Yoğun Bakım Hastalarında Basınç Yaralanmalarının Önlenmesinde Hemşirenin Rolü: Risk Faktörleri, Girişimler ve Klinik Uygulamalar

Yıl 2025, Cilt: 6 Sayı: 2, 273 - 281, 31.08.2025

Mehmet Dalkılıç , Ferzan Kalayci Emek , Özlem Bilik

https://doi.org/10.58605/bingolsaglik.1694661

Öz

Basınç yaralanmaları, özellikle yoğun bakım ünitesi (YBÜ)’nde yatan hastalarda sık karşılaşılan, ciddi ve önlenebilir komplikasyonlardandır. Bu derleme çalışması, hemşirelerin basınç yaralanmalarının önlenmesindeki rolünü; risk faktörleri, girişimler ve klinik uygulamalar bağlamında ele almayı amaçlamaktadır. Literatür, basınç yaralarının etiyolojisinde içsel (immobilizasyon, yaş, malnütrisyon, kronik hastalıklar) ve dışsal (basınç, sürtünme, nem) faktörlerin etkili olduğunu göstermektedir. Hemşirelik bakımında en sık kullanılan risk değerlendirme aracı Braden Skalası’dır. Kanıta dayalı önleyici uygulamalar arasında destek yüzeylerinin kullanımı, düzenli pozisyon değişikliği, yeterli beslenme ve hidrasyon sağlanması, tıbbi cihazların neden olduğu basınca karşı önlem alınması yer almaktadır. Yoğun bakım hemşirelerinin bilgi düzeylerinin ve klinik uygulama becerilerinin yetersiz olması, basınç yarası gelişim oranlarını artıran temel faktörlerdendir. Eğitim eksiklikleri, iş yükü ve personel yetersizliği, önleyici stratejilerin uygulanmasını güçleştirmektedir. Türkiye'de basınç yarası prevalansı hastane genelinde %11,4–12,7 arasında değişmekte; YBÜ’nde bu oran %56,8’e kadar çıkmaktadır. Bu durum, basınç yaralarının bireysel sağlık ve sistem maliyeti üzerindeki yükünü ortaya koymaktadır. Sonuç olarak, hemşirelerin bu alandaki bilgi düzeylerinin artırılması, multidisipliner yaklaşımla desteklenmiş bakım protokollerinin uygulanması ve kanıta dayalı eğitimin yaygınlaştırılması, basınç yaralanmalarının önlenmesinde temel stratejiler olarak öne çıkmaktadır.

Anahtar Kelimeler

Basınç yarası , yoğun bakım , hemşirelik , risk değerlendirme

Etik Beyan

Bu çalışma, insan veya hayvan denekleri üzerinde yapılan bir klinik veya deneysel araştırma niteliği taşımamaktadır. Çalışma kapsamında herhangi bir bireysel sağlık verisi toplanmamış, doğrudan insan katılımcılara yönelik veri toplama süreçleri gerçekleştirilmemiştir. Bu nedenle, ilgili mevzuatlar ve araştırma etiği ilkeleri doğrultusunda etik kurul iznine gerek bulunmamaktadır.

Destekleyen Kurum

Araştırma için herhangi bir kurum yada kuruluştan destek alınmamıştır.

Teşekkür

Yoktur.

The Role Of The Nurse In The Preventıon Of Pressure Injurıes In Intensıve Care Unıt Patıents: Rısk Factors, Interventıons And Clınıcal Practıces

Öz

Pressure injuries are common, serious, and largely preventable complications, especially among intensive care unit (ICU) patients. This review highlights the critical role of nurses in preventing these injuries by examining risk factors, interventions, and clinical practices. Both intrinsic (e.g., immobilisation, age, malnutrition, chronic diseases) and extrinsic (e.g., pressure, friction, moisture) factors contribute to the development of pressure injuries. The Braden Scale is widely used by nurses for risk assessment. Evidence-based practices such as using support surfaces, frequent repositioning, ensuring proper nutrition and hydration, and protecting the skin from medical device-related pressure are essential preventive measures. However, many ICU nurses lack adequate knowledge and skills, which, along with heavy workloads, limited staff, and insufficient training, hinders effective prevention. In Turkey, the overall hospital prevalence of pressure injuries is between 11.4–12.7%, rising to 56.8% in ICUs. This highlights their significant impact on patient health and healthcare costs. To address this, it is vital to enhance nurses’ knowledge, promote the implementation of care protocols within a multidisciplinary framework, and support widespread, evidence-based education initiatives aimed at reducing the incidence of pressure injuries.

