Wednesday, August 26, 2020
Preventing Pressure Injuries Outside the Wheelchair
Last week Australia was encouraged to create awareness around chronic wounds as part of Wounds Awareness week.
This week it’s New Zealand’s turn to promote awareness with their Wound Awareness week running this month. As such we will continue our theme of Pressure Injury (PI) prevention and redistribution surfaces in this week’s blog.
Good Pressure Injury (PI) risk reduction requires us to consider all the support surfaces being used. We can apply many of the same principles of design, forces, and materials science to multiple surfaces and positions to specifically address potential equipment risks. Today’s blog, whilst still addressing reduction of risk of PI, will look at some of the other positions and surfaces that we need to consider.
End users that are dependant on carers for transfer assistance can spend increased time in bed based on the availability of support staff. Whilst this is not ideal it is the reality for many with mobility impairments. This can result in an increased need to complete functional tasks in bed and for the user to use the bed functions such as head raise to enable seated tasks.
Although this bed function can assist someone to complete tasks in bed, we need to acknowledge the shear forces that accompany this bed movement. Using a knee break in conjunction with head raise can reduce the amount of slide but not eliminate the risk of sustaining a shear sacral injury. We also need to consider the mattress surface and how it will interface with the user and the bed profiling.
As with sitting, those that have significant movement limitations will be at a higher risk of sustaining an injury due to lack of movement. For these users the mattress materials and design can be crucial.
A ROHO Mattress Overlay
When we think about the materials that provide the highest levels of redistribution the first thought is air. When air is used in a container that enables it to work as a fluid, we are considering hydrostatic forces rather than peak forces, this enables maximum immersion and envelopment. A benefit of a non-powered air mattress is that there are no power chords as potential trip hazards or risk of power outage impacting the usage.
Other commonly prescribed air mattress options include air alternating systems. These work on the concept of loading and off-loading. These systems usually consist of rows of tubes that inflate and deflate in sequence so that there are times when the depressed cells mean there is no contact on the corresponding area of the body. As such the peak pressure increases when the cells are inflated. This constant changing can make some users feel like they are on gentle waves like water.
Talley Quattro Acute Mattress Replacement
When considering air alternating systems, you do need to check the minimum user weight requirements as this differs between manufacturer design as does the sequence or ratio of inflated cells. For some users the inflation of cells may not be tolerated. Another point frequently raised by users is the noise of the power unit; whilst most manufacturers have significantly reduced the noise we need to consider the impact even a small noise can make in the quiet silence of the middle of the night….many of us have experienced that dripping tap you may not hear until you lie awake trying to sleep!!
Consider the location of the users home, some areas are known for power cuts and a contingency plan may be required for what to do in the event of a power outage, this may include consideration of a generator in some remote locations.
With both types of air mattresses we do need to consider transfers. Generally the higher the pressure redistribution properties the harder bed mobility is. A foam mattress may not provide the same level of immersion and envelopment or offloading, however because it is a more static, solid option it also has less impact on independent movement. With an alternating mattress there is usually a “hard” or “transfer” mode but pressure risk will be increased if this isn’t returned to normal cycle for lying.
Like wise with the ROHO mattresses, transfers need to be considered. The mattress is available in sections and can be inserted into foam surrounds to assist with bed mobility and transfers.
Bathroom and Personal Care Tasks
Independent self-care and ADLs can take longer for those with impairments and may be completed from surfaces we don’t consider. When assessing for pressure risk it is important to consider all the support surfaces that are being used.
Commodes come standard with a seat made of similar materials to a toilet seat. Although this is not an issue for someone with full sensation, the ability to move and for short periods of time, it is important to find out more about the tasks and time spent to ensure it is not a concerning risk factor. If risk is identified, consideration of the seat needs to be addressed with padding or a pressure redistribution surface.
A ROHO Toilet Seat Cushion
Skin tears and injuries do not always come as a direct result of pressure forces, but they can become chronic wounds. Not having the strength to complete a side transfer or mis-judgement may result in the user landing on a surface not intended eg the wheelchair wheel, and sustain a skin injury. Transfer style and other assistive technology such as slide boards may need to be addressed to prevent injury.
Be aware of all surfaces! Be open and have discussions around PI risk, prevention strategies and equipment options. Pressure injuries are for the most part preventable. Chronic wounds can have significant negative impacts both physically and emotionally. Our education team can provide clinical support and education around pressure care and the clinical application to our equipment ranges.
You can contact us at firstname.lastname@example.org or reach out to your local Permobil Territory Sales Manager.
Clinical Education Specialist
Tracee-lee Maginnity joined Permobil Australia in July 2019, as a clinical education specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.
Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.