Xodus Medical invites you to visit us at the following upcoming events
Jan. 28-31, 2019
April 7-9, 2019
Is it Time to Bag Bean Bags?
The Pink Pad makes Trendelenburg easier, safer and more economical.
Pamela Goss, BSN, RN, CNOR, San Diego
Most of us no longer use dial-up internet, 8-track tapes, floppy disks or slide rules. We no longer own rotary phones or VHS video players. Is it time to consign bean bags to the same scrap heap? At least for Trendelenburg positioning, I think the answer is yes. There's a much safer, more efficient, more economical solution available -the Pink Pad from Xodus Medical. I know of what I speak. As recently as a couple years ago, I was a seasoned member of the bean bag brigade. As robotics coordinator at the University of California-San Diego medical center, I used them all the time to secure GYN, urology and colon patients in Trendelenburg. But I was never a fan.
- Especially with heavier patients, bean bags sometimes just aren't stable;
- Bean bags can have hidden pinholes that prevent suction, a major problem if the patient is already intubated. During long cases they can also lose suction and pancake, threatening the patient's stability;
- Their use sometimes results in skin ulcers and nerve damage. That's not only bad care; it can be a costly "never event";
- They have to be cleaned between cases, slowing room turnover because the surface needs to air dry;
- They are potential cross-contamination sources. I've seen bodily fluids on reusable bean bags more than once.
Fortunately, bean bags are no longer necessary for Trendelenburg. I found that out the day we tried our first pink pad.
When I first saw it, I was dubious. How would this colorful flat pad perform the function of a form-fitting bean bag? I watched in amazement as the Pink Pad held an obese patient like glue on a table tilted 40 degrees. Since then I've learned:
- It's incredibly comfortable. It molds to the patient's contours and grips the skin while reducing pressure and shear. The high-tech Pink Pad material feels like the viscoelastic gel pads on expensive beds.
- With bean bags, if the patient sweats, there's nowhere for the liquid to go, and that can exacerbate skin breakdown. The Pink Pad material wicks away moisture, helping to prevent ulcers. The material is so skin-friendly that I sometimes cut off the corners and use the scraps to cushion the hard parts of the IV.
- Once you're in tilt, there's no pressure on the head, neck or shoulders and no worries about pressure or nerve injuries there.
- Set up is less than a minute, saving us 5 to 6 minutes per procedure. When you consider that OR time can cost as much as $80 per minute, the Pink Pad pays its own way and then some.
- The Pink Pad is single-use, so there's no risk of cross-contamination.
Remember DVD rental stores? They were great in their time, but now that time is over. In my mind, bean bags are in the same category. It's time to move on. When you need to position patients in Trendelenburg, do your patients, your facility and your staff a solid and "think pink." You'll be glad you did.
Ms. Goss is Robotics Coordinator at UCSD Thornton Hospital in La Jolla, Calif.
Positioning your Way to Better Economic Outcomes
There’s a better, safer, more economical way to do Trendelenburg.
Joe X. Jung, RN, MBA, CNOR Los Angeles
In this era of austerity, we all need to work to contain surgical case costs. But as we do so, we need to keep the big picture in mind.
Yes, price is important, but only as it relates to the value or worth of the product. A cheap product can end up being very expensive.
To explain what I mean, consider robotic surgery supply costs.
Traditionally, we’ve used disposable egg-crate foam combined with reusable shoulder braces or beanbags to keep patients stable in steep Trendelenberg. On the surface, this is a very inexpensive strategy, with an up-front cost of maybe $30 or so. But a deeper look reveals that this seemingly cheap solution actually results in very high costs—well over $500 per case on average. Here’s why:
- The cost of slippage. In many cases, patients slip enough to force the OR team to undock the robot and sometimes retuck the arms and reposition the stirrups, taking 15 minutes or more. If OR time costs $100/minute1, that adds up to at least $1,500. For example, if this occurs in one case out of 10, slippage adds at least $150 to the cost of each case on average. Of course if skin shear or port trauma occurs during the slip, the cost is even higher.
