Oral Mucosal Microcirculation in the Context of Endotracheal Tube-Related Pressure Ulcer Development.

dc.contributor.author Chun, Nicolle M.
dc.contributor.department Nursing (PhD)
dc.date.accessioned 2019-05-28T20:21:56Z
dc.date.available 2019-05-28T20:21:56Z
dc.date.issued 2018-08
dc.identifier.uri http://hdl.handle.net/10125/62610
dc.subject oral mucosal microcirculation
dc.subject oral mucosa pressure ulcer
dc.subject endotracheal tube
dc.subject nursing
dc.title Oral Mucosal Microcirculation in the Context of Endotracheal Tube-Related Pressure Ulcer Development.
dc.type Thesis
dcterms.abstract Critically ill patients commonly require multiple medical devices such as cardiac monitors, ventilators, non-invasive positive pressure ventilators, nasal gastric tubes (NG), orogastric tubes (OG), and urinary tract catheters. Nurses are challenged to prevent hospital acquired pressure ulcers (HAPUs) because many of these devices can cause ulcers on bony prominences and mucosa. The literature indicates that medical device-related pressure ulcers (MDRPUs) associated with endotracheal tube (ETT) were the most frequent (Coyer, F., Stotts, N. & Blackman, V., 2014; Hanonu & Karadag, 2016), with highest rates of MDRPUs were observed among Medical Intensive Care Unit (MICU) patients (Hanonu & Karadag, 2016). The purpose of this study was to explore the effects of ETT pressure and ETT repositioning frequency on oral mucosa microcirculation among intubated patients to guide clinicians in the prediction and prevention of oral mucosa pressure ulcers (OMPrU). A single-site, prospective, descriptive, observational study was conducted with a convenient sample of six patients who were enrolled between January 7, 2016 and June 30, 2016. Age, vital signs (including body temperature, heart rate (HR), mean arterial pressure (MAP)) , Sequential Organ Failure Assessment (SOFA) score, usage of anticoagulant, usage of pressor, total capillary density (TCD), functional capillary density (FCD), the percentage of perfused and non-perfused capillary loops (PPC) and microvascular flow index (MFI) were measured to address three research questions: What microcirculation changes of upper lip oral mucosa occur from ETT pressure every two hours upon ETT repositioning during the first eight hours of intubation using the ETT holder, AnchorFast?; What relationships exist between participants’ vital signs and oral mucosal microcirculation?; What relationship exists between participants’ age, SOFA score, and Braden Scale for Predicting Pressure Sore Risk (BSPPSR) and final 8-hour vital signs and final 8-hour oral mucosal microcirculation? This study provides additional evidence to support current practice of ETT repositioning every 4 hours. Future research on oral mucosa microcirculation in context of ETT-related pressure ulcer prevention should address the relationship of oral mucosa microcirculation including other variables such as patients’ underlying medical diagnoses, BSPPSR subscale, choice of sedation medication, gender, and angle of ETT.
dcterms.description Ph.D. Thesis. University of Hawaiʻi at Mānoa 2018.
dcterms.language eng
dcterms.publisher University of Hawaiʻi at Mānoa
dcterms.rights All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
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