Comparison of interface pressures on three operating table support surfaces during surgery.

AIM OF THE STUDY: To investigate the effect of support surface usage and positions on interface pressure during surgery. MATERIALS AND METHODS: This randomized controlled experimental study was conducted between October 2018 and June 2019. The study included patients who had planned surgery in supine and prone positions. The sample size was 72 patients. Patients were assigned to three groups (gel support surface, viscoelastic support surface and standard operating table) according to the determined randomization table. During the surgery, the pressure in the patients' body was recorded. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. RESULTS: There was no statistically significant difference between the total body average interface pressure (mmHg) values between the supporting surfaces in the prone position. There was a statistically significant difference between the total body average interface pressure (mmHg) values between the support surfaces in the supine position, and the average interface pressure measured on the viscoelastic foam support surface was significantly lower than the gel support surface and the standard operating table. CONCLUSION: In the study, the use of viscoelastic foam support surface was found to be more effective than the use of a standard operating table and gel support surface. Viscoelastic foam support surface is recommended for patients at risk for pressure injury in the operating room.

A comparison of air-cell and gel surgical table pads and an evaluation of the influence of pressure distribution and other factors on pressure injury prevention.

Guidelines for pressure injury prevention consider the use of pressure-redistributing pads to prevent tissue deformation. However, limited research exists to assess the pressure distribution provided by the operating tables and the effectiveness of pressure-redistributing pads in preventing pressure injuries. In this study, we compared the pressure distribution properties of two surgical table pads and identified parameters influencing pressure injury outcomes after a lengthy surgical procedure. Twenty-seven patients undergoing left ventricular assist device implantation surgery participated in the study. Participants were randomly assigned to use either an air cell-based pad or a gel pad. Interface pressure was recorded during the surgery. We analyzed the effect of surgical table pad type, interface pressure distribution and pressure injury outcomes and analyzed what characteristics of the patients and the interface pressure are most influential for the development of pressure injuries. Comparing the interface pressure parameters between the air-cell group and the gel group, only the peak pressure index x time was significantly different (p < 0.05). We used univariate logistic regression analysis to identify significant predictors for the pressure injury outcome. The support surface was not significant. And, among patient characteristics, only age and BMI were significant (p ≤ 0.05). Among the interface pressure parameters, pressure density maxima, peak pressure index x time, and coefficient of variation were significant for pressure injury outcome (p ≤ 0.05). Peak pressure index, average pressure, and the surgery length were not statistically significant for pressure injury outcomes.

Defining Best Practices for Patient Safety in Positioning and Transferring Patients With the Surgical Spine Table.

This quality improvement project's purpose was to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table to increase patient safety. Using the Define, Measure, Analyze, Improve, and Control quality improvement framework, a multidisciplinary team analyzed surveys, qualitative interviews, ergonomics, near-miss sentinel events and skin integrity data to standardize this process. Results reinforced the need to develop and standardize the process of patient positioning and transfer from cart to table. Findings resulted in practice changes, including a standardized best practice for transfer of patients, educational tools, and checklists for continued monitoring of patient safety issues. Metrics for intervention effectiveness include reduced patient skin integrity, increased staff satisfaction, and improved comfort level with use of spine table accessories and equipment. This practice improvement has a patient safety focus in the perioperative nursing practice.

Effect of Using a Cardiac Catheterization Table-Stabilizing Stick on the Quality of Cardiopulmonary Resuscitation in the Cardiac Catheterization Laboratory: A Simulation-Based Study.

Rapid defibrillation and high-quality cardiopulmonary resuscitation (CPR) are necessary for patients with cardiopulmonary arrest, one of the most serious and frequently encountered complications in cardiac catheterization laboratories. However, when the catheterization table is withdrawn from its neutral position for fluoroscopy, it is unstable and unsuitable for resuscitation because of its cantilever structure. To stabilize the table in its withdrawn position, the use of a table-stabilizing stick might improve CPR quality. To investigate the effect of using a cardiac catheterization table-stabilizing stick on CPR quality, a CPR simulation mannequin was placed on a cardiac catheterization table that was withdrawn from the C-arm of the X-ray machine. CPR quality was assessed with or without the use of a table-stabilizing stick under the table. The CPR quality assessment (Q-CPR) scores were 79.6 ± 11.4% using the table-stabilizing stick and 47.7 ± 30.3% without the use of the stick device (p = 0.02). In this simulation-based study, the use of a table-stabilizing stick in a cardiac catheterization table withdrawn from the C-arm of the X-ray machine improved the quality of CPR.

The Modified Lithotomy: A Surgical Position for Lower Extremity Wound Care Procedures in Super Morbidly Obese Patients. A Case Study.

