Nursing care plan for the prevention of pressure ulcers secondary to prone positioning in COVID-19 patients
DOI:
https://doi.org/10.15649/cuidarte.2234Keywords:
Prevention & control, Pressure Ulcer, Prone Position, Coronavirus infections, PandemicsAbstract
Abstract
Introduction: Prone position (PP) is a therapeutic alternative widely used and recommended in patients with COVID-19. Although PP is a non-invasive procedure, it is complex and could be associated with complications such as the development of pressure ulcers (PU). We aimed to propose a standardized nursing care plan in terms of NANDA-International, NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) to prevent PU secondary to the PP in people with COVID-19. Content synthesis: In patients with COVID-19, in addition to risk factors such as advanced age and the presence of comorbidities, PP contributes to the presence of pressure ulcer risk nursing diagnoses [00249], of deterioration of skin [00047] and tissue [00248] integrity. On the other hand, the nursing intervention for the prevention of pressure ulcers [3540], due to the specificity and scientific basis of its activities, is key to minimize the development of this complication, improve the quality of care and the prognosis in this type of patients. Finally, to evaluate the effectiveness of nursing care, we propose the nursing results (NOC): consequences of immobility: physiological [0204] and tissue integrity: skin and mucous membranes [1101]. Conclusion: PP is a recommended adjunctive therapy for the management of critically ill COVID-19 patients due to its benefits to improve lung function. However, it is associated with adverse effects such as PU. This article presents recommendations based on a narrative review for a better implementation of preventive nursing care that reduces the frequency of PU in this population.
How to cite this article: Rojas LZ, Mora Rico LA, Acosta Barón JV, Cristancho Zambrano LY, Valencia Barón YD, Hernández Vargas JA. Plan de cuidados de enfermería para la prevención de úlceras por presión secundarias a la posición prono en pacientes COVID-19. Revista Cuidarte. 2021;12(3):e2234. http://dx.doi.org/10.15649/cuidarte.2234
References
Barker J, Koeckerling D, West R. A need for prone position CPR guidance for intubated and non-intubated patients during the COVID-19 pandemic. Resuscitation. 2020. 151:135-6. https://doi.org/10.1016/j.resuscitation.2020.04.029
Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med. 2020. 8(8):765-74. https://doi.org/10.1016/S2213-2600(20)30268-X
Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017. 195(1):67-77. https://doi.org/10.1164/rccm.201606-1306OC
Guerin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018. 44(1):22-37. https://doi.org/10.1007/s00134-017-4996-5
Barakat-Johnson M, Carey R, Coleman K, Counter K, Hocking K, Leong T, et al. Pressure injury prevention for COVID-19 patients in a prone position. Wound Practice and Research. 2020. 28(2):50-7. https://doi.org/10.33235/wpr.28.2.50-57
Settembre N, Maurice P, Paysant J, Theurel J, Claudon L, Kimmoun A, et al. The use of exoskeletons to help with prone positioning in the intensive care unit during COVID-19. Ann Phys Rehabil Med. 2020. 63(4):379-82. https://doi.org/10.1016/j.rehab.2020.05.004
Schub E, Pilgrim J. Patient positioning (critical care patients): prone. Nursing practice & Skill. 2018. https://www.baccn.org/static/uploads/resources/NRCP_Prone_Position_ICU_pt.pdf
Ghelichkhani P, Esmaeili M. Prone Position in Management of COVID-19 Patients; a Commentary. Arch Acad Emerg Med. 2020. 8(1):e48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/
Mora-Arteaga JA, Bernal-Ramirez OJ, Rodriguez SJ. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med Intensiva. 2015. 39(6):359-72. https://doi.org/10.1016/j.medine.2014.11.004
Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc. 2017. 14(Supplement_4):S280-S8. https://doi.org/10.1513/AnnalsATS.201704-343OT
Stephen-Haynes J, Maries M. Pressure ulcers and the prone position. Br J Nurs. 2020. 29(12):S6. https://doi.org/10.12968/bjon.2020.29.12.S6
Bentley SK, Iavicoli L, Cherkas D, Lane R, Wang E, Atienza M, et al. Guidance and Patient Instructions for Proning and Repositioning of Awake, Nonintubated COVID-19 Patients. Acad Emerg Med. 2020. https://doi.org/10.1111/acem.14067
