MEASUREMENTS OF INTERFACE PRESSURE BETWEEN BODY SITES AND THE SURFACES OF FOUR SPECIALISED AIR MATTRESSES

SUMMARY Four specialised air mattresses had interface pressure measured under six body sites prone to pressure sores in 10 subjects, supine and sitting. The mattresses were the Clinirest (SSI) and FirstStep (KCI) continuous airflow mattress overlays, and Airwave (Pegasus) and Nimbus (Huntleigh) alternating pressure air mattresses. On the mattress overlays, average supine interface pressures were 2.33 kPa (scapula), 4.15 kPa (elbow), 1.94 kPa (sacrum) and 2.79 kPa (buttock), although they were higher at the occiput (7.97 kPa) and heel (11.7 kPa). The alternating pressure air mattresses had an average minimum interface pressure close to zero for three sites, rising to 4.28 kPa under the heel. Average maximum interface pressures were 8.61 kPa (occiput), 5.21 kPa (scapula), 4.90 (elbow), 4.85 kPa (sacrum), 4.61 kPa (buttock) and 13.2 kPa (heel). No accepted scientific method exists for comparing the two types of mattress. Our data suggest a clinical benefit at the occiput and heel (supine) in using an alternating pressure air mattress and a benefit in using a continuous airflow mattress overlay at other sites.     

Effects of position and mattress overlay on sacral and heel pressures in a clinical population.

A comparison of pressure reducing properties of alternating air, static air, and water mattress overlays was conducted with 57 patients in a surgical intensive care unit. Sacral and heel pressures in both recumbent and semi-Fowler's positions were tested for each surface using a repeated measures design. Mean pressures for the alternating air mattress were significantly higher than pressures with other surfaces, regardless of position or site. There were significant main effects for position and site, with higher pressures in the semi-Fowler's position and at the sacral site. A significant interaction between surface, site, and position was found. Pressure sores developed in eight patients, but the incidence was not significantly different across groups. A pressure measuring device constructed from available clinical materials proved to be both sensitive and reliable. The findings suggest alternating air overlays should be avoided, and that positioning and periodic position change to reduce sacral pressures for patients requiring prolonged upper body elevation is important.     

The Use of the Modified Norton Scale in Nursing-Home Patients

Patients in three nursing-home wards in Sweden were in 1991 assessed by the Modified Norton Scale (MNS). Of the 71 patients, 38 (49%) were considered to be at risk of developing pressure sores. Six of the patients had a total of eight pressure sores. Five sores were assessed as stage II, two sores as stage III and one sore as stage IV. Only two of the six patients with pressure sores had any preventive equipment in their beds. The nursing and medical documentation of the existing pressure sores was not satisfactory. Individual programs for skin care and routine assessment with a pressure sore prediction instrument, such as the MNS, would serve the dual purpose of directing the relevant measures to the patient groups at the greatest risk and would aid in assessing the efficacy of pressure sore treatment strategies.     

Healing of advanced pressure ulcers by a generic total contact seat: 2 randomized comparisons with low air loss bed treatments

DESIGN: Randomized prospective cohort study. SETTING: Long-term care facilities. PARTICIPANTS: Two hundred seven subjects with stage III or IV pressure ulcers. INTERVENTION: Two separate randomized control studies of advanced pressure ulcers that compared wound healing on 3 different support surfaces. Subjects were allocated to low air loss bed, upgraded bed overlay (only in study 1), or 4h/d sitting on an experimental generic total contact seat. The seat was designed using prosthetics principles aimed at distributing pressure off bony prominences onto less pressure-sensitive areas. Subjects were followed for 6 months or until they were totally healed. MAIN OUTCOME MEASURES: Number of subjects who totally healed, time to total healing, and pressure ulcer status score after 4 weeks of treatment. Interface pressures and functional capacity were also measured at 4 weeks. RESULTS: In study 1, 3 subjects worsened on the bed overlay condition and were withdrawn from the study. None worsened on low air loss or generic total contact seat. At 4 weeks in both studies, pressure ulcer status score was lowest for the generic total contact seat (P<.0001), compared with the other surfaces. Subject populations were similar, so to analyze total healing, results from both studies were combined. Total healing of pressure ulcers occurred as early as 4 weeks in some subjects using the generic total contact seat. Even at 8 weeks, total healing was primarily seen with use of that seat, on which interface pressures, function, and seating tolerance were best. CONCLUSIONS: Faster healing and better function indicate that treatment using the generic total contact seat is superior to low air loss bed therapy, which is standard care for advanced pressure ulcers.     

