AMELİYAT GEÇİREN HASTALARDA BASINÇ YARALANMALARININ ÖNLENMESİ

Basınç yaralanması, tüm dünyada olduğu gibi ülkemizde de sık görülen, hastanın ağrı ve acı çekmesine yol açarak yaşam kalitesini etkileyen ve sağlık bakımına mali yük getiren önemli bir sağlık sorunudur. Ameliyata bağlı basınç yarasının tanımıyla ilgili farklı görüşler bulunmasına rağmen genel kabul gören görüş ameliyat sonrası ilk 48-72 saat içerisinde gelişen yaralar, ameliyata bağlı basınç yaralanması olarak kabul edilmektedir. Ameliyata bağlı basınç yaralanması için risk faktörleri; anestezi, ameliyatın süresi, ameliyatın tipi, immobilizasyon süresi, hastanın ameliyat sırasındaki pozisyonu, ameliyat sırasında kullanılan destek yüzeyler, derinin nemli olması, kan kaybı, hipotansiyon, ısıtıcı araç/gereç kullanımı, hipotermi ve hipertermi, pozisyon vermede kullanılan aletler ve vazopressör kullanımıdır. Ameliyata bağlı basınç yaraları cerrahi girişim, hastanın mevcut sağlık sorunları gibi çeşitli durumlara odaklanılması nedeniyle göz ardı edilebilmektedir. Hemşireler, ameliyat sırasında basınç yaralanması risk faktörlerinin farkında olmalı ve hemşirelik bakımının göstergesi olan basınç yaralanmarının önlenmesinde kanıta dayalı rehberlerin önerileri doğrultusunda gerekli girişimleri uygulamalıdır.

Anahtar Kelimeler:

Hemşirelik, basınç yaralanması, basınç ülseri, ameliyathane, önleme

PREVENTION OF PRESSURE INJURIES IN SURGICAL PATIENTS

Pressure injury is a common disease in the whole World and our county. Pressure injury is an important health problem that causes pain, affects their life quality and places a financial burden on health care institutions. Even though there are different opinions about the definition of pressure injury due to surgery, it is generally accepted that injuries which develop within the first 48-72 hours after the operation are pressure injury caused by surgery. Risk factors for pressure injuries caused by surgery include; anesthesia, duration of surgery, type of surgery, duration of immobilization, patient's position during surgery, supporting surfaces used during surgery, skin humidity, blood loss, hypotension, use of warming blanket, hypothermia and hyperthermia, tools used in positioning and use of vasopressor. Pressure injuries caused by surgery might be ignored as a result of focusing on various conditions like surgical intervention, patient's present health problems. Nurses must know the risk factors for pressure injury during surgery and apply the required interventions according to the recommendations of evidence-based guides in the prevention of pressure injuries, which are an indicator of nursing care.

Keywords:

