluated before surgery. Evidence-based guidelines for the prevention of pressure injuries due to surgery; it recommends performing perioperative pressure wound risk assessment, repositioning the patient, using support surfaces cutting off the contact of the heels with the operating table, and distributing the pressure evenly throughout the body. Operating room nurses, who are an important member of the operating room team, should be careful about pressure injuries that may develop during surgery, should regularly check the skin and prevent the risk, taking into account the individual risk factors of the patient.

Anahtar Kelimeler

• Pressure sore
• operating room
• pressure sore prevention
• pressure sore risk factors

Kaynakça

1. 1. Gül Ş. Cerrahi Girişim Uygulanan Hastalarda Basınç Ülseri Gelişimin Önlenmesi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2014;1(3):54–61.
2. 2. Haesler E. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Indıvıduals ın the operatıng room. Cambridge Media: Osborne Park, Australia; 2014. p.57-9.
3. 3. Karg P, Ranganathan VK, Churilla M, Brienza D. Sacral skin blood flow response to alternating pressure operating room overlay. Journal of Tissue Viability 2019;28(2):75-80.
4. 4. Primiano M, Friend M, McClure C, Nardi S, Fix L, Schafer M, Savochka K, McNett M. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. Association of Operating Room Nurses Journal 2011;94(6):555-66.
5. 5. Riemenschneider KJ. Prevention of Pressure Injuries in the Operating Room A Quality Improvement Project. Journal of Wound Ostomy & Continence Nursing 2018;45(2):141-5.
6. 6. Khong BPC, Goh BC, Phang LY, David T. Operating room nurses' self-reported knowledge and attitude on perioperative pressure injury. International Wound Journal 2020;17(2):455-65.
7. 7. Eberhardt TD, Lima SBS, Avila Soares RS, Dutra Siveria ABT, Pozzebon BR, Reis CR. et al. Prevention Of Pressure İnjury İn The Operating Room:Heels Operating Room Pressure İnjury Trial. International Wound Journal 2020;17(7):1–8.
8. 8. Ter N, Yavuz Giersbergen M. Basınç Yaralarının Önlenmesi. Yavuz Van Gıersbergen M, Kaymakçı Ş, editör. Ameliyathane Hemşireliği. İzmir: Meta Basım Matbaacılık; 2015. p.483-9.

