What should surgical professionals consider when purchasing patient positioning products?
March 24, 2010
1. Patient Position. There are two main goals necessary when positioning the patient. The first is to provide access to the surgical site. This is reasonably straight forward with modern devices that provide secure positioning while allowing necessary motion specific to the procedure being done. The second is to insure that other complications aren’t created during the procedure. This gets a bit more complicated as the whole patient is involved not just the surgical site. Pressure ulcers of varying severity are regrettably all too common.
2. Protecting the patient during the procedure. The genesis of a pressure ulcer is when capillary blood flow is stopped long enough for tissue to begin to die. Values vary with the general health, age and part of the body but a pressure of 32-36 mm/hg is generally enough to stop the flow. This ischemia typically starts at a bony prominence deep, necrosis begins in as little as two hours and works out toward the surface. In the past, it was thought that most pressure ulcers were created during recovery periods. Latest data indicate that that isn’t so and that most ulcers started perhaps 2-5 days before they present at the surface. This points directly at the Operating Room.
3. Pressure redistribution. To prevent pressure ulcers the pressure must be redistributed over a larger area. The best way to accomplish this is by simulating immersion. As Archimedes determined, a body that is immersed will have an equal pressure exerted upon the area of immersion. While floating a patient is obviously impractical, compounds such as gels that simulate a liquid can be used to help redistribute this pressure. Compressible materials such as foam cannot.
4. The Risk. A fully developed stage 3 or 4 pressure ulcer can cost $40-$50,000.00 to treat. Typically necrotic tissue must be debrided, skin/tissue graphs may be necessary, and, Medicare/Medicaid and many insurance companies have ceased covering the cost.