Operative positioning of morbidly obese patients presents unique challenges and can cause complications, especially when the operative field involves the proximal lower extremity or genitoperineal region. PURPOSE: The purpose of this case study was to describe a modified lithotomy operative positioning technique that has helped the authors improve care of these patients. METHODS: Double-layer, foam padding at least 4 inches thick is secured to the top and sides of 2 small rolling preparation tables using 3-inch silk tape to create "lithotomy" leg holders, the operating table is raised appropriately, the abducted legs are placed onto the padded prep tables, and the footboard is carefully lowered to provide access to the groin and medial thighs. CASE STUDY: A super morbidly obese (body mass index 74), 47-year-old African American man with a history of hypertension and type 2 diabetes controlled on oral medications presented to the authors' wound care clinic with 2 large, medial left thigh lymphedema masses requiring resection. Both procedures were successfully completed using the modified lithotomy position. No adverse events occurred. CONCLUSION: The modified lithotomy is easy to implement, does not require unique equipment, improves access to the surgical site, and may reduce the risk of complications. Larger and longer-term follow-up studies are needed to monitor the outcomes of this positioning technique.

Influence of support surfaces on the distribution of body interface pressure in surgical positioning / Influência das superfícies de apoio na distribuição da pressão de interface corporal durante o posicionamento cirúrgico / Influencia de las superficies de apoyo en la distribución de presión de la interfaz corporal durante el posicionamiento quirúrgico *

Abstract Objective: to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences. Method: a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data. Results: the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg). Conclusion: IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.

RESUMO Objetivo: valiar a pressão de interface (PI) das superfícies de apoio (SAs) em proeminências ósseas. Método: um estudo quase experimental com medidas repetidas em diferentes SAs. Vinte voluntários adultos saudáveis participaram do estudo. Os participantes foram colocados em decúbito dorsal em uma mesa cirúrgica para avaliação da PI nas proeminências ósseas das regiões occipital, subescapular, sacral e calcânea utilizando sensores. Sete avaliações foram realizadas para cada proeminência óssea: uma avaliação em uma mesa de operação padrão e as outras avaliações em mesas contendo SAs à base de polímero viscoelástico, espuma macia, ou espuma selada. Estatística descritiva e análise de variância foram utilizadas para analisar os dados. Resultados: a PI média foi maior na SA feita de polímero viscoelástico em comparação com as outras SAs (p<0,001). A PI média foi relativamente menor na espuma selada de densidade 33 e na espuma macia de densidade 18. Além disso, essa variável foi comparativamente maior na região sacral (42,90 mmHg) e na região calcânea (15,35 mmHg). Conclusão: a PI foi menor em SAs à base de espuma, especialmente espuma macia de densidade 18 e espuma selada de densidade 33. No entanto, a PI não foi reduzida na SA à base de polímero viscoelástico comparado com a SA controle.

RESUMEN Objetivo: evaluar la presión de interfaz (PI) de las superficies de apoyo (SAs) en prominencias óseas. Método: un estudio casi experimental con medidas repetidas en diferentes SAs. Veinte voluntarios adultos saludables participaron del estudio. Los participantes fueron colocados en decúbito dorsal en una mesa quirúrgica para evaluación de la PI en las prominencias óseas de las regiones occipital, subescapular, sacra y calcánea utilizando sensores. Siete evaluaciones fueron realizadas para cada prominencia ósea: una evaluación en una mesa de operación estándar y otras evaluaciones en mesas que contenían SAs a base de polímero viscoelástico, espuma blanda, o espuma sellada. Fueron utilizadas la estadística descriptiva y el análisis de la varianza para analizar los datos. Resultados: la PI media fue mayor en la SA hecha de polímero viscoelástico en comparación con las otras SAs (p<0,001). La PI media fue relativamente menor en la espuma sellada de densidad 33 y en la espuma blanda de densidad 18. Además, esa variable fue comparativamente mayor en la región sacra (42,90 mmHg) y en la región calcánea (15,35 mmHg). Conclusión: la PI fue menor en SAs a base de espuma, especialmente espuma blanda de densidad 18 y espuma sellada de densidad 33. Sin embargo, la PI no fue reducida en la SA a base de polímero viscoelástico comparado con la SA control.

Falls From the O.R. or Procedure Table.

