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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
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Conclusion
Superior and Quality Products
Innovative Research & Development
Offering the protection your
patient deserves!