Anahtar Kelimeler

Pressure Injury , Intensive Care , Nursing , Risk Assessment

Kaynakça

• Al-Dorzi HM. Prevention of pressure injury in the intensive care unit. Saudi Crit Care J. 2019;3(1):24–28. doi:10.4103/2543-1854.259474
• European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: Clinical practice guideline. EPUAP/NPIAP/PPPIA; 2019.
• Cox J, Edsberg LE, Koloms K, VanGilder C. Pressure injuries in critical care patients in US hospitals. J Wound Ostomy Continence Nurs. 2022;49(1):21–28. doi:10.1097/WON.000000000000083
• Lee SY, Oh DK, Hong S, Lim C, Huh JW. Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit. Korean J Intern Med. 2022;37(6):1186–1194. doi:10.3904/kjim.2021.546
• Coyer F, Gardner A, Doubrovsky A, Cole R, Ryan FM, Allen C, McNamara G. Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). Am J Crit Care. 2015;24(3):199–209. doi:10.4037/ajcc2015930
• Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016;43(6):585–597. doi:10.1097/WON.0000000000000281
• Coyer F, Cook JL, Doubrovsky A, Campbell J, Vann A, McNamara G. Understanding contextual barriers and enablers to pressure injury prevention practice in an Australian intensive care unit: An exploratory study. Aust Crit Care. 2019;32(2):122–130. doi:10.1016/j.aucc.2018.02.008
• Jacq G, Valera S, Muller G, Decormeille G, Youssoufa A, Poiroux L, et al. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The Pressure study. Aust Crit Care. 2021;34(5):411–418. doi:10.1016/j.aucc.2020.12.001
• Makic BFM. [Editorial]. J PeriAnesth Nurs. 2015;30(4):336–337. doi:10.1016/j.jopan.2015.05.004
• Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, et al. Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: The DecubICUs study. Intensive Care Med. 2021;47(4):503–520. doi:10.1007/s00134-020-06234-9
• Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, et al. Device-related pressure ulcers: SECURE prevention. J Wound Care. 2022;31(Sup3a):S1–S72
• Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, et al. Incidence and prevalence of pressure injuries in adult intensive care patients: A systematic review and meta-analysis. Crit Care Med. 2018;46:e1074–e1081. doi:10.1097/CCM.0000000000003366
• Çavuşoğlu A, Yeni K, İncekara H, Acun A, Polat Dünya C, Tülek Z. Bir yoğun bakım ünitesinde basınç yarası prevalansı: Retrospektif bir çalışma. J Acad Res Nurs (JAREN). 2020;6(2).
• Dang W, Liu Y, Zhou Q, Duan Y, Gan H, Wang L, et al. Risk factors of medical device‐related pressure injury in intensive care units. J Clin Nurs. 2021;31(9-10):1174–1183. doi:10.1111/jocn.15974
• Fulbrook P, Lovegrove J, Hay K, Coyer F. State‐wide prevalence of pressure injury in intensive care versus acute general patients: a five‐year analysis. J Clin Nurs. 2023;32(15-16):4947–4961. doi:10.1111/jocn.16687
• Lien R, Wang C, Hung S, Lu S, Yang W, Chin S, et al. Reduction in the incidence density of pressure injuries in intensive care units after advance preventive protocols. Healthcare (Basel). 2023;11(15):2116. doi:10.3390/healthcare11152116
• Çor Z, Soysal GE. Basınç yarası önleme çalışmaları: Güncel bakış. Ahi Evran Med J. 2024;8(2):242–250.
• Esen H, Özbek C. Root Cause Analysis and Prevalence of Pressure Injuries a Neurointensive Care Unit. Turk J Intensive Care. 2023;21(2).