Patient safety secured by constant vigilance remains a primary responsibility of every anesthesia professional. Although significant attention has been focused on patient falls occurring before and after surgery, a potentially catastrophic complication is when patients fall off an operating room or procedure table during anesthesia care. Because such events are (fortunately) uncommon, and because very little information is published in our literature, we queried 2 independent closed claims databases (the American Society of Anesthesiologists Closed Claims Project and the secure records of a private, anesthesia specialty-specific liability insurer) for information. We acquired documentation of patient events where a fall occurred during anesthesia care, noting the surrounding conditions of the provider, the patient, and the environment at the time of the event. We identified 21 claims (1.2% of cases) from the American Society of Anesthesiologists Closed Claims Project, while information from a private liability insurer identified falls in only 0.07% of cases. The percentage of these patients under general, regional, or monitored anesthesia care anesthesia was 71.5%, 19.5%, and 9.5%, respectively. To educate personnel about these uncommon events, we summarized this cohort with illustrative examples in a series of mini-case reports, noting that both inpatients and outpatients undergoing a broad array of procedures with various anesthetic techniques within and outside operating rooms may be vulnerable to patient falls. Based on detailed reports, we created 2 supplementary videos to further illuminate some of the unique mechanisms by which these events and their resulting injuries occur. When such information was available, we also noted the associated liability costs of defending and settling malpractice claims associated with these events. Our goal is to inform anesthesia and perioperative personnel about the common patient, provider, and environmental risk factors that appear to contribute to these mishaps, and suggest key strategies to mitigate the risks.

Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including microscope.

PURPOSE: Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope. MATERIALS AND METHODS: We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position. RESULTS: Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus. CONCLUSION: This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue.

A prospective, in vivo evaluation of two pressure-redistribution surfaces in healthy volunteers using pressure mapping as a quality control instrument .

Deep tissue injury (DTI) can rapidly evolve into a higher stage pressure ulcer. Use of pressure-redistribution surfaces is a widely accepted practice for the prevention of pressure ulcers in acute care patients, particularly in departments where care processes limit mobility. A 15-year-old patient developed a sacral DTI 24 hours after completion of a lengthy (12- hour) electrophysiology (EP) study and catheter ablation. A root cause analysis (RCA) conducted to investigate the origin of the hospital-acquired suspected DTI prompted a small investigation to evaluate the pressure-distribution properties of the EP lab surface and an OR table pad. Five healthy adult employee volunteers were evaluated in the supine position by placing a sensing mat between the volunteer and the test surface. Interface pressures (on a scale of 0 mm Hg to 100 mm Hg) were captured after a "settling in" time of 4 minutes, and the number of sensors registering very high pressures (above 90 mm Hg) across the surface were recorded. On the OR table pad, zero to six sensors registered >90 mm Hg compared to two to 20 sensors on the EP lab surface. These data, combined with the acquired DTI, initiated a change in EP lab surfaces. Although interface pressure measurements only provide information about one potential support surface characteristic, it can be helpful during an RCA. Studies to compare the effect of support surfaces in all hospital units on patient outcomes are needed.

The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy.

BACKGROUND: Outcome of Extracorporeal Shockwave Lithotripsy (SWL) is determined by physical factors that affect stone fragmentation and clearance. PURPOSE: To evaluate the predictive value of the Lithotripsy Table Height (LTH) in SWL outcome. Lithotripsy Table Height (LTH) is a variable that represents skin to therapy head distance, and it is proportional to the energy that reaches the stone. MATERIALS AND METHODS: A prospective study enrolled patients undergoing SWL for radiopaque urinary stones. All procedures were performed using a Modulith SLX (Karl Storz, Germany) Lithotripter. Patient weight, height and age; stone location and size; number of shock waves delivered, and LTH were recorded. One month post-procedure a KUB was obtained. Logistic regression analysis was used to evaluate the effects of these variables on stone-free outcome. A ROC curve was plotted. RESULTS: Fifty-six patients were enrolled. After one month follow-up, overall success rate (Stone Free) was 83.9% (n = 47). LTH was the only independent predictor of outcome in both univariate and multivariate analysis (p = 0.029). Stone size (p = 0.45) and BMI (p = 0.32) were not significant. In the ROC curve, LTH showed an Area under the Curve = 0.791. Patients with LTH < 218 (n = 8) had relative risk of residual stones = 7.5, odds Ratio: 6.6 (Stone free rate 37.5% vs. 91.5%). CONCLUSION: LTH appears to be an independent predictor of SWL outcome. High success rates can be expected if LTH > 218. Patients with lower LTH had a less effective therapy, therefore, worse stone fragmentation and clearance. These findings may help improve patient selection for SWL therapy.

1993 Federal Nursing Service Award recipient. Use of air-filled pads to reduce risk of intraoperatively acquired pressure ulcers.

This descriptive study utilized a two-phased retrospective review of medical records to investigate the development of pressure ulcers during cardiothoracic or vascular surgery. Using descriptive and chi-square statistics, the charts of 104 patients having surgery on standard table pads were compared with those of 124 patients having similar surgical procedures while positioned on air pads. Eight (8%) of the patients who had surgery without an air pad developed pressure ulcers, while none (0%) of the patients who were positioned on air pads developed pressure ulcers. Six (75%) of the eight patients who developed pressure ulcers were diabetic.