- The cost of pressure injuries (PIs). PIs are all too common with the traditional approach. In our facility, we find that shoulder braces result in shoulder pain for at least 1 in 4 patients, while beanbags result in skin issues for about 1 in 5. Let’s say these develop into a full-blown PI once every 100 cases. Each pressure injury costs a facility $43,1802. That means PIs raise the cost of the traditional approach by another $432 per case.
- Legal/reputational costs. At least 17,000 pressure injury patients file lawsuits every year. It’s the second most common claim after wrongful death.3 Even a successful defense of a malpractice suit costs $50,000 according to AMA. When the case involves use of products like egg-crate foam for unintended/unapproved purposes, it may be even harder to defend. Such cases may also sour patients and surgeons on your facility because of Never Events there. What’s the cost of that?
There’s a far superior solution on the market. It’s called the Pink Pad, from Xodus Medical. This shape-conforming pad grips patients firmly in Trendelenberg without shoulder braces or bean bags. The material is designed to wick away moisture and preserve the skin’s integrity. Its up-front cost may be slightly higher, but its value dwarfs that of other options such as foam and bean bags. It’s truly a “no brainer”—better for the patient and better for facility economics.
More than 90 percent of an iceberg rests below the waterline. OR supply costs can be similarly deceptive. Just a reminder to keep your eyes open and the big picture in mind as you steer your facility through the challenging times ahead.
Mr. Jung is Department Administrator, Perioperative Services at Kaiser Permanente Los Angeles Medical Center.
1 Girotto JA, Koltz PF, Drugas G: Optimizing your operating room: Or, why large, traditional hospitals don’t work. Intl. J. Surg., Volume 8, Issue 5, 2010, pp 359-367.
2 Agency for Healthcare Quality and Research
How We Combat Our Pressure Injury Problem
Switching to BackPacks dramatically reduced the incidence of PIs in this facility
Maria Kramer, MSN, RN, Pittsburgh, PA.
Ask surgical professionals to name the most important advances of the last 5 years and most will say 4K video, lasers or maybe the use of robots. Although these are groundbreaking advancements in healthcare, the product that has changed patient outcomes for our service is none of the above. It’s a seemingly simple set of single-use pads and positioners called Surgical BackPacks.
Trust me: If you do prone positioning, it is a flat-out game-changer. Trial it. You’ll see.
At our hospital, we do about 60 neuro cases a week, with many in prone position. Pressure injuries can often be a big problem with this group. The cases are time intensive. Comorbidities are common, and the OR environment can be unfriendly to the skin.
For years, the tools we had to help us were limited. We had table covers designed to protect the equipment, not necessarily the patient, and low-tech foam pads inappropriate for prolonged skin contact. Back then, it was not uncommon to see one to two pressure-related events per week, such as abdominal skin tears, persistent erythema and/or blisters. Then, two years ago, we had an opportunity to trial Xodus Medical Surgical BackPacks. That’s when our skin integrity outcomes began to improve.
BackPacks are extremely convenient custom kits for prone positioning. Each one includes a slotted headrest, two arm boards, four hip/knee pads and a special abdominal pad that allows for chest and diaphragm expansion. But BackPacks are a lot more than that. What makes them truly groundbreaking is the DermaProx covering, a proprietary layer of protection that maximizes skin protection. It’s open cell and breathable, specially designed to prevent shear and wick away moisture.
DermaProx is far superior to the foam products we used before. Unlike traditional table covers, DermaProx helps prevent tear and shear. Unlike foam pads, DermaProx removes moisture, preserving skin pH and preventing irritation and breakdown. Unfortunately, areas where pressure is present will always exist in prone positioning, but patient pressure injuries are dramatically less common thanks in large part to BackPacks.
