Effect of different positioning before, during and after surgery on pressure injury: a randomized controlled trial protocol

Authors

  • Bedia Guler Marmara University Institute of Health Sciences, Istanbul, Turkey https://orcid.org/0000-0002-0405-7034
  • Aysel Gurkan Department of Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey

DOI:

https://doi.org/10.18203/2349-3259.ijct20240042

Keywords:

Surgery-induced pressure injury, Prevention, Positioning

Abstract

Background: Patients undergoing surgery are at risk of developing pressure injuries because they remain immobile and in a fixed position on the operating table for a long time under anesthesia. Prevention of surgery-induced pressure injuries is the best strategy and requires risk assessment and timely implementation of preventive interventions. This trial aims to evaluate the effect of positioning in a different position pre-operatively and post-operatively than the position adopted during surgery on pressure injuries.

Methods: This trial was designed as a prospective randomized controlled study. Participants meeting the inclusion criteria will be assigned to the intervention or control groups using a random number generator. The participants in the intervention group will be placed in different positions than their surgical position during the night before surgery, and the first 36 h after surgery. The control group will receive only routine care. The groups will be evaluated in terms of pressure injury development for at least 72 h, until discharge.

Conclusions: Surgery-induced pressure injuries have important effects on patients, healthcare professionals, and healthcare organizations. Current guidelines recommend that patients be positioned in a different position preoperatively and postoperatively than the surgical position to redistribute the pressure generated during surgery. There is a need for well-designed, comprehensive studies to investigate the effectiveness of this weak evidence-level recommendation. This trial will provide valuable evidence to inform clinical practice, guide surgical nurses, and allow evaluation of the effects of this intervention.

Trial registration: Clinical trials registration number NCT05549830

References

Walton-Geer PS. Prevention of pressure ulcers in the surgical patient. AORN J. 2009;89(3):538-48.

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance (NPUAP/EPUAP/PPPIA). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Perth, Australia. 2014.

Shafipour V, Ramezanpour E, Gorji MAH, Moosazadeh M. Prevalence of postoperative pressure ulcer: A systematic review and meta-analysis. Electronic Physician. 2016;8(11):3170-6.

Peixoto CA, Ferreira MBG, Felix MMS, Pires PS, Barichello E, Barbosa MH. Risk assessment for perioperative pressure injuries. Rev Lat Am Enfermagem. 2019;27:e3117.

Spuce L. Back to basics: preventing perioperative pressure injuries. AORN J. 2017;105(1):92-9.

Primiano M, Friend M, McClue C, Nardi S, Fix L, Schafer M et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94(6):555-66.

Munro CA. The development of a pressure ulcer risk-assessment scale for perioperative patients. AORN J. 2010;92(3):272-87.

Kandemir D, Yüksel S. Effective evidence-based interventions in preventing surgical pressure injuries. J Hacettepe University Faculty Nursing. 2021;8(1):85-92.

Buso FD, Ferreira MB, Felix MM, Galvão CM, Barichello E, Barbosa MH. Pressure injury related to surgical positioning and associated factors. Acta Paul Enferm. 2021;34:eAPE00642.

Ramezanpour E, Emami ZA, Heidari MA, Yazdani CJ, Moosazadeh M, Shafipour V. Incidence and risk factors of pressure ulcers among general surgery patients. J Nursing Midwifery Sci. 2018;5(4):159-64.

Kim JM, Lee H, Ha T, Na S. Perioperative factors associated with pressure ulcer development after major surgery. Korean J Anesthesiol. 2018;71(1):48-56.

Chen Y, He L, Qu W, Zhang C. Predictors of intraoperative pressure injury in patients undergoing major hepatobiliary surgery. J Wound Ostomy Continence Nurs. 2017;44(5):445-9.

Shaw L, Chang P, Lee J, Kung H, Tung T. Incidence and predicted risk factors of pressure ulcers in surgical patients: experience at a medical center in Taipei, Taiwan. Biomed Res Int. 2014;2014:416896.

Guo Y, Zhao K, Zhao T, Li Y, Yu Y, Kaung 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.

Akan C, Sayın YY. Prevalence of pressure injuries and risk factors in long-term surgical procedures. Bezmialem Sci. 2021;9(1):75-83.

Karadag M, Gümüskaya N. The incidence of pressure ulcers in surgical patients: a sample hospital in Turkey. J Clin Nurs. 2006;15(4):413-21.

