It's All About that Risk: What Pediatric Hematology/Oncology Patients Have Taught Us About Their Pressure Injury Risk

Introduction: While there is an abundance of literature that is descriptive of pressure injury risk in the adult patient population, there is much less data on pressure injuries in children. In pressure injuries involving pediatric hematology/oncology patients, even less information is available.  Accurately describing pressure injury risk in pediatric hematology/oncology patients is the first step before pressure injury prevention measures can be applied.Methods:A memorable pneumonic can help clinicians keep pertinent risk factors for the development of pressure injuries fresh in their mind as they treat their patients. A pneumonic was created from the known risk factors that are commonly associated with pediatric hematology/oncology patients.Results: Risk factor categories pertinent to pediatric hematology/oncology patients are contained in the pneumonic C.H.E.M.O. (Comorbidities, Has or has had a pressure injury, Equipment, Medications, Oncology). Comorbidities seen in pediatric hematology/oncology patients range from neurologic deficits and genetic variations to nutritional deficits such as cachexia and obesity. Many of these comorbidities carry inherent risks for developing pressure injuries (Delmore et al., 2019).  Pressure injuries in pediatric patients are not common, and the presence of an injury is a sign that the patient has more than a theoretical risk (Delmore et al., 2019). Pediatric patients that have or have had a pressure injury should always be considered at high risk for developing a new pressure injury. Equipment or medical devices are the number one cause of pressure injuries in children (Delmore et al. 2019). Medications like steroids, vasopressors and immunosuppressants can also increase the likelihood of skin breakdown (Arai, Yamamoto, Mitsukawa, 2020). Oncologic factors affecting the resilience and vulnerability of the skin range from chemotherapy, immunotherapy to surgery and radiation (Aljewazi & Tubaishat, 2019).Discussion: Pediatric hematology/oncology patients have a myriad of possible risk factors that are complex and not limited to finite description. The C.H.E.M.O. pneumonic may not incorporate all the possible indications of pressure injury risk but may serve as a guide to recognize high risk patients. Once the pressure injury risks are identified, appropriate prevention measures can be implemented in this special patient population.References:Arai K., Yamamoto K.H., Suzuki T., Mitsukawa N, & Ishii I. (2020, May). Risk factors affecting pressure ulcer healing: Impact of prescription medications. Wound Repair Regen, 28(3), 409-415. https://doi: 10.1111/wrr.12791. Aljezawi, Ma'en; Tubaishat,& Ahmad. (2018, May/June). Pressure Injuries Among Hospitalized Patients with Cancer: Prevalence and Use of Preventive Interventions. Journal of Wound, Ostomy and Continence Nursing, 45(3), 227-232. https://doi: 0.1097/WON.0000000000000429. Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., & Nie, A-M. (2019, September). Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Advances in Skin & Wound Care, 32(9), 394-408. https://doi: 10.1097/01.ASW.0000577124.58253.66