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Pressurecare

Patient Positioning in Operating Room

Agenda

Recap on Product Range

4 Main Positions & Associated Risks with backup Info on

Pressure Mapping

Background info on Pressure Ulcers and Nerve Injuries

Implications and Considerations for Clinical Practice

Reasons for Pressurecare Range

Some Interesting Findings…

• Surgical patients account for 20% to 30% of all pressure injuries.

• Pressure Sores are ‘not only life altering but life threatening’!

• Usually presents as a burn or bruise with rapid progression within 1–3

days post surgery.

• Pressure injuries are, in most cases, preventable!

• Patient Positioning: Education is key. (www.surgicalproductsmag.com. 2010. Claire Williams

Tager)

Preventative Measures…

Positioning a patient properly on the operating table is critical

Why Silicone

• Medical Grade Silicone

• Silicone is a ViscoElastic material

• Redistributes weight better than PU gels (ACTION)

• Scientifically Developed & Proven through R&D

• Soft as skin and underlying fatty tissue

• Redistributes pressure very effectively

• Reduces Impact of Shear and Friction

Additional Benefits of Silicone

• Distributes Weight Effectively

• Hypoallergenic / Latex Free

• X-ray Translucent / MRI Compatible

• Easy to Clean / Won’t Support Bacterial Growth

• Reusable & Very Durable

• Most Extensive Range

• Dampens Impact

• Thermal Stability: Cool or Heat

• Fire Rated as Self Extinguishing

• Non Conductive

• Oasis + is autoclavable

Features & Benefits

Original gel solution,

100% silicone

Very extensive range of

products

Resembles human skin Pressure mapping

19.7mmHg

Effectively redistributes

pressure

Interface pressure

should be less than 32

mmHg

Features & Benefits

Pre-Contoured.

Combination of Gel and

Foam

Pressure mapping

results: 11.4mmHg

Enhanced redistribution

of pressure

Most extensive range of

products

50% lighter than Oasis

Range

Features & Benefits

Dual-layer silicone

protection with

anatomical design

Facilitates excellent

redistribution of pressure

20% lighter than Oasis

Range

Pressure mapping

8.64mmHg

Product range designed

for the Supine and

Lithotomy Position

Features & Benefits

Medical grade siloxane

elastomer

Easy to clean and fully

autoclavable

No outer film ensures

exceptional durability

Non-slip properties for

patient comfort and

support

Pressure mapping

10.28mmHg

Ergonomic design for

effective pressure relief

Oasis+ offers the ultimate

in pressure relief, and

positioning.

The products are fully

autoclavable, re-usable,

ergonomically designed,

with an anti-slip base. This

entirely unique range is a

revolution in Pressurecare

Pressure Mapping

• In Trulife we use FSA (Force Sensitive Applications).

• Strict protocol to ensure accurate representations of

body form and body mass are applied when using the

apparatus

Enables us to evaluate & design our pressurecare range

for optimal pressure relief

Pressure Injuries

Incidence Definition

Risk Assessment

Pressure Injuries

Pressure Ulcer – Definition

A pressure ulcer is an injury to skin as a result of

constant pressure due to impaired mobility

JAMA, 2006 – Vol 296, No 8. Pressure Ulcers

What is a Pressure Ulcer?

“ ”

Skin Cell

Stage 1:

Reddening

Stage 4:

Necrosis of

Muscle

Stage 2:

Epidermis Broken Stage 3:

Subcutaneous

Stages of Pressure Ulcers

Incidence

Sacral Ischial

49%

Other

Elbow/Head

30.5%

Hip – Greater

Trochanter

11%

Heels

9.5%

Risk Assessment: Example

Supine: Areas at Risk

Pressure Ulcer

Occipital Region

Elbow

Sacrum

Buttocks

Heels

Nerve Damage

Elbow: Ulnar Nerve

Arm: Brachial Plexus

Lumbar: Sciatic Nerve

Supine: Azure

Lumbar

Sciatic

Nerve

Elbow

Ulnar

Nerve

Heels

AZ400 AZ300 AZ201

Head in Supine or Lithotomy

EL011

EL012

OA012

OA011

OA010

AZ100

Head Rings

• Aim: to prevent

occipital Pressure

Ulcers

• This should in turn

prevent Alopecia

• NB: Important to

use right size

head ring!

