Pressure ulcer risk factors in cardiac surgery: a review of the research literature.

ABSTRACT

BACKGROUND: Pressure ulcer incidence in patients undergoing cardiac surgery is reported to be up to 29.5%. Common known risk factors for pressure ulcer development include compressive and shearing forces. However, knowledge about the specific risk factors in a defined population is helpful in the development of an effective prevention management. This literature review is part of a quality improvement project to reduce pressure ulcer incidence in the cardiac surgery population. OBJECTIVES: The objective is to determine "which specific risk factors for pressure ulcer development in the cardiac surgery population are identified in the literature." RESULTS: The results of this literature review indicate a high-risk potential in the tissue tolerance for oxygen as temperature manipulation, vasoactive drugs, hypotensive periods, and reduced hemoglobin and hematocrit levels. Time on the operating room table, frequency of repositioning, immobility time, older age, low albumin level, and corticosteroid are also found as significant risk factors in this population. CONCLUSION: Diseases that influence oxygen supply in older patients in combination with the special demands of temperature and circulation regulation during the cardiac surgical procedure place the patient at risk for pressure ulcer development. Prevention measures should be aimed at supporting tissue tolerance for pressure and tissue tolerance for oxygen. These measures should be additional to pressure-relieving devices on the operating room table and, postoperatively in bed, a defined minimum frequency of postoperative turning and early mobilization after the surgical procedure should be considered.