9. 9. Chen HL, Chen XY, Wu J.The incidence of pressure ulcers in surgical patients of the last 5 years: a systematic review. Wounds 2012;24(9):234-41.
10. 10. Spector WD, Limcangco R, Owens PL, Steiner CA. Marginal hospital cost of surgery-related hospital-acquired pressure ulcers. Medical Care 2016;54(9):845-51.
11. 11. Miller MW, Emeny RT, Freed GL. Reduction of Hospital-acquired Pressure Injuries Using a Multidisciplinary Team Approach: A Descriptive Study. Wounds 2019;31(4):108–13.
12. 12. Rızalar S. Ameliyat geçiren hastalarda basınç yaralanmalarının önlenmesi. Sakarya Üniversitesi Holistik Sağlık Dergisi 2020;3(1):88-97.
13. 13. Joseph J, McLaughlin D, Darian V, Hayes L, Siddiqui A. Alternating Pressure Overlay for Prevention of Intraoperative Pressure Injury. Journal of Wound Ostomy & Continence Nursing 2019;46(1):13-7.
14. 14. Coomer NM, Kandilov AM. Impact of hospital-acquired conditions on financial liabilities for Medicare patients. American Journal of Infection Control 2016;44(11):1326–34.
15. 15. Allegretti AL, Malkiewicz A, Brienza DM. Measuring Interface Pressure and Temperature in the Operating Room. Advances in Skin & Wound Care 2012;25(5):226-30.
16. 16. Kimsey DB. A Change in Focus: Shifting From Treatment to Prevention of Perioperative Pressure Injuries. Association of Operating Room Nurses Journal 2019;110(4):379-93.
17. 17. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. The International Guideline, 3rd Edition; 2019. https://internationalguideline.com/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf. Erişim tarihi: 05.01.2021.
18. 18. Burlingame, BL. Guideline Implementation: Positioning the Patient. Association of Operating Room Nurses Journal 2017;106(3):227-37.
19. 19. Rao AD, Preston AM, Strauss R, Stamm R, Zalman DC. Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients: a systematic review. Journal of Wound Ostomy & Continence Nursing 2016;43(3):242-7.
20. 20. Oliveira KF, Nascimento KG, Nicolussi AC, Chavaglia SRR, Araújo CA, Barbosa MH. Support surfaces in the prevention of pressure ulcers in surgical patients: An integrative review. International Journal of Nursing Practice 2017;23(4):e12553.
21. 21. Peixoto CA, Ferreira MBG, Felix MMS, Pires PS, Barichello E, Barbosa MH. Risk assessment for perioperative pressure injuries. Revista Latino-Americana de Enfermagem 2019;27:e3117.
22. 22. Menezes S, Rodrigues R, Tranquada R, Müller S, Gama K, Manso T. Injuries resulting from positioning for surgery: incidence and risk factors. Acta Medica Portuguesa 2013;26(1):12-6.
23. 23. Slowikowski GC, Funk M. Factors associated with pressure ulcers in patients in a surgical intensive care unit. Journal of Wound Ostomy & Continence Nursing 2010;37(6):619-26.
24. 24. National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and treatment of pressure ulcers: Quick reference guide. 2014. http://www.epuap.org/wpcontent/uploads/2010/10/Quick-Reference-GuideDIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf Erişim Tarihi: 19.08.2021.
25. 25. Robertson J, Stern M, Buelow-Smith L, Birt J, Buchel E, Campbell A, et al. Pressure ulser prevention and treatment of pressure ulcers clinical practices guideline. 2012. https://professionals.wrha.mb.ca/old/extranet/eipt/files/EIPT-013-004.pdf Erişim Tarihi: 19.08.2021.
26. 26. Gould L, Stuntz M, Giovannelli M, Ahmad A, Aslam R, Mullen-Fortino M, et al. Wound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair and Regeneration. 2016;24(1):145-62.
27. 27. Fırat Kılıç H, Sucudağ G. Basınç Yarası Değerlendirilmesinde Sık Kullanılan Ölçekler. Journal of Academic Research in Nursing 2017;1(1):49-54.
28. 28. He W, Liu P, Chen HL. The Braden scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis. Ostomy Wound Management 2012;58(2):34-40.
29. 29. Taşdemir N, Sönmez M, Çetinkaya B.E. Perioperative pressure injuries: risk faktors and risk assessment. Dönmez K, eds. Academic studies in educational sciences-II. 1 st ed. Ankara: Gece Kitaplığı; 2020. p.103-11.
30. 30. Lopes CM, Haas VJ, Dantas RA, Oliveira CG, Galvão CM. Assessment scale of risk for surgical positioning injuries. Revista latino-americana de enfermagem 2016;24:e2704.
31. 31. Munro, CA The development of a pressure ulcer risk-assessment scale for perioperative patients. Association of Operating Room Nurses Journal 2010; 92(3):272-87.
32. 32. Scott, SM. Progress and Challenges in Perioperative Pressure Ulcer Prevention. Journal of Wound, Ostomy, and Continence Nursing. 2015;42(5):480-5.
33. 33. Gao XL, Hu JJ, Ma Q, Wu HY, Wang ZY, Li TT, et al. Design and Research on Reliability-Validity for 3S Intraoperative Risk Assessment Scale of Pressure Sore. Journal of Huazhong University of Science and Technology [Medical Sciences] 2015;35(2):291-4.
34. 34. Soyer Ö, Özbayır T. 3S Ameliyathane Basınç Yarası Risk Tanılama Ölçeği’nin Türkçe’ye Uyarlanması. Uluslararası Hakemli Hemşirelik Araştırmaları Dergisi 2018;13:46-64.
35. 35. 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. Journal of Clinical Nursing 2019;28(7-8):1148-55.
36. 36. Engels D, Austin M, McNichol L, Fencl J, Gupta S, Kazi H. Pressure ulcers: Factors contributing to their development in the OR. Association of Operating Room Nurses Journal 2016;103(3):271-81.
37. 37. Kandemir D, Yüksel S. Ameliyat Kaynaklı Basınç Yaralanmalarını Önlemede Etkili Kanıt Temelli Girişimler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2021;8(1):85-92.
38. 38. AORN. Recommended practices for positioning the patient in the perioperative setting. Perioperative standards and recommended practices. Denver, CO: Association of Operating Room Nurses Journal, Inc; 2014.
39. 39. Spruce L, Van Wicklin SA. Back to Basics: Positioning the Patient. Association of Operating Room Nurses Journal 2014;100(3):298-305.
40. 40. Yoshimura M, Ohura N, Tanaka J, Ichimura S, Kasuya Y, Hotta O. et al. Soft silicone foam dressing is more effective than polyurethane film dressing for preventing intraoperatively acquired pressure ulcers in spinal surgery patients: the border operating room spinal surgery (BOSS) trial in Japan. International Wound Journal 2018;15(2):188-97.
41. 41. Haleem S, Mihai R, Rothenfluh DA, Reynolds J. Preventing iatrogenic facial pressure ulcers during spinal surgery: Prospective trial using a novel method and review of literature. International Wound Journal 2020;17(5):1391-5.
42. 42. Ezeamuzie O, Darian V, Katiyar U, Siddiqui A. Intraoperative use of low-profile alternating pressure mattress for prevention of hospital acquired pressure injury. Perioperative Care Operating Room Management 2019;17(2019):100080.
43. 43. Kirkland-Walsh H, Teleten O, Wilson M, Raingruber B. Pressure mapping comparison of four OR surfaces. Association of Operating Room Nurses Journal 2015;102(1):61.e1-61.e9.
44. 44. Aktaş D, Koçaşlı S. Ameliyathanede Çalışan Hemşirelerin Cerrahiye Bağlı Basınç Yaralanmalarına İlişkin Bilgi Düzeyleri. Celal Bayar Üniversitesi Sağlık Bilimleri Üniversitesi Dergisi 2020;7(2):173-9.