Alternative

EL151

EL030

Also

Available:

EL152

Adolescent

Head Rest

For Eye Surgery Resuscitation Trolleys – Airway

Management

Head & Neck

OP151

Head & Neck

OP015

Table Pads

OA030 EL031

OA032 After 1 Hour

OA032 After 5 Hours

Alternative Sacral Protector

Conforms

to Patient

Excellent Product, Unique!

AZ301

Offers

contoured

Lateral

protection

to Patient

Nerve

Protection/

Shear

Protection

Reddening of Skin?

• Cannot eliminate all pressure

• Reddening can occur after long cases

• If it is blanchable & clears within 30

minutes: No pressure damage has

occurred

AZ300 After 1 Hour

AZ300 After 5 Hours

Arm Adducted: Supine

OA110 Positioning

Belt

OA100

OA061

Supine - Trendelenberg

Brachial

Nerve

Elbow

Hand Knees

OA213 OA113 OA101

Arms

OP101

Arm Adducted: Supine

OA061

EL072

EL070

AZ201

Heels

AZ401

EL130

OA131

Lateral: Areas at Risk

Pressure Ulcer

Ear

Elbow

Hip: Greater

Trochanter

Knee

Ankle

Nerve

Damage

Musculo-

Skeletal

Shoulder:

Brachial

Plexus

Shoulder

dislocation

Elbow: Ulnar

Nerve

Lumbar

Strain

Lateral Position

Hip Hand Knees Ankles

OA200 OA071 OA050 OA031 OA061

Elbow Shoulder

Elbow

EL070 EL900

Head in Lateral

EL022

EL021

Open Head Ring

No Pressure on Eyes or Ears

Lateral: Leg Positioner

EL800

For Hip

Surgery

Lateral Position: Other Options

OA113

EL800 EL900 OA101 EL022

Lateral Park Bench Positioner

Recommended for Neurosurgery

ELP913

Lateral: Ankles

OA200

AZ500

Lateral: Vac Pacs

Neuropathy – Definition

Neuropathy is the term used when a nerve is

damaged. Motor, Sensory and Autonomic nerve

function can be affected

What is a Neuropathy?

“ ”

Perioperative Causes

• Stretch

• Compression

• Ischaemia

• Metabolic Derangement

• Surgical field

Neuropathy Effects

Ulnar Weak grip, flexion

‘Claw’ Hand

Sciatic Nerve Back Pain

Leg Pain

Common Peroneal Drop Foot

Loss of Sensation

Perioperative Neuropathy

Prone: Areas at Risk

Pressure Ulcer

Elbows

Hips: Iliac Crest

Knees

Toes / Feet

Nerve

Damage Specific

Considerations

Ocular

Nerve

Face: Eyes, Nose

Mouth

Brachial

Plexus

Respiratory

Insufficiency

Ulnar

Nerve

Breasts /

Genetalia

Prone Position

Hip Iliac Crest Knees Ankles Toes

EL030 EL210 EL401 EL905

Shoulder Brachial

Nerve

Elbow Ulnar

Nerve

EL072

Prone Position

Head in Prone

Protect Face & Soft Tissue – Eyes, Nose & Mouth

Facilitate Requirements for Safe Ventilation

EL141

OA030

Prone Positioner

Surgical Indication

Example Spinal Surgery

EL904

Prone Positioner

EL904 EL141 EL218

Eliminates Pressure on Abdomen &

Facilitates Ventilation

Prone: Oasis Options

Open Head Rings allow more access to airway

OA021

OA022

Prone: Alternative Foot / Ankle Support

EL216

EL215

EL214

EL217

EL218

Elite Positioners Prone Pad

Recommended for Laminectomy procedures and

surgery to the back of legs

ELP914

Lithotomy: Areas at Risk

Nerve Damage

Arms abducted:

Brachial Nerve Injury

Arms adducted:

Compartment syndrome

Elbow: Ulnar Nerve

Hamstrings overstretched:

