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Turning and Repositioning the Critically Ill Patient With Hemodynamic Instability: A Literature Review and Consensus Recommendations

Brindle, C. Tod; Malhotra, Rajiv; O'Rourke, Shelby; Currie, Linda; Chadwik, Debbie; Falls, Pam; Adams, Christi; Swenson, Jacob; Tuason, Dhol; Watson, Stephanie; Creehan, Sue

Journal of Wound, Ostomy and Continence Nursing: May/June 2013 - Volume 40 - Issue 3 - p 254–267
doi: 10.1097/WON.0b013e318290448f
WOUND CARE
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In the critical care population, heart rate and rhythm, blood pressure, respiratory rate, and oxygen saturation are monitored continuously, providing immediate feedback regarding any changes in patient status. Hemodynamic instability is a term commonly used by clinicians to describe labile changes in cardiopulmonary status, although this term is poorly defined in the literature. The clinician's perception of hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to pressure ulcer formation. The intensive care unit's practice culture and individual clinician perceptions regarding hemodynamic instability may lead to staff not turning patients out of fear that they are “too unstable to turn.” This article provides a discussion of the link between pressure ulcers and immobility, provides a review of current literature on progressive mobility and hemodynamic instability, and presents the results of a critical care consensus panel on safe and effective turning of critical care patients.

C. Tod Brindle, MSN, RN, CWOCN, Wound Care Team, VCU Medical Center, Richmond, Virginia.

Rajiv Malhotra, DO, Assistant Professor Internal Medicine, Critical Care Intensivist VCU Medical Center, Richmond, Virginia.

Shelby O'Rourke, BSN, RN, CCRN, Cardiac Surgery ICU, VCU Medical Center, Richmond, Virginia.

Linda Currie, MSN, RN, CCRN-CSC, Cardiac Surgery ICU, VCU Medical Center, Richmond, Virginia.

Debbie Chadwick, BSN, RN, CCRN, Surgical Trauma ICU, VCU Medical Center, Richmond, Virginia.

Pam Falls, BSN, RN, CCRN, Medical Respiratory ICU, VCU Medical Center, Richmond, Virginia.

Christi Adams, MSN, RN, Surgical Trauma ICU, VCU Medical Center, Richmond, Virginia.

Jacob Swenson, MSN, RN, CCRN, Nurse Clinician, Evans-Hayes Burn Center at the VCU Medical Center, Richmond, Virginia.

Dhol Tuason, BSN, RN, Cardiac Surgery ICU, VCU Medical Center, Richmond, Virginia.

Stephanie Watson, BS, RN, CNRN, CCRN, Neuroscience ICU, VCU Medical Center, Richmond, Virginia.

Sue Creehan, RN, CWON, Wound Care Team, VCU Medical Center, Richmond, Virginia.

Correspondence: C. Tod Brindle, MSN, RN, CWOCN, Wound Care Team, VCU Medical Center, Richmond, VA 23298 (cbrindle@mcvh-vcu.edu).

The authors declare no conflicts of interest.

Copyright © 2013 by the Wound, Ostomy and Continence Nurses Society