Authors (including presenting author) :
Chung KH (1), Wong WT (2)
Affiliation :
(1) Registered nurse in Operation Room, Department of Anaesthesiology, Pain Medicine and Operating Services, United Christian Hospital, Kowloon East Cluster.
(2) Advanced practice nurse in Operation Room, Department of Anaesthesiology, Pain Medicine and Operating Services, United Christian Hospital, Kowloon East Cluster.
Introduction :
Pneumatic tourniquets in Orthopaedic surgery safely provide blood-free surgical fields, but tourniquet-induced pressure injuries can potentially cause their use. Pressure injuries are mainly caused by prolonged pressure, shear, and friction on the skin. However, excess moisture can weaken the skin and make it more susceptible to injury, particularly the use of skin disinfectants and irrigation fluid during the surgery, which caused skin maceration under the cuff.
Given the clinical situation, patients undergoing total knee replacement (TKR) are in the high-risk group. Few years ago, cutaneous abrasions and blisters were reported underneath the cuff. Even though an adhesive drape was pasted on the cuff to prevent those solutions from infiltrating beneath, skin maceration was still unavoidable. Thus, perioperative nurses in the Orthopaedics & Traumatology (O&T) Team have initiated a bundle of strategies to prevent the risk of tourniquet-induced pressure proactively.
Objectives :
1. Reduce the skin maceration beneath the tourniquet cuff.
2. Prevent tourniquet-induced pressure injuries.
Methodology :
1. Plan
In December 2022, perioperative nursing O&T team members formulated a bundle of strategies. The team was inspired by the commercial extremity drape design to mimic its features of elastic fenestration hold to invent a new waterproofed product "Extremity Protection Drape", which perfectly fit on the skin in various limb sizes to seal against fluid accumulation underneath of the cuff. The team reviewed the standard operating procedures and disseminated it to all perioperative personnel in the O&T team.
2. Do
In January 2023, a bundle of strategies was implemented in each TKR operation, including assessing the limb conditions, applying the Vaseline and Velband padding, and applying the new Extremity Protection Drape. Team members drew attention to surgeons to avoid pooling the disinfectants and solutions, and maintain the appropriate tourniquet pressure.
3. Check
O&T surgeons checked the staff's compliance. Circulating nurses documented the skin conditions. Team members collected feedback and analyzed the effectiveness of the strategies.
4. Act
Continuous monitoring and iterative improvements ensured ongoing enhancements in patient safety and injury prevention.
Result & Outcome :
Result and Outcome:
From January 1, 2023, to November 30, 2024, 238 TKR cases done.
1. O&T surgeons confirmed that 100% of the staff complied with the application of interventions.
2. Circulating nurses agreed that 90% of the skin maceration beneath the tourniquet cuff was reduced.
3. No incidences related to tourniquet-induced pressure injuries occurred after the operation.
