FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Prevention of Pressure Ulcers in Pediatric Care
Guido Ciprandi 1* , Enrico Castelli 2 , Michaela Carletti 3 and Massimo Rivosecchi 1
1 Wound Care Pediatric Surgical Center, Dpt of Surgery and Transplantation, Bambino Gesu’ Children’s
Hospital, Palidoro and Rome, Italy, guidociprandi@gmail.com
2 Unit of NeuroRehabilitation, Bambino Gesu’ Children’s Hospital, Palidoro and Rome, Italy
3 Unit of Microbiology, Bambino Gesu’ Children’s Hospital, Palidoro and Rome, Italy
Introduction
Prevention of Pressure Ulcers (PUs) in children begins
from the maintenance of the skin integrity: accepting
that the skin is the largest organ of the body this
statement requires an heavy work and a complete
understanding of the wound healing process, which is
a complex regulated physiologic response to traumatic
skin injury. Skin integrity, clinical examination,
analysis of the risk, educational strategies, and a
natural comprehension of the different PUs stages are
the main tessera of the important wound care puzzle
called “Prevention”. Pediatric is an heterogeneous age
most prone to be affected by PUs because of the
fragility of the skin, the thickness of the complex
epidermis-dermis (less than 2.1 mm) and high-risk for
skin breakdown (SB) patients: prematures, newborn.
Methods
During the last 6yrs, 363 children affected by Pressure
Ulcers (Pus) were treated at Bambino Gesu’ Children’s
Hospital for a total of 602 lesions. At the same time a
Prevention’s Program had been instituted. Considering
the differences from adults, children admitted to NICU,
PICU, and NeuroRehabilitation Units have to be
managed by an aggressive prevention. All kind of
undue friction or pression at the level of occiput, ear
and heels, which symbolizes in children the main
affected sites by PUs (60%), must be avoided. The
“head to toe” skin assessment, mobility, incontinence,
nutrition, pain and an immediate counselling of the
parents represent the 1 st step of our prevention
protocol. The 2 nd step is the classement of the
admitted patiens. We considered 6 top-risk class of
children: 1. disabled, 2. still-motionless, 3. mentalimpaired,
4. incontinent, 5. spinal and 6. syndromic
patients. The third step is to pay more attention to the
oedema development. Whatever is the cause, the prearteriolar
space is increased, the distance between the
capillary boundles and diffusion of the Oxygen to the
tissues is reduced. The fourth step is the accurate
surveillance of devices and a rotational protocol is
advocated.
Results
Considering the 4 steps of the protocol, we analysed
the difference between the 1 st period (2005-2007) vs
78
the 2 nd period (2008-2010) (Table 1). The Student
unpaired t-test was used and is pointed at p