POTENTIAL FOR BED SORES DUE TO HIGH PRESSURES : INFLUENCE OF BODY SITES,BODY POSITION,AND MATTRESS DESIGN

SUMMARY Pressures were measured on 10 subjects, supine and sitting, under six anatomical sites prone to bed sores on three different mattresses. Studied were the Clinifloat and Therarest specialist replacement mattresses, and a standard hospital mattress. Mean supine pressures were less than 5 kPa under four sites. Average supine buttock pressure was 2.93 kPa. Occiput and heel pressures were much higher than under other sites, being on average 2.6 and 4.5 times greater respectively than the mean buttock pressure. On sitting up, buttock pressure increased by a factor of 1.7 on average, to a level higher than the accepted capillary closing pressure. Measurements were consistent with mattress design, specific features of which can significantly affect pressure under certain sites.     

低位截瘫患者难愈性压疮的康复护理

目的探讨早期的康复介入在低位截瘫患者难愈性压疮治疗中的作用和成效。方法对15例低位截瘫患者压疮创面予改良封闭式负压引流技术处理的同时予康复介入,进行肢体功能锻炼、膀胱功能训练、肠道功能训练,增强患者心理社会的调适能力。结果15例低位截瘫患者的难愈性压疮全部治愈,半年回访无再发压疮。结论早期的康复介入可以提高截瘫患者的生活自理能力,提高患者的个人皮肤照顾能力,加快截瘫患者压疮的愈合速度,减少压疮的再发。     

低位截瘫患者难愈性压疮的康复护理

目的 探讨早期的康复介入在低位截瘫患者难愈性压疮治疗中的作用和成效.方法 对15例低位截瘫患者压疮创面予改良封闭式负压引流技术处理的同时予康复介入,进行肢体功能锻炼、膀胱功能训练、肠道功能训练,增强患者心理社会的调适能力.结果 15例低位截瘫患者的难愈性压疮全部治愈,半年回访无再发压疮.结论 早期的康复介入可以提高截瘫患者的生活自理能力,提高患者的个人皮肤照顾能力,加快截瘫患者压疮的愈合速度,减少压疮的再发.     

Bridging: an effective and practical method of preventive skin care for the immobilized person.

Various methods have been used in an attempt to decrease prolonged pressure on skin, especially over bony prominences, and thus prevent pressure sores in immobilized patients: turning frames, circle beds, flotation beds, and special mattresses. Bridging is one means of relieving pressure on bony prominences which is both simple and inexpensive. Through the proper positioning of pillows, a patient is supported above the surface of the bed with free space between the bony prominences and the bed surface. Several different positions for pressure relief are possible. Advantages of the technic include its low cost, patient acceptance, lack of mechanical components which can fail, and ease of training personnel or family members to carry it out.     

A review of pressure reduction device studies.

When considering patient morbidity, mortality and costs, pressure sore formation is a major health care concern. An adjunct to the nursing care plan for prevention and treatment is the selection of a pressure reduction/relief device. This review of four pressure reduction device studies is intended to increase the vascular nurse's knowledge base concerning pressure reduction device efficacy. Each study is reviewed and graphed to identify like patterns within each study. Foam is judged to be least effective. Air cell and air mattress overlays are found to be intermediate devices and the low air loss beds appear to be the most effective. Few of the tested devices reduced pressure below 32mmHg at the heel site, leaving the heel at risk for breakdown.     