BackPacks are not only great for the safety of our patients. They are financially beneficial. The price is competitive, but more importantly it saves us on the back end. The average cost of caring for a Stage III or IV pressure ulcer is $43,180, and CMS no longer pays for that. Preventing even one ulcer makes it all worthwhile. As a bonus, because Backpacks contain everything we need in one vacuum-packed bag, it saves us a minimum of 5 minutes every case, and frequently more, increasing staff satisfaction.
Every day, in surgery facilities everywhere, patients sustain pressure injuries. We can do better. Our experience proves that. If you do prone positioning and you have pressure injuries, I encourage you to consider the Xodus Medical Surgical BackPackTM
. Your patients will thank you.
Ms. Kramer is Director of the Neurosurgery Surgical Division of a large level 1 trauma center in Pittsburgh, PA.
This Product Really Prevents Pressure Injuries
The Pink Heart Pad is extremely effective, efficient and economical.
Susie Hammant, RN, CNOR, Metairie, Louisiana
From stents to heart-lung machines to ultrasound to ablation and so much more, medical advances have markedly improved heart surgery over the last 50 years.
Unfortunately, one of the most serious cardiac surgery complications still persists. Pressure injuries occur in as many as 29% of all cardiac cases.1
But now technology has finally caught up with pressure injuries in the form of the Pink Heart Pad from Xodus Medical. We all know cardiac surgery patients almost always have circulatory problems, due to age, obesity, inactivity, poor nutrition and diabetes. They must be supine for more than four hours, during which time, we periodically hall or slow circulation. But in our cardiac unit. the Pink Heart Pad has neutralized these problems. It has drastically reduced the incidence of this painful, dangerous, expensive complication. and it does it economically and efficiently.
If you already use Xodus's Pink Pad for urology and GYN, then you know how amazingly breathable the Pink Pad's proprietary open-cell material is. It prevents shear and wicks away liquids like bodily fluids, irrigatants and prep solutions, preserving the skin's pH and preventing irritation and breakdown.
The Pink Heart Pad performs just as well in the cardiac room. So much so that we now use it for every single case, from cardiac ablations to valve repair/replacements to CABG.
Pressure injury prevention is the most important reason, but there are many others:
- The kit comes with DermaProx-lined arm protectors. These help you position the arms perfectly, protect from crush injuries and lift IV lines away, while still allowing free access.
- Energy passes through the Pink Pad without resistance, so you can place your MegaSoft* grounding pad and your warming system underneath.
- If you're using the frog-leg position, you can fold the end of the Pink Heart Pad up so that it gently holds the patient's feet in place, securing it with the enclosed strap. Frog leg positioning pads are available as an accessory item for the kits.
The Pink Heart Pad is much easier to set up than our old system. It saves us 20 minutes of OR time. No more making shoulder rolls out of sheets, cleaning and inspecting gel pads, or hunting for foam positioning donuts. Everything we need is in the single-use kit. OR assistants simply clean the table and put this right on. We also no longer fret about HAIs from reusable positioning devices.
Everyone worries about economics, and here the Pink Heart Pad shines. In our facility, the price of the Pink Heart Pad is similar to the price of the devices we were using previously. Meanwhile, every pressure injury it prevents saves us $43,1802
, and each minute we save in the OR saves us $1003
A product that markedly improves patient safety and reduces the cost of healthcare? Yes please. And thank you Xodus Medical.
Ms. Hammant is the CVT Charge Nurse at East Jefferson Hospital.
1 Ballesteros, C: Teamwork for prevention: Reducing HAPUs in cardiac surgery patients. Nursing Management: July 2017 - Volume 48 - Issue 7 - p17-20
2 Girotto JA, Koltz PF, Drugas G: Optimizing your operating room. Intl. J. Surg., Volume 8, Issue 5, 2010, pp 359-367.
3 Agency for Healthcare Quality and Research
*MegaSoft is a registered trademark of Ethicon Endo-Surgery