Nursing, pressure injury, pressure ulcer, operating room, prevention,

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Uzun Ö. Basınç Ülserlerinin Önlenmesi: Hızlı başvuru kılavuzu.2010 Ankara. http://www.epuap.org/wp-content/uploads/2016/10/qrg_prevention_in_turkish.pdf ( Erişim tarihi: 5 Kasım 2019)
http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a -change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/.(Erişim tarihi:11 Ekim 2017)
Ünver S, Yıldırım M, Akyolcu N, Kanan N. Doğru sözcüklerden doğru bakıma: hemşireler arasında “basınç yarası” teriminin kullanılma durumu. F.N. Hem. Derg. 2016; 24(3): 127-132. ISSN 2147-4923
Preventing pressure ulcers in hospitals: are we ready for this change? Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html. Reviewed October 2014. (Erişim Tarihi:10 Ekim 2017.
Spruce L. Back to Basics: Perioperative Pressure Injuries, AORN J, January 2017,105, No.1; 92-99.
Chen HL, Chen XY, Wu J.The incidence of pressure ulcers in surgical patients of the last 5 years: a systematic review. Wounds. 2012 Sep;24(9):234-41.
Karadağ M, Gümüşkaya N. The incidence of pressure ulcer in surgical patients: a sample in Turkey. Journal of ClinicalNursing 2005; 15: 413-421.
Rao AD, Preston AM, Strauss R, Stamm R, Zalman DC. Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients: a systematic review. J Wound Ostomy Continence Nurs. 2016; 43(3):242-247.
Primiano M, Friend M, McClure C, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94(6):555-566.
Nilsson UG. Intraoperative positioning of patients under general anesthesia and the risk of postoperative pain and pressure ulcers. J Perianesth Nurs. 2013;28(3):137-143.
Robertson J. et. al. Pressure ulser Prevention and Treatment of Pressure Ulcers Clinical practices guideline. 2012.
Haesler E. (Ed.). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Indıvıduals ın the operatıng room. Cambridge Media: Osborne Park, Australia; 2014; 57-59. http://www.npuap.org/wp-content/uploads/2014/08/Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-Jan2016.
Black J, Scott SM, Fawcett, D Operating Room Ulcers: Who is at Risk?   Can They be Prevented? http://www.npuap.org/wp-content/uploads/2015/08/NPUAP-OR-Webinar-August-2015-Handouts.pdf.
Engels D, Austin M, McNichol L, Fencl J, Gupta S, Kazi H. Pressure ulcers: factors contributing to their development in the OR. AORN J. 2016;103(3):271-281
Song JB, Vemana G, Mobley JM, Bhayani SB. The second “timeout”: a surgical safety checklist for lengthy robotic surgeries. Patient Saf Surg. 2013;7(1):19.
He W, Liu P, Chen HL. The Braden scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis. Ostomy Wound Manage. 2012;58(2):34-40.
Prevention of Perioperative Pressure Ulcers Tool Kit. AORN, Inc. http://www.aorn.org/guidelines/clinical-resources/tool-kits/prevention -of-perioperative-pressure-ulcers-tool-kit.
Scott SM. Progress and challenges in perioperative pressure ulcer prevention. J Wound Ostomy Continence Nurs. 2015;42(5): 480-485.
Munro CA. Munro Pressure Ulcer Risk Assessment Scale for Perioperative Patients https://www.aorn.org%2F-%2Fmedia%2Faorn%2Fguidelines%2Ftool-kits%2Fpressure-ulcer%2Fmunro-pressure-ulcer-risk-assessmentscale.xlsx%3Fla%3Den&usg. (Erişim tarihi: 11 Ekim 2017)
National Pressure Ulcer Advisory Panel Support Surface Standards Initiative. National Pressure Ulcer Advisory Panel. http://www.npuap.org/wp content/uploads/2012/03/NPUAP _S3I_TD.pdf. Published January 29, 2007. ( Erişim tarihi: 11 Ekim 2017)
Gül, Ş. Cerrahi Girişim Uygulanan Hastalarda Basınç Ülseri Gelişiminin Önlenmesi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2014: 54–61.
McInnes E, Bell-Syer SE, Dumville JC, Legood R, Cullum NA. Support surfaces for pressure ulcer prevention. Cochrane Database SystRev 2008; CD001735. 43. Reddy M, Gill SS, Rochon PA.
Preventing pressure ulcers: a systematic review. JAMA 2006; 296:974-84. 44.
Gül Ş. Ameliyathanede Sıvı Dolgulu Destek Yüzeyi Kullanmanın Basınç Ülserini Önlemeye Etkisi, Yüksek Lisans Tezi 2011; Gazi Üniversitesi; Ankara.
Guideline for positioning the patient. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2016:649-667.http://www.aornstandards.org/content/1/SEC32.extract (Erişim tarihi: 22.Eylül 2017)
Kirkland-Walsh H, Teleten O, Wilson M, Raingruber B. Pressure mapping comparison of four OR surfaces. AORN J. 2015;102(1): 61.e1-61.e9.
http://www.npuap.org/wp -content/uploads/2014/03/UPDATED-3-9-2014-RCA-Template.pdf. Published March 2014.
Fuzy KM, Vega RA. Hospital-acquired pressure ulcers in the ambulatory surgery setting. AORN J. 2016;103(2):224-228.