Evaluation of Pressure Injury Risks in Patients Undergoing Hemofiltration in Intensive Care Units

Purpose: Patients treated in intensive care units are at high risk of developing pressure injuries due to their critical illnesses as well as many risk factors such as immobility, changes in level of consciousness, hemodynamic instability, mechanical ventilation, sedative and vasoactive drug use, nutritional deficiencies and long-term hospitalization. In patients receiving hemofiltration treatment, the long duration of treatment, exposure to medical devices, limitation of movement and the severity of the clinical condition may further increase this risk. Pressure injuries can negatively affect the patient's quality of life, increase the duration of care and health care costs, and lead to significant complications. Therefore, it is important to determine the risks of pressure injuries in intensive care patients receiving hemofiltration at an early stage and to reveal risk-related factors. The aim of this study is to evaluate the risks of pressure injury in patients receiving hemofiltration therapy in the intensive care unit and to determine the clinical and treatment-specific factors associated with the development of pressure injury.

Method: The research was planned as descriptive. The study will be carried out between 15 July 2025 and 1 July 2026 by Prof. Dr. It is planned to be carried out in Süleyman Yalçın City Hospital Anesthesia and Reanimation Intensive Care Unit. The population of the research will consist of patients who will receive hemofiltration treatment in the intensive care unit between the specified dates. The sample size was calculated based on logistic regression analysis using the G*Power 3.1 program; It was determined that a minimum of 109 participants should be reached, taking into account the 5% significance level, over 95% statistical power and OR = 2.5 effect size. Patients who are 18 years of age or older, receive hemofiltration, and are approved to participate in the research by their legal representatives will be included in the study. Patients whose planned intensive care unit stay is less than 48 hours and whose skin integrity is impaired due to special treatments other than hemofiltration will be excluded from the study.

Data will be collected using the Intensive Care Clinical Observation and Patient Information Form created by the researchers, as well as the Glasgow Coma Scale (GCS), Richmond Agitation-Sedation Scale (RASS), APACHE II, Braden Pressure Sore Risk Assessment Scale and Medical Device-Dependent Pressure Sore Risk Assessment Scale. Clinical characteristics of the patients, such as age, gender, height, weight, body mass index, diagnosis and reason for hospitalization, length of stay in the intensive care unit, smoking history, mechanical ventilation status and parameters, diet, frequency of positioning, medications used and paralytic agents will be recorded. In addition, daily blood gas measurements and albumin, hemoglobin, CRP and other relevant laboratory values will be evaluated. Patients' clinical and treatment-related data will be recorded on the first day, last day of hemofiltration and 72 hours after leaving treatment.

Skin integrity and pressure injury development will be evaluated on the first day, last day of hemofiltration and 72 hours after leaving treatment, taking into account EPUAP and NPIAP guidelines. The presence, location, size, stage, infection status and clinical symptoms of the pressure injury will be recorded. General risk of pressure injury by Braden Scale; With the Medical Device-related Pressure Sore Risk Assessment Scale, the risk of pressure injury due to medical devices will be evaluated. Thus, the relationship of variables such as hemofiltration duration, level of consciousness and sedation, disease severity, medical device exposure, positioning frequency, nutritional status and blood parameters with the risk of pressure injury will be examined.

Evaluation of Data: Research data will be analyzed using SPSS 22.0 package program. Descriptive data will be presented as numbers, percentages, mean and standard deviation. Chi-Square and Fisher exact tests will be used to compare categorical variables in independent groups. Logistic regression analysis will be performed to determine the independent factors affecting the development of pressure injury. Statistical significance level will be accepted as p<0.05.

Conclusion: The findings from this study are expected to contribute to the identification of important risk factors for pressure injuries in intensive care patients receiving hemofiltration, the early identification of high-risk patients, and the development of risk-based approaches to prevent pressure injuries in nursing care. It is also thought that the study will contribute to intensive care nursing practices and improving patient safety in terms of evaluating the risk of pressure injury due to medical devices.