Deep Tissue Injury in Mechanically Ventilated Cardiovascular Postoperative Patients

DEEP TISSUE INJURY IN MECHANICALLY VENTILATED, POSTOPERATIVE ,CARDIOVASCULAR PATIENTS

A deep tissue injury (DTI) is a category of pressure ulcer described by the NPAUP as a "Purple or maroon discoloration of intact skin or a blood-filled blister due to damage of soft tissue from pressure and/or shear. Research shows that predictors of pressure ulcers in adult critical care patients include age, length of stay, mobility, friction & shear, and cardiovascular disease. Two high risk criteria for patients aquiring DTI's are:  Vasopressor administration for at least 24hours, and patients requiring mechanical ventilation for 24hours postoperatively. CLINICAL PROBLEM: 3 case studies of patients who  developed DTI's and met this criteria will be presented. Interestingly, it was also observed that in each case, the DTI was developed on the buttock closest to the ventilator. Patients were turned every 2 hrs. per nursing records. However, when turning practices were observed, when the patient was on his back, he was  turned  next to his side closest the ventilator.  This was done either as a matter of convenience or perceived limited turning surfaces. DISCUSSION/CONCLUSION: Increased awareness of turning practices, weekly skin rounds by unit management, and biweekly multidisciplinary rounds that incude a WOCN have resulted in decreased DTI's and no further unilateral buttock DTI's. While looking at the amount of pressure a patient sustains is certainly important, future mangement of this cardiovascular high risk population must also include looking at the patients tolerance for that pressure.