• Gencer ZE, Ünal E, Özkan Ö. Basınç ülserleri tedavi maliyetleri etkililik analizi: Konvansiyonel ve modern yara bakım tedavi maliyetlerinin karşılaştırılması. Akdeniz Tıp Derg. 2019;5(2):201–208.
• Padula WV, Delarmente BA. The national cost of hospital‐acquired pressure injuries in the United States. Int Wound J. 2019;16(3):634–640. doi:10.1111/iwj.13071
• Teixeira-Vaz A, Rocha JA, Oliveira M, Reis DA, Moreira TS, Silva AI, Paiva JA. The PRINCOVID retrospective study: A predictive model of pressure injuries for critical COVID-19 patients. Am J Phys Med Rehabil. 2023;102(8):707–714.
• Roussou E, Fasoi G, Stavropoulou A, Kelesi M, Vasilopoulos G, Gerogianni G, Alikari V. Quality of life of patients with pressure ulcers: A systematic review. Med Pharm Rep. 2023;96:123–130. doi:10.15386/mpr-2531
• Han Y, Jin Y, Jin T, Lee SM, Lee JY. Impact of pressure injuries on patient outcomes in a Korean hospital: A case-control study. J Wound Ostomy Continence Nurs. 2019;46:194–200. doi:10.1097/WON.0000000000000528
• Alderden J, Drake KP, Wilson A, Dimas J, Cummins M, Yap TL. Hospital acquired pressure injury prediction in surgical critical care patients. BMC Med Inform Decis Mak. 2021;21(1):1. doi:10.1186/s12911-020-01371-z
• Cambaz C, Köken ZÖ, Sayın MM. Incidence, characteristics and risk factors of endotracheal tube‐related pressure injuries in intensive care units. Nurs Crit Care. 2024;29(6):1610–1618. doi:10.1111/nicc.13164
• Özlüer YE, Doğruyol S, Karaman K, Doğruyol T. Victims of terrorism-related disasters: Experience of a hospital on the border of Iraq. Disaster Emerg Med J. 2021;6(1):26–32. doi:10.5603/demj.a2021.0005
• Waladani B, Suwaryo PAW, Yuniar I, Yuwono P, Setianingsih E. Predictive value of non-invasive intracranial pressure monitoring in profoundly impaired traumatic brain injury patients. Babali Nurs Res. 2023;4(4):714–722. doi:10.37363/bnr.2023.44281
• Borojeny LA, Albatineh AN, Dehkordi AH, Gheshlagh RG. The incidence of pressure ulcers and its associations in different wards of the hospital: A systematic review and meta-analysis. Int J Prev Med. 2020;11. doi:10.4103/ijpvm.IJPVM_182_19
• Kalkavan EB, Şendir M. Braden ölçeği ile basınç yarası riski belirlenen hastalarda risk faktörleri ile basınç yarası arasındaki ilişkinin incelenmesi. Sağlık ve Spor Bilimleri Dergisi. 2024;7(1):28–54.
• Konateke S. Ameliyathanede önlenmesi gereken önemli bir risk: basınç yaralanması. J Anatolia Nurs Health Sci. 2021. doi:10.17049/ataunihem.902979
• Sibbald RG, Ayello EA. Results of the 2022 wound survey on skin failure/end-of-life terminology and pressure injuries. Adv Skin Wound Care. 2023;36(3):151–157. doi:10.1097/01.asw.0000919400.33004.17
• Yusharyahya SN, Legiawati L, Astriningrum R, Jonlean R, Andhira V. Characteristics of pressure injuries among geriatric patients at an Indonesian tertiary hospital: A cross-sectional study. Med J Indones. 2023;32(3):183–189. doi:10.13181/mji.oa.237092
• Lim SY, Jeong YM, Jeong SY. Characteristics and risk factors for pressure ulcers in severe trauma patients admitted to the trauma intensive care unit. J Acute Care Surg. 2023;13(2):47–57.
• VanGilder C, Cox J, Edsberg LE, Koloms K. Pressure injury prevalence in acute care hospitals with unit-specific analysis. J Wound Ostomy Continence Nurs. 2021;48(6):492–503. doi:10.1097/WON.0000000000000817
