New Approaches to Reduce Occiput Pressure Injuries on Pediatric ECMO Patients

Pediatric patients receiving extracorporeal membrane oxygenation (ECMO) therapy are at an increased risk of hospital-acquired pressure injuries (HAPIs). At a large, free-standing academic children’s hospital, ECMO skin protocols were in place to prevent HAPIs in these fragile patients. Despite previous interventions, severe occiput HAPIs continued, causing significant patient harm.

In 2019, the rate of occiput HAPIs among patients receiving ECMO was 17.72 per 1000 ECMO patient days. Unfortunately, most of the HAPIs were deep tissue injuries, stage 3 or higher. Previously, there was no standard device for occiput HAPI prevention; however, fluidized positioners were used frequently. Due to ECMO cannula location, these fluidized positioners often were unable to be remolded adequately to redistribute pressure.

A multidisciplinary approach was taken to reduce HAPIs by optimizing surfaces under the occiputs of ECMO patients. A trial protocol was initiated at the start of 2020 utilizing a non-powered reactive air pressure redistribution cushion to offload the occiput for patients older than 1 year, and a gel cushion was used for patients younger than 1 year.

The ECMO occiput HAPI rate decreased by 56.7% during the first 6 months of utilizing non-powered reactive air pressure redistribution cushions and gel cushions. After implementation, the occiput HAPI rate dropped from 17.72 to 7.67 per 1000 ECMO patient days. Of the postintervention HAPIs, only 3 injuries occurred, and they all occurred shortly after implementation, potentially indicating a learning curve.

Innovation is important in pediatrics due to a lack of supporting evidence for this population. Utilizing reactive air pressure redistribution cushions and gel pillows decreased occiput pressure injuries on some of the most high-risk patients. Nursing engagement and sustainable practice changes occurred under the leadership of the wound ostomy continence nurses and ECMO team.

References

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