Technique
Our approach focuses on the following:
- Easily accessed readily available materials – Given the demand
healthcare services are under around the world a complex and expensive
solution requiring multiple bespoke components is not desirable.
- Respectful of surrounding structures – If not applied with
consideration of surrounding structures you risk swapping nasal injury
for corneal or labial
- Easily Monitored – Proning presents a significant challenge for
visualisation of the nose and eyes, bulky padding risks obscuring the
affected area preventing monitoring. Skin breakdown and infection are
a real concern with pressure damage in this area.
- Easily Adapted – A bespoke solution for each patient may be effective
but will also be expensive and likely to take time to produce/acquire
Surgical sponge has already been described as an appropriate material to
immobilise and protect delicate grafts 9and it is our
practice to also make use of it in the early stages of recovery post
rhinectomy. It is our opinion that surgical scrub sponges meet the
criteria set out above and represent an effective method of pressure
relief in patients being ventilated prone:
- Easily accessed readily available material – these sponges are
available in all operating theatres and are bought in bulk at
relatively low cost
- Respectful of surrounding structures – the sponges can be adjusted
and cut to avoid nearby structures
- Easily monitored – the 3 part design allows the sponge to be moved
and the nose viewed
- Easily Adapted – can be cut to any size and additional sponges can be
added to account for larger anatomy
The steps taken to measure and apply the sponge are detailed in figure
1.
The solution can be seen in figure 1 and2. Figure 2 demonstrates that
because the sponges are only secured together at one edge they can splay
slightly allowing pressure to be re-distributed and stopping the sponge
bulging and encroaching on the eyes.