Bamford P, Bentley A, Dean J, Whitmore D, Wilson-Baig N. ICS Guidance for Prone Positioning of the Conscious COVID Patient 2020. Intensive care society. https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-conscious-proning.pdf
Albott CS, Wozniak JR, McGlinch BP, Wall MH, Gold BS, Vinogradov S. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg. 2020. 131(1):43-54. https://doi.org/10.1213/ANE.0000000000004912
Shearer SC, Parsa KM, Newark A, Peesay T, Walsh AR, Fernandez S, et al. Facial Pressure Injuries from Prone Positioning in the COVID-19 Era. Laryngoscope. 2021. https://doi.org/10.1002/lary.29374
Rodriguez-Huerta MD, Diez-Fernandez A, Rodriguez-Alonso MJ, Robles-Gonzalez M, Martin-Rodriguez M, Gonzalez-Garcia A. Nursing care and prevalence of adverse events in prone position: Characteristics of mechanically ventilated patients with severe SARS-CoV-2 pulmonary infection. Nurs Crit Care. 2021. https://doi.org/10.1111/nicc.12606
Ibarra G, Rivera A, Fernandez-Ibarburu B, Lorca-Garcia C, Garcia-Ruano A. Prone position pressure sores in the COVID-19 pandemic: The Madrid experience. J Plast Reconstr Aesthet Surg. 2020. https://doi.org/10.1016/j.bjps.2020.12.057
Capasso V, Cox J, Cuddigan J, Delmore B, Tescher A, Solmos S. Pressure injury prevention-pip tips for prone positioning. National pressure injury advisory panel. 2020 https://cdn.ymaws.com/npiap.com/resource/resmgr/online_store/posters/npiap_pip_tips_-_proning_202.pdf
Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J. 2020. https://doi.org/10.1111/iwj.13435
Kim RS, Mullins K. Preventing Facial Pressure Ulcers in Acute Respiratory Distress Syndrome (ARDS). J Wound Ostomy Continence Nurs. 2016. 43(4):427-9. https://doi.org/10.1097/WON.0000000000000247
Zingarelli EM, Ghiglione M, Pesce M, Orejuela I, Scarrone S, Panizza R. Facial Pressure Ulcers in a COVID-19 50-year-old Female Intubated Patient. Indian J Plast Surg. 2020. 53(1):144-6. https://doi.org/10.1055/s-0040-1710403
Perrillat A, Foletti JM, Lacagne AS, Guyot L, Graillon N. Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?. J Stomatol Oral Maxillofac Surg. 2020. https://doi.org/10.1016/j.jormas.2020.06.008
Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, et al. A new pressure ulcer conceptual framework. J Adv Nurs. 2014. 70(10):2222-34. https://doi.org/10.1111/jan.12405
Boyko TV, Longaker MT, Yang GP. Review of the Current Management of Pressure Ulcers. Adv Wound Care (New Rochelle). 2018. 7(2):57-67. https://doi.org/10.1089/wound.2016.0697
Gupta S, Hayek SS, Wang W, Chan L, Mathews KS, Melamed ML, et al. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. JAMA Intern Med. 2020. https://doi.org/10.1001/jamainternmed.2020.3596
Taneri PE, Gomez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Diaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020. https://doi.org/10.1101/2020.06.04.20122267
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020. https://doi.org/10.1001/jama.2020.5394
Herramienta online para la consulta y diseño de planes de cuidados de enfermería. NNNConsult. Elsevier. 2015 [cited 2021Abril08]. http://www.nnnconsult.com/
Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care. 2020. 29(6):312-20. https://doi.org/10.12968/jowc.2020.29.6.312
Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, et al. Device-related pressure ulcers: SECURE prevention. J Wound Care. 2020. 29(Sup2a):S1-S52. https://doi.org/10.12968/jowc.2020.29.Sup2a.S1
Park SH, Lee YS, Kwon YM. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis. West J Nurs Res. 2016. 38(4):459-83. https://doi.org/10.1177/0193945915602259
Park SH, Lee HS. Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis. Iran J Public Health. 2016. 45(2):122-33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841867/
European Pressure Ulcer Advisory Panel NPIAPaPPPIA. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The International Guideline. 2019. 3rd: http://www.internationalguideline.com
Girard R, Baboi L, Ayzac L, Richard JC, Guerin C, Proseva trial g. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014. 40(3):397-403. https://doi.org/10.1007/s00134-013-3188-1
