Prophylactic Sacral Foam Dressing to Prevent Deep Tissue Injury in Post-Operative Cardiac Surgery Patients

Robyn Strauss, ACNS-BC, MSN, RN, WCC

Ave Preston, ACNS-BC, MSN, RN, CWOCN

Nancy Findley, AGCNS-BC, MSN, RN, PCCN

Aditi Rao, PhD RN

Prophylactic Sacral Foam Dressings to Prevent Deep Tissue Injury in Post-Operative Cardiac Surgery Patients

Purpose: To determine if the use of prophylactic silicone foam dressings placed on the sacrum would prevent deep tissue pressure injury among critically ill cardiac surgery patients in an urban academic medical center.

Methodology: A prospective observation methodology was used to determine if placing sacral 9cm x 9cm silicone foam dressing on cardiac surgery patients preoperatively would reduce deep tissue pressure injury (DTPI) in the immediate postoperative period. Dressings were maintained for 5 days postoperatively. Twice daily, nursing staff peeled back the sacral dressing to assess sacral skin for breakdown. The same dressing was re-adhered to the sacrum. On post op day five, the dressing was removed. Starting in February of 2016, we examined 600 elective cardiac surgery patients (300 pre/300 post intervention) in the preoperative area, ICU, and step-down unit. Excluded were patients with pre-existing sacral pressure injury, patients who refused, patients with a preoperative length of stay greater than 2 days, and emergency cases where the patient bypasses the preoperative holding area.

Results: The outcome of this investigation demonstrated a clinically significant decrease (p <0.05) in the incidence of sacral deep tissue pressure injuries from 2.3% to 0% (n=300).

Conclusion: Critical care nurses often bear responsibility for the prevention and management of hospital acquired pressure injuries (HAPI) . Goal attainment, as defined by zero DTPI, was achieved within our 6 month post intervention period. Utilization of prophylactic sacral foam dressings has prevented the development of DTPI in postoperative cardiac surgical patients and has become the standard of care for this patient population.