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Bariatric Pressure Injury: Skin and Wound care in the Home Care Setting

By Vicki Haugen RN, BAN, MPH, CWOCN, OCN 

Obesity is an increasingly serious health care issue and health risk in America with more than one third of Americans considered obese (NIH/CDC). An even greater health care concern is the increasing rate of morbid obesity (the bariatric patient) as well as the increasing rate of super obesity. According to the CDC a BMI (body mass index) of >40 is morbid obesity and a BMI >50 is now considered super obesity. The rate of persons with a BMI greater than 40 or 50 is growing in prevalence.1

Skin injury to bariatric patients can involve a combination of factors such as pressure injury, moisture or incontinence associated injury, and alteration in skin perfusion. Unique needs in the bariatric population involve problems such as pressure injury from catheters buried deep in skin folds or sides of wheel chairs or other furniture that are too small. Due to their body shape, any point of contact such as the fleshy gluteal part of the buttocks is often at risk for pressure injury, rather than a bony prominence.

Enteral Connectors: Being Prepared and Adopting New Enteral Connectors: 

Interview with Peggi Guenter, PhD, RN, FAAN  


Why do enteral nutrition (EN) connectors need to change?

To reduce the frequency of medical tubing misconnections. An international group of clinicians, manufacturers and regulators, such as the FDA, is collaborating with the International Organization of Standardization (ISO) and the Association for the Advancement of Medical Instrumentation (AAMI) to develop ISO 80369 standards. Unique international standard designs will promote better patient safety and help ensure that connectors for unrelated delivery systems are incompatible. The program that is helping introduce the new standards is called the Stay Connected initiative for using safer connectors. Much of the information in this article came from the extensive FAQ documents on that site.


Enteral Connectors: Long Term Care and Home Care

Kristy Klug, RD, LDN

Tubing is used in the healthcare setting to connect patients to medical devices for the provision of liquids and gases. Tubing misconnections can occur when tubing from one medical device is inadvertently connected to a functionally dissimilar tube of a patient, allowing for medical liquids or gases to be delivered into parts of the body for which they were not intended. For example, tubing from an enteral feeding accidentally connected to an intravascular (IV) port, allowing enteral nutrition to be administered into the patient’s bloodstream. The results of these misconnections can be devastating, often leading to severe patient harm including permanent injury or death.1 Industry changes are occurring across the healthcare continuum to create safer connections for all patients. In this article, we will discuss the introduction of the new ENFit enteral connectors in the long term care and home care settings.


Fighting VAP one step at a time: Early mobility for the ventilated patient


With the introduction of VAP prevention bundles by the Institute for Healthcare Improvement (IHI), critical care units have reported dramatic reductions in VAP rates. In her article, Ms. Andrews reviews the evidence supporting or questioning recommendations for VAP prevention and explores the evidence-based practices beyond the basic bundle including early tracheostomy and early mobility.


Since its inception, tracheostomy has become one of the more frequently performed procedures in ICU care. It has been estimated that 15-20% of ICU patients undergo tracheostomy at some point during their clinical course. Tracheostomy offers several important advantages over endotracheal intubation. Over the years many technological advances have occurred both in terms of the procedure and the tracheostomy tube technology. In his article, Mr. Davies describes the types and incidences of complications in light of today’s technology and population distributions.  

Tracheostomy and VAP

Ventilator-associated pneumonia (VAP) is defined as a lower respiratory tract infection occurring at least 2 days after beginning mechanical ventilation. The estimated associated mortality rate is 24% to 50%.  Because VAP is prevalent in ICU patients on mechanical ventilation, numerous studies have been undertaken to determine ways to decrease its incidence. One area of study surrounds the utility of early tracheostomy as a deterrent to VAP. The association of tracheostomy with VAP, the benefits of an early tracesotomy is the purpose of Dr. Durbin’s review.


Tracheostomy is an intensive-care measure that requires specialized care and monitoring. Despite its potential for reducing ventilator-associated pneumonia, it has its own risks, which are minimized by careful attention to device and patient care.  In this issue of Perspectives, we have assembled a panel of experts to discuss trach care, strategies to minimize morbidity and mortality in this patient population, patient and family education, and decisions regarding weaning and decannulation. Differences in adult versus pediatric populations are also highlighted.

Respiratory Care of the Morbidly Obese Patient – Nurses


The word obesity has its origins in the Latin language; it refers to the state of becoming “fattened by eating.” Obesity is a relatively common health condition, and its prevalence is increasing nationally and globally. Of all Americans between the ages of 26 and 75, 10 - 40% are obese, and nearly 5% are morbidly obese. The health consequences of obesity range from chronic conditions that reduce the general quality of life to a significantly increased risk of premature death. Along with other organs, the respiratory system is compromised by obesity. In their article, Gentile and Davies, discuss the many challenges to health professionals when caring for the respiratory needs of the obese, and how to reduce complications associated with their hospitalization. Critically ill morbidly obese patients are more likely to be intubated and remain intubated. They will stay in the ICU longer and are at risk for mortality during their stay when compared with their non-obese counterparts. In his article, Dr. Op’t Holt discusses the role of tracheostomy in the mechanically ventialted obese patient.

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