Baktoft B. Nursing care of patients in the prone position. The World of Critical Care Nursing. 2001. 1(3):83-6. https://doi.org/10.1891/1748-6254.1.3.87
Lucchini A, Bambi S, Mattiussi E, Elli S, Villa L, Bondi H, et al. Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications. Dimens Crit Care Nurs. 2020. 39(1):39-46. https://doi.org/10.1097/DCC.0000000000000393
Barakat-Johnson M, Lai M, Wand T, Li M, White K, Coyer F. The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review. J Wound Care. 2019. 28(8):512-21. https://doi.org/10.12968/jowc.2019.28.8.512
Black J, Alves P, Brindle CT, Dealey C, Santamaria N, Call E, et al. Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices. Int Wound J. 2015. 12(3):322-7. https://doi.org/10.1111/iwj.12111
Park KH, Kim KS. Effect of a structured skin care regimen on patients with fecal incontinence: a comparison cohort study. J Wound Ostomy Continence Nurs. 2014. 41(2):161-7. https://doi.org/10.1097/WON.0000000000000005
Avsar P, Karadag A. Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis. Worldviews Evid Based Nurs. 2018. 15(1):54-61. https://doi.org/10.1111/wvn.12264
Otero DP, Dominguez DV, Fernandez LH, Magarino AS, Gonzalez VJ, Klepzing JV, et al. Preventing facial pressure ulcers in patients under non-invasive mechanical ventilation: a randomised control trial. J Wound Care. 2017. 26(3):128-36. https://doi.org/10.12968/jowc.2017.26.3.128
Weng MH. The effect of protective treatment in reducing pressure ulcers for non-invasive ventilation patients. Intensive Crit Care Nurs. 2008. 24(5):295-9. https://doi.org/10.1016/j.iccn.2007.11.005
Prebio M, Katz-Papatheophilou E, Heindl W, Gelbmann H, Burghuber OC. Reduction of pressure sores during prone positioning of ventilated intensive care patients by the prone-head support system: a pilot study. Wien Klin Wochenschr. 2005. 117(3):98-105. https://doi.org/10.1007/s00508-004-0299-2
Katzengold R, Gefen A. What makes a good head positioner for preventing occipital pressure ulcers. Int Wound J. 2018. 15(2):243-9. https://doi.org/10.1111/iwj.12857
Levy A, Kopplin K, Gefen A. Device-related pressure ulcers from a biomechanical perspective. J Tissue Viability. 2017. 26(1):57-68. https://doi.org/10.1016/j.jtv.2016.02.002
Grisell M, Place HM. Face tissue pressure in prone positioning: a comparison of three face pillows while in the prone position for spinal surgery. Spine. 2008. 33(26):2938-41. https://doi.org/10.1097/BRS.0b013e31818b9029
Kumagai A, Ohno N, Miyati T, Okuwa M, Nakatani T, Sanada H, et al. Investigation of effects of urethane foam mattress hardness on skin and soft tissue deformation in the prone position using magnetic resonance imaging. J Tissue Viability. 2019. 28(1):14-20. https://doi.org/10.1016/j.jtv.2018.10.007
Roth S. Perioperative visual loss: what do we know, what can we do?. Br J Anaesth. 2009. 103 Suppl 1:i31-40. https://doi.org/10.1093/bja/aep295
Gefen A, Farid KJ, Shaywitz I. A review of deep tissue injury development, detection, and prevention: shear savvy. Ostomy Wound Manage. 2013. 59(2):26-35. https://pubmed.ncbi.nlm.nih.gov/23388395/
Shi C, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS One. 2018. 13(2):e0192707. https://doi.org/10.1371/journal.pone.0192707
Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013. 368(23):2159-68. https://doi.org/10.1056/NEJMoa1214103
Araujo MS, Santos M, Silva CJA, Menezes RMP, Feijao AR, Medeiros SM. Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review. Rev Lat Am Enfermagem. 2021. 29:e3397. https://doi.org/10.1590/1518-8345.4732.3397
Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for Predicting Pressure Sore Risk. Nurs Res. 1987. 36(4):205-10. https://doi.org/10.1097/00006199-198707000-00002
Norton D, McLaren R, Exton-Smith A. An investigation of geriatric nursing problems in hospital. London: Churchill Livingstone. Scientific Research. 1962. https://www.scirp.org/(S(czeh2tfqyw2orz553k1w0r45))/reference/ReferencesPapers.aspx?ReferenceID=1191367
Drahnak DM, Custer N. Prone Positioning of Patients With Acute Respiratory Distress Syndrome. Crit Care Nurse. 2015. 35(6):29-37. https://doi.org/10.4037/ccn2015753
Downloads
Published
How to Cite
Issue
Section
Altmetrics
Downloads
License
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.