A major role in pressure injury prevention is turning and repositioning patients who are at high risk and who are unable to reposition themselves. Turning a morbidly obese patient requires proper staff training, access to equipment and technology where available.
Patients who are morbidly obese are at a high risk of altered skin integrity because of increased weight and adipose distribution. This puts them at high risk for mobility issues and increases the likelihood of long periods of sitting/not moving. Melissa Klaeb, PT and Bernadette Walters, RN (2019) noted that in addition to poor mobility and sedentary lifestyle “as adipose tissue grows and multiplies, the density of the capillaries supplying the tissue doesn’t proportionally increase.” It is because of this that obese patients have decreased vascular tissue perfusion making off-loading to allow reperfusion critical. If pressure-induced ischemia occurs this can lead not only to pressure injuries, but tissue necrosis.
The three most important proponents of reducing pressure injury risk in this population include:
Repositioning an obese patient is not safe to be done alone and a team approach is needed to avoid injury of the patient and staff. If a hospital doesn’t have a dedicated repositioning team, best practice strategies, support from the team and equipment should be utilized for safety.
Ceiling lifts can be used for safe patient repositioning and bariatric beds have enough room for turning large patients. Patients with a BMI > 35 who cannot reposition themselves should be placed on a wide bed and patients that have a BMI greater than 45 need to be on a wide bed even if they can reposition (Klaeb & Walters). Pillows are often not adequate for off-loading as an obese patients’ weight will compress the pillow and will not allow for off-loading, therefore, for this patient population bariatric wedges should be used.
Technology is available in patient-monitoring systems with sensors that can track patient movement and can alert the nurse when assistance or off-loading is needed.
To read more about repositioning and turning the morbidly obese patient and to read a case study click here.
Klaeb, M., Walters, B. (2019). Turning and repositioning patients who are morbidly obese. American Nurse Today, 14(4), 44-46.