• Bustamante YIV, Martinez OFA. Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study. Belitung Nurs J. 2025;11(1):25.
• Gönderen K, Gönderen A, Simavlıoğlu G, İdil D. Yoğun bakım ünitesine yatış anında basınç ülseri olan ve yatışı sırasında basınç ülseri gelişen hastaların karşılaştırılması. Ankara Eğit Araştırma Hastanesi Tıp Derg. 2024;56(3):178–181. doi:10.20492/aeahtd.738260
• Alkhatieb MT, Abdulwassi HK, Fallatah AM, Alghamdi KM, Al-Abbadi W, Altaifi R. Knowledge of diabetic foot among nurses at a tertiary hospital in Saudi Arabia. Med Arch. 2022;76(3):190. doi:10.5455/medarh.2022.76.190-197
• Yılmazer T, Tüzer H, Tarla A. Basınç yarasının önlenmesinde hemşirelerin bilgi düzeylerinin incelenmesi. Sağlık Akademisi Kastamonu. 2019;4(3):211–22
• Mostafa OE, Zakari N, Salem MR. Evaluation of nurses’ attitudes, behaviors, and barriers toward pressure ulcer prevention in neonatal and pediatric intensive care units. Front Pediatr. 2024;12. doi:10.3389/fped.2024.1455950
• Isfahani P, Alirezaei S, Samani S, Bolagh F, Heydari A, Sarani M, et al. Prevalence of hospital-acquired pressure injuries in intensive care units of the eastern Mediterranean region: a systematic review and meta-analysis. Patient Saf Surg. 2024;18(1). doi:10.1186/s13037-023-00383-8
• Karahan E, Çelik S, Uçar Ö. Incidence of pressure ulcers in the patients on mechanical ventilation: A prospective study. J Contemp Med. 2020;10(1):62–69. doi:10.16899/jcm.628095
• Alshahrani B, Middleton R, Rolls K, Sim J. Critical care nurses’ knowledge and attitudes toward pressure injury prevention: A pre and post intervention study. Intensive Crit Care Nurs. 2023. doi:10.1002/nop2.2110
• Lin F, Wu Z, Song B, Coyer F, Chaboyer W. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. Int J Nurs Stud. 2020; 102:103483.
• Uçar Ö, İlçe A. Palyatif hemşirelerin basınç yarası önleme bilgi düzeyleri ile tutumları arasındaki ilişki. Bingöl Univ Sağlık Derg. 2023;4(2):213–223.
• Beeckman D, Serraes B, Anrys C, et al. A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents. Int J Nurs Stud. 2019; 97:105–113.
• Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, et al. Factors affecting the incidence and prevalence of pressure ulcers in COVID‐19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J. 2022;19(8):2039–2054. Doi:10.1111/iwj.13804
• Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, et al. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud. 2024; 155:104768. doi:10.1016/j.ijnurstu.2024.104768
• Alves J, Azevedo R, Marques A, Encarnação R, Alves P. Pressure injury prediction in intensive care units using artificial intelligence: A scoping review. Nurs Rep. 2025;15(4):126. doi:10.3390/nursrep15040126
• Shi C, Dumville JC, Cullum N. Evaluating the development and validation of empirically-derived prognostic models for pressure ulcer risk assessment: A systematic review. Int J Nurs Stud. 2019; 89:88–103.
• National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: Clinical practice guideline. NPUAP/EPUAP/PPPIA; 2014. [Available from: https://www.npuap.org]
• López M, Jiménez JM, Fernández M, Martín B, Cao MJ, Castro MJ. Relationship between pressure ulcer risk based on Norton Scale and on the “Eating/Drinking” need assessment. J Nurs Manag. 2019;27(1):117–124.