Gürkan A, Kırtıl İ, Aydın DY, Kütük G. Pressure injuries in surgical patients: a comparison of Norton, Braden and Waterlow risk assessment scales. J Wound Care. 2022;31(2):170-7.

Black J, Fawcett D, Scott S. Ten top tips: preventing pressure ulcers in the surgical patient. Wounds Int. 2014;5(4):14-8.

Chen HL, Chen XY, Wu J. The incidence of pressure ulcers in surgical patients of the last 5 years. Wounds. 2012;24(9):234-41.

Scott SM. Progress and challenges in perioperative pressure ulcer prevention. J Wound Ostomy Continence Nurs. 2015;42(5):480-5.

Lumbley JL, Ali SA, Tchokouan LS. Retrospective review of predisposing factors for intraoperative pressure ulcer development. J Clin Anesth. 2014;26(5):368-74.

Haisley M, Sorensen JA, Sollie M. Postoperative pressure injuries in adults having surgery under general anaesthesia: systematic review of perioperative risk factors. Br J Surg. 2020;107(4):338-47.

Walsh M. Pressure ulcer prevention. AORN J. 2011;93(2):197-8.

Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.

Gül A, Şengül T, Yavuz HÖ. Assessment of the risk of pressure ulcer during the perioperative period: adaptation of the Munro scale to Turkish. J Tissue Viability. 2021;30(4):559-65.

Lei L, Zhou T, Xu X, Wang L. Munro pressure ulcer risk assessment scale in adult patients undergoing general anesthesia in the operating room. J Healthc Eng. 2022;2022:4157803.

Bruno R, Bertolino D, Garbarino E, Munro CA, Barisone M, Molin AD. Translation, cross-cultural adaptation, and validation of the Munro scale in Italian. Index Wound Manag Prev. 2022;68(2):34-41.

Li D, Tang J, Gan X. Reliability and validity of the Munro scale on the assessment of pressure ulcer risks in adult perioperative patients: a cross-sectional study. Int J Clin Exp Med. 2018;11(9):9811-8.

Heye ML, Foster L, Bartlett MK, Adkins S. A preoperative intervention for pain reduction, improved mobility, and self-efficacy. Appl Nurs Res. 2002;15(3):174-83.

Ayoğlu T, Akyolcu N. Validity and reliability study of Turkish version of patient mobility and observer mobility scales. In: 19th National Surgery Congress, 14th Surgical Nursing Congress Proceedings Book. Antalya, Turkey. 2014: HP-07. Available at: https://www.turkcer.org.tr/files/files/2014_bildiri_kitabi.pdf. Accessed on 19 February 2023.

Yolcu S, Akın S, Durna Z. Evaluation of patients' movement levels and factors associated with movement levels in the postoperative period. J Educ Res Nurs. 2016;13(2):129-38.

Aksuoğlu A, Yanmış S, Deşer SB. Mobility levels and classification of postoperative patients in the cardiovascular surgery intensive care unit. SETSCI Conference Indexing System. 2018;(3):970-2.

Xiong C, Gao X, Ma Q, Yang Y, Wang Z. Risk factors for intraoperative pressure injuries in patients undergoing degistive surgery: a retrospective study. J Clin Nurs. 2019;28(7-8):1148-55.

Putnam K. Minimizing pressure ulcer risk for surgical patients. AORN J. 2016;103(4):7-9.

Ezeamuzie O, Darian V, Katiyar U, Siddiqui A. Intraoperative use of low-profile alternating pressure mattress for prevention of hospital acquired pressure injury. Perioper Care Oper Room Manag. 2019;17.

Joseph J, McLaughlin D, Darian V, Hayes L, Siddiqui A. Alternating pressure overlay for prevention of intraoperative pressure injury. J Wound Ostomy Continence Nurs. 2019;46(1):13-17.

Kirkland-Walsh H, Teleten O, Wilson M, Raingruber B. Pressure mapping comparison of four OR surfaces. AORN J. 2015;102(1):61.e1-9.

Malkoun M, Huber J, Huber D. A comparative assessment of interface pressures generated by four surgical theatre heel pressure ulcer prophylactics. Int Wound J. 2012;9(3):259-63.

Goodwin CR, Recinos PF, Omeis I, Momin EN, Witham TF, Bydon A et al. Prevention of facial pressure ulcers using the Mayfield clamp for sacral tumor resection. J Neurosurg Spine. 2011;14(1):85-7.

Kimsey DB. A Change in focus: Shifting from treatment to prevention of perioperative pressure injuries. AORN J. 2019;110(4):379-90.

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Published

2024-01-24