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Iatrogenesis as origin of pressure ulcers in a cricital care unit
Esperón Güimil J.A., Fernández Camiña Mª. C., Freire Rodríguez M., Angueira Castelo C., Rodríguez Fernández C.

Introduction: The appearance of pressure ulcers (PUs) is a negative indicator of health care, for such an event is avoidable and, therefore, it should not appear. PUs are related inversely with the attention to the ill person, they produce pain, uneasiness and increase the consumption of resources and the risk of complications.

Objective: To discover the percentage of patients with iatrogenic pressure ulcers (IPU) and the number of these lesions to be found in the Critical Care Unit (UCC), as well as to generate hypothesis about the factors related with their appearance.

Material and methods: Descriptive, analytic, prospective prevalence study, repeated in several cross-sections. They registered the following variables: diagnosis, age, gender, stay period, punctuation in the scales Nova 4, NEMS and S.C. Glasgow, treatment with vasoactive drugs, and treatment with sedation. All the patients registered with iatrogenic PUs and the number of IPUs; as well as the producing causes (materials, tools), localization and phases. The analysis of the data was carried out using the statistical package SPSS v10.0.

Results: The sample included 131 patients, 61% men and 39% women, with an average age of 63.4 years; and an average stay period of 7.5 days. A total of 17 prevalence cross-sections were carried out. The observed iatrogenic PUs prevalence range expanded from 0% to 71,4%, with a global mean of 28,24% (37 patients with iatrogenic PUs, of a total of 131 patients). They registered a total of 53 IPUs, 38 (71,7%) in stadium-I and 15 (28,3%) in stadium-II. Thirty-seven dot seven per cent were located in the nose and ears, 7 (13.2%) were registered in the fingers (13,2%), due to the thimble of the pulsioximeter. The oxygen mask and nasal glasses produced 12 IPUs (22,6%), the same thing happened with the orotraqueal tube and its fixation system with 11 (20,7%) IPUs. The muff of the mensuration of the arterial pressure produced 10 pressure ulcers (18,8%) in a total of 9 patients. There exists no association between age, stay period and gender, and the appearance of IPU. An statistically significant association exists between the appearance of IPU and the subjected patients to sedation or treatment with vasoactive drugs, in both cases the appearance of IPUs was higher. The S.C.Glasgow and the NEMS scales are related with the appearance of IPUs.

Conclusion: So unimportant activities as pulsioximetry or arterial pressure control produce a number of lesions that should be take into account. We find that the prevalence of iatrogenic-originated PUs indicate a far-reaching problem. We consider that it would be advisable to bring forth specific protocols regarding this type of iatrogenic pressure ulcers.