• Serrano ML, Méndez MIG, Cebollero FMC, Rodríguez JSL. Risk factors for pressure ulcer development in intensive care units: A systematic review. Med Intensiv. 2017; 41:339–346. doi: 10.1016/j.medin.2016.09.003
• Ladios-Martin M, Fernández-de-Maya J, Ballesta-López FJ, Belso-Garzas A, Mas-Asencio M, Cabañero-Martínez MJ. Predictive modeling of pressure injury risk in patients admitted to an intensive care unit. Am J Crit Care. 2020;29:e70–e80. doi:10.4037/ajcc2020237
• Picoito R, Lapuente S, Ramos A, Rabiais I, Deodato S, Nunes E. Risk assessment instruments for pressure ulcer in adults in critical situation: A scoping review. Rev Lat Am Enferm. 2023;31: e3983. Doi:10.1590/1518-8345.6659.3983
• Wei M, Wu L, Chen Y, Fu Q, Chen W, Yang D. Predictive validity of the Braden Scale for pressure ulcer risk in critical care: A meta-analysis. Nurs Crit Care. 2020; 25:165–170. doi:10.1111/nicc.12500
• Vocci MC, Lopes Saranholi T, Amante Miot H, Fernandes Abbade LP. Intensive care pressure injuries: A cohort study using the CALCULATE and Braden Scales. Adv Skin Wound Care. 2022; 35:1–8. doi: 10.1097/01.ASW.0000815488.17717.68
• Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev. 2019;(1):CD006471. doi: 10.1002/14651858.CD006471.pub4
• Adıbelli Z, Korkmaz M. Effects of repositioning intervals on pressure sore development in critically ill patients: A systematic review. J Nurs Res. 2018;26(3):253–261. doi:10.1097/jnr.0000000000000258
• Nisa MU, Rafiq N, Ali A, Rizwan Z, Ilyas F, Fatima N. Evaluation of knowledge among nurses about pressure ulcer in a tertiary care hospital, Lahore. J Health Rehabil Res. 2024;4(2):543–547.
• Wahyuni S, Sahar J, Rustina Y. A systematic review of pressure ulcer prevention. Fundam Manag Nurs J. 2023;6(1):e41956. Doi:10.20473/fmnj. v6i1.41956
• Peng G, Wang L, Tian S, Fan Y. Modular pressure redistribution cushion with proprioceptive soft–rigid hybrid actuator. Adv Intell Syst. 2024;6(1):2300422.
• Teleten O, Polyak TS, Espinoza J, Li AI, Rodgers AJ, Kirkland-Kyhn H. Measuring pressure redistribution properties of 4 hospital bed surfaces: A quality improvement project. Wound Manag Prev. 2022;68(6):18–26.
• Neupane G, Sah C. Knowledge regarding preventive measures of pressure ulcer among nurses. J Chitwan Med Coll. 2020;10(2):40–45. doi:10.54530/jcmc.119
• Anita F, Chayati N, Wantonoro W. Pressure-relieving devices to prevent pressure injury in bedridden patients: A literature review. Bali Med J. 2021;10(3):1357–1363. Doi:10.15562/bmj. v10i3.3037
• Galetto SGS, Nascimento ERP, Hermida PMV, Malfussi LBH. Medical device-related pressure injuries: an integrative literature review. Rev Bras Enferm. 2019;72(2):505–512. doi:10.1590/0034-7167-2018-0530
• Ni TF, Wang J, Chen C, Shih DF, Wang J. Can a prolonged healing pressure injury be benefited by using an AI mattress? A case study. BMC Geriatr. 2024;24(1). Doi:10.1186/s12877-024-04900-x
• Martel T, Orgill DP. Medical device–related pressure injuries during the COVID-19 pandemic. J Wound Ostomy Continence Nurs. 2020;47(5):430–434. doi:10.1097/WON.0000000000000689
• Erbay Dallı Ö, Kelebek Girgin N. Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence. Intensive Crit Care Nurs. 2024; 82:103622. Doi: 10.1016/j.iccn.2024.103622