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Pressure Ulcer Prevention in Mechanically Ventilated Patients in the ICU in the face of hemodynamic instability

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Always have a questioning attitude

Evidence-based practice

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Prevlon AirTAP Patient Repositioning System

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Prevlon AirTAP Patient Repositioning System

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(Sage Products, 2017)

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Create a mandatory Computer Based Learning Module to disseminate evidence-based practice research findings that it can take patients with hemodynamic instability anywhere from 5 – 10 minutes to recover to their baseline following a lateral shift in position (as a means to begin to fight the stigma they should not be repositioned), and signs to look out for in a patient considered too unstable (Brindle et al., 2013).

Have a unit-wide initiative to institute Continuous Lateral Rotation Therapy in hemodynamically unstable patients to help their bodies begin to adjust to shifts in position and not become calibrated to lying supine, which greatly increases their risk of pressure ulcer formation.

See VCU Hemodynamic Instability Guideline

Provide Turn and Positioning devices (TAP) (such as the Prevlon AirTAP pictured right) for all ICUs, after extensive research on their effectiveness, to improve nursing compliance with frequent weight shift assistance in those client’s mechanically ventilated and sedated.

Benefits:

Takes less time and fewer nursing staff to turn and reposition

Anchor wedge system keeps the patient at a 30° turn (optimal) and off their sacrum

Minimizes friction and shear when pulling the patient up in bed
(Sage Products, 2017)

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Social: Nurses are used to hearing hemodynamic instability and automatically assuming the patient cannot tolerate frequent weight shift assistance (Brindle et al., 2013).  Nurses have to be willing to challenge this norm in front of their peers, based on findings from evidence based practice.

Financial: ICU units not ensuring there are 1-2 unlicensed assistant personnel to help nurses task, which contributes to limited participation in frequent turning and repositioning save hemodynamic instability.

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Analysis: Importance of Nurse's Involvement

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Analysis: Importance of Nurse's Involvement

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Involvement in prevention of pressure ulcers in critically ill and ventilated patients in the ICU is paramount for nurses to prevent future patient infections, help cut down hospital length of stay and readmission rates, and improve the overall cost of care

Patients in the ICU are on continuous cardiac monitoring, which allows nurses to always aware of their current hemodynamic status.  They can use their discretion as to whether or not it is safe to reposition a patient.

Nurses can implement evidence-based practices regarding prevention of pressure ulcers/injury in critically ill patients into their care, as well as, discuss findings with their units at Practice Counsel

Nurses being aware of a patient’s hemodynamic status and their risk of skin breakdown will allow them to provide the frequent weight assistance necessary to help prevent pressure ulcers

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Nurses are responsible for:

Assessing patient’s risk for pressure ulcer formation and skin breakdown by completing the Braden scale as part of their head-to-toe assessments

Nursing actions that could potentially exacerbate the issue:

Patients with a score of 12 or below (high risk for developing a HAPI) are not always being frequently turned and repositioned by nurses in the ICU (per observation during preceptorship experience), increasing the risk of acquring a pressure ulcer/injury

Nursing actions that are improving the issue:

Frequently repositioning devices that cause 10% of pressure ulcers in the ICU, such as endotracheal tubes, pulse oximeters, and Foley catheters (Cooper, 2013)

Assessing albumen levels, which allows a nurse to have an understanding of a patient's nutritional status and risk for skin breakdown

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Pressure ulcer formation in critically ill patients in the ICU who are mechanically ventilated and sedated, meaning they are unable to reposition themselves without nursing staff intervention.

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Incidence, Prevalence, and Importance of Prevention

Incidence of pressure ulcers in the ICU is 3.8 – 12.4%

Prevalence is 4 – 49%

Prevention- reduces costs and length of hospital stay, and allows hospitals to receive Medicaid and Medicare reimbursements

Assessment of Risk of Developing Pressure Ulcers/Injury

Braden scale

Prevention

Frequent turning and repositioning

Continuous Bedside Pressure Mapping

Turn and Positioning device (TAP)

Contraindications for Frequent Turning and Repositioning & Solutions

Major contraindication= hemodynamic instability

Solution= Continuous Lateral Rotation Therapy

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Continuous Lateral Rotation Therapy for ICU Patients with Hemodynamic Instability

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Continuous Lateral Rotation Therapy for ICU Patients with Hemodynamic Instability

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(Brindle, Malhotra, O’Rourke, Currie, Chadwick, Falls, Adams, Swenson, Tuason, Watson, & Creehan, 2013)

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Pressure Ulcer Prevention in Mechanically Ventilated Patients in the ICU in the face of hemodynamic instability

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Amanda Mouring