Bed surfaces and pressure sore prevention: an abridged report

PURPOSE: This article summarizes the results of a systematic review of randomized controlled trials testing the effectiveness of special beds, mattresses, and cushions in preventing and treating pressure sores. The review's citation is Cullum, N., Deeks, J., Sheldon, T.A., Song, F., & Fletcher, A.W. (2000). Beds, mattresses and cushions for pressure sore prevention and treatment (Cochrane Review). The Cochrane Library, 4. DESIGN: An integrative research review. SAMPLE: 37 studies were included in the analysis. METHODS: A broad search of databases and unpublished studies was conducted. Data were extracted from those that met the inclusion criteria. Studies were grouped in various ways but mainly by type of product evaluated. FINDINGS: Many special products designed to prevent or treat pressure sores are more effective than standard hospital foam mattresses in preventing and treating pressure sores. CONCLUSIONS: Special pressure-relieving surfaces should be used for patients at risk for skin breakdown. IMPLICATIONS FOR NURSING PRACTICE: Individual practitioners and agencies should have a systematic protocol for assessing patients' risk of skin breakdown and for taking action when patients are determined to be at risk. The findings of this review provide some guidance for choosing particular products, albeit not definitive evidence for matching risk levels to products.     

非长期卧床患者发生压疮原因分析及对策

目的总结分析临床非长期卧床患者被动发现压疮的原因,并提出针对性对策。方法回顾性分析2003年4月-2007年8月在本院住院的17例非卧床发生压疮患者的临床资料,应用Norton量表对压疮进行评分,分析发生压疮的原因。结果Norton量表评分轻度危险11例、中度危险5例、重度危险1例,通过局部清创、全身营养等支持治疗和护理,除1例患者病情恶化死亡外,其他患者压疮均得到有效控制或治愈。结论加强压疮相关知识培训,以《压疮危险因素评估表》为依据,对患者做好连续评估和分期护理,重视特殊部位皮肤交接班,可以及时、主动发现压疮,积极干预,及时控制患者压疮的发展,减少患者的痛苦。     

自制水袋配合赛肤润按摩预防脑卒中后压疮的效果观察

目的探讨自制水袋配合赛肤润按摩预防脑卒中后压疮的效果。方法将60例脑卒中后卧床患者随机分为对照组和观察组,每组各30例。对照组患者按常规预防压疮护理方法,观察组患者在对照组基础上使用自制水袋配合赛肤润按摩预防压疮。观察两组患者皮肤潮湿感、压疮发生情况。结果两组患者皮肤潮湿感、压疮发生情况比较,均P<0.05,差异具有统计学意义,观察组患者皮肤潮湿感、压疮预防效果明显优于对照组。结论使用自制水袋配合赛肤润按摩能有效预防脑卒中后卧床患者压疮的发生,值得临床推广应用。     

1例肺癌骨转移并发左股骨转子处压疮的护理

目的探讨肺癌骨转移并发左股骨转子处压疮的护理原则。方法对1例肺癌骨转移并发左股骨转子处压疮,采用湿性愈合治疗,观察治疗过程及疗效情况。结果本例经积极护理及治疗处理后,左股骨转子处压疮创面完全愈合,周围皮肤痊愈,于治疗后11 d出院。出院后2周定期随访,无压疮复发情况发生。结论肺癌骨转移并发左股骨转子处压疮的治疗关键在于正确的压疮分级评定、合理的治疗和并发症的预防。     

A method for quantifying the area of closed pressure sores by sinography and digitometry

Neurologically impaired and elderly patients who remain in the same position for prolonged periods risk developing pressure sores. The most insidious of these are closed pressure sores. Conservative treatment of closed pressure sores frequently is the only treatment option. However, no systematic method to assess the effectiveness of conservative treatment modalities exists. The purposes of this study were to develop a method for quantifying the area of closed pressure sores by means of sinography and digitometry and to determine the utility of this method for monitoring healing. A convenience sample of 40 veterans with closed pressure sores was selected. Four individuals independently traced 116 regions from 30 sinograms of closed pressure sores from a subsample of ten patients. A fifth individual calculated areas of closed pressure sores in units, using digitometry. Findings and nursing implications will be presented.     