Sciatic Nerve

Popliteal Fossa: Peroneal

Nerve

Pressure Ulcer

Occipital Region

Elbows

Sacrum

Lithotomy: Azure

Brachial

Nerve Sacrum

Perineal

Nerve

AZ410 AZ300 AZ201 AZ100

Elbow

Ulnar

Nerve

Alternative Sacral Protector

Stirrup too

high

= Hip joint

affected

Stirrup too

low

= Interferes

with

circulation

Pressure

on Sacrum

= Pressure

Ulcer

Pressure

on popliteal

fossa = Can

result in

Drop Foot

Lithotomy: Stirrup

Stirrup Pads Protect the Peroneal Nerve

Crutch

Stirrup

Pads

AZ410

OA090

OA091

OA092

Lithotomy: Options

Boot Stirrups, Heel/Ankle Protectors, Crutch Stirrups

Pads Protect the Peroneal Nerve

OA200 OA090

OA091

OA092

Lithotomy: Specific for GU or Gynae

Perineal Table Pad: Ideal when Irrigation required

OA040 EL031

Heating & Cooling

• Heat to +40 Degrees or

Cool to -12 Degrees

• Heat also by bathing in

warm water

Cleaning

• Should be disinfected after every patient

• Water based solutions

• Foam Or Cotton

• Single patient use (without cover)

• How are standards maintained?

• Costs of single use

• Greater risk of contamination

Please refer to Technical File Page 8

Prone Positioner

• Store Flat

• Ideally within the theatre

• Possibly holding bay for

table pads

Repair

Temporary

Measure

Compatibility

Compatible with Warming Blankets/Mattresses!

Summary

Pressurecare

Pressure Sores & Injuries

• Costs of treatment higher than preventative measures.

• Cost to patient: Numerous!

• Pain, discomfort, prolonged hospital stay, altered body image

• Costs incurred by litigation high. JAMA 2006. Vol 296, No 8. Preventing Pressure Ulcers: A

Systematic Review

Implications of Clinical Practice

• Nurses play a vital role in pressurecare

• Must take part responsibility for positioning

• Nurse must act as patient advocate

• Risk assessment tool would be useful

• Be fully informed of equipment available to facilitate adequate pressurecare

• All OR Staff should be briefed on PC

Considerations

• Thoracic? Lateral positioners.

• Spinal? Prone positioners.

What types of surgery performed?

Age profile in the Hospital

• Orthopaedics? Older population at higher risk

• Paediatrics? Different range of products

Considerations Continued

• Have they enough equipment?

• Should be viewed as universal precaution

How many theatres in the Hospital?

Are staff trained on use of products?

• Theatre staff need regular updates and training

• Is there a Tissue Viability Nurse at the Hospital?

Comparison

Chart Trulife original

Competitor product:

Action

• Most comparable products to Action

• Industrial grade Silicone

• “Silicone shows resistance to

weathering which is important for the

long term life of the products”

• “ Silicone has close physical and

chemical relationship with human

skin”

NOT Silicone Gel

Viscoelastic Polymer

Contoured

• Contoured range – provides

enhanced positioning and nerve

protection

• 50% lighter

• Extensive range

Some equivalents on the market

• Anatomically designed

• Surrounding & Lateral Support –

Provides nerve protection

• Elastic properties – Superior pressure

relief

• 20% Lighter

No Equivalent

• Most durable range

• Anti-Slip

• Autoclavable

• Siloxane elastomers

No Equivalent

Testing & General Info

As its countermeasure, a gel type Horseshoe Headrest

recently has been introduced, resulting in reduced

frequency of decubitus ulcer

“ ”

• Technical guide at the back of the Pressure catalogue – covers

90% of questions

• We have an internal Q&A file for OR and Relax

• Test on Silicone v Polymer See tech file

• We have independent testing from PMI - DORO® Multi-Purpose

Skull Clamp

Testing Continued

“

” AORN Guidelines “ Foam and Gel mattresses are effective for

preventing both skin changes and pressure sore formation”

Chinese Clinical Application

For Oasis series position pads, the main material is a silica gel with

unique formula (TruGel). The main material is a unique formula

(trugel) silica gel with soft texture and good biological features which

allow the body weight to be evenly distributed onto the silica gel

without being compressed to an extreme state. Therefore, it provides

very good protection for the skin during surgical procedures.

AORN Guidelines

“ ”

Testing Continued

German Clinical Application

Manufacturer: pro med instruments GmbH

As its countermeasure, a gel type Horseshoe Headrest

recently has been introduced, resulting in reduced

frequency of decubitus ulcer. “

”

MOVIES

Movies

General

Range

Azure

Range

General

Range

Elite

Trendelenburg

System

Oasis+

Production

New Products

2018/2019

Pressurecare

ICU Range

Elite Trendelenburg System

Designed to overcome the challenges of the

Trendelenburg position – patient slippage, nerve

injury and the formation of decubitus sores.

ELTS20

ELTS40

Best Sellers

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Conclusion

Superior and Quality Products

Innovative Research & Development

Offering the protection your

patient deserves!