Prevention, treatment and healing of pressure sores in long-term care patients

ABSTRACT Of 515 consecutive patients newly admitted to the long-term medical ward, 16% already had skin lesions which were classified as pressure sores upon arrival in the ward, and 7.6% developed pressure sores during the observation period which was more than three days but not more than 26 weeks. The relation between the condition of the patient and the development of pressure sores and their prevention and treatment was followed with a modified Norton scale. Proportionally more sores progressed which were initially recorded as skin discoloration as compared with the other stages, i.e. epithelial damage, damage to the full thickness of the skin and lesion with a cavity. Preventive measures were not used to a greater extent in those patients who developed pressure sores as compared with those who did not. Preventive measures were used rather as treatment or secondary prevention after a patient had already developed a lesion. The treatment measures were used in many different combinations. In this study no healing effect could be proved for the various treatment measures which were undertaken.     

马勃联合伤口护理产品治疗压疮的效果

目的观察联合应用马勃联合墨尼克伤口护理系列产品治疗压疮的疗效。方法将47例（91处）Ⅱ～Ⅳ压疮患者随机分为观察组24例（49处）和对照组23例（42处）。观察组患者应用马勃联合墨尼克伤口护理系列产品治疗,对照组仅使用墨尼克伤口护理系列产品治疗。结果观察组压疮治愈率为88％,显效率为98％,对照组治愈率为62％,显效率为83％,两组比较差异有统计学意义（X2分别为8．24,4．35;P〈0．05或P〈0．01）。结论马勃联合墨尼克伤口护理系列产品治疗压疮疗效显著。     

Infection and pressure sores

Pressure sores cause considerable morbidity and prolonged hospitalization in debilitated patients. Healing of pressure sores may be delayed if they are infected, although response to appropriate topical therapy is satisfactory. However, some pressure sores that appear uninfected may have associated infection of deeper tissues and require specific diagnosis and treatment to close the sores. Two hundred sixty-seven debilitated patients, mostly with spinal cord injury, are reviewed. Included in this group are 49 patients with pressure sores that did not appear to be infected but were associated with deep infections. Diagnosis of nonhealing sores associated with deep infection requires clinical suspicion and a variety of laboratory tests, such as sinograms, radionuclide studies, computed tomography, and biopsy. Treatment usually requires a combination of appropriate antibiotics and surgery. Prevention of pressure sores and infection by offering specialized care for nonambulatory patients should be the ultimate goal.     

Program for lowering the incidence of pressure sores in neurosurgical patients

Pressure sores are one of the well known problems that occur in hospitals. As the literature on the subject indicates, a lot of money is expended in managing this problem every year, and 12-66% of pressure sores are caused during surgery. Patients who undergo neurosurgical procedures are susceptible to pressure sores because of lengthy operations. We collected data on patients with pressure sores who underwent surgery between May 2004 and August 2004, and found that the incidence of pressure sore in neurosurgical patients was 9.5%, which was the highest among all surgical patients. This project was developed to solve the problem of pressure sores by setting up standard preventive procedures, a nursing follow up system and continuing education courses, and utilizing cotton rolls to pad sites of pressure sores. The incidence of pressure sore in neurosurgical patients was reduced from 9.5% to 7% after the improvement project was carried out. The more concerned nurses are about pressure sores, the better the quality of operative nursing care.     

“立奇膏”治疗老年压疮的临床疗效

目的 探索“立奇膏”治疗老年压疮的临床疗效。方法 选择60例分为2组,治疗组30例、对照组30例。治疗组在压疮护理常规基础上采用自制的中药药膏“立奇膏”进行外敷换药,对照组采用在压疮护理常规方法,观察两组压疮患者治疗的有效率。二组均3个疗程,治疗组患者好转率均明显高于对照组,提示“立奇膏”治疗效果好于对照组,差异有统计学意义(P相似文献