Use of Pressurease and Airform mattresses in pressure ulcer care

Large cell dynamic air mattresses are effective in the prevention of pressure ulcers but they still have inherent problems, e.g. the ability of the mattresses to move patients along the mattress through the inflation and deflation of the cells. Also, there have been reports that the inflation and deflation of cells can cause motion sickness. This article reviews two mattresses from Sareo Healthcare Ltd: a static system, Pressurease; and a unique dynamic system, Airform. These two systems offer a cost-effective and clinically effective method of pressure ulcer prevention and therapy.     

Matching patient need for pressure sore prevention with the supply of pressure redistributing mattresses

The authors have conducted a series of pressure sore prevalence surveys within one health district over a 4-year period. Additional surveys of the availability and deployment of pressure redistributing (PR) bed mattresses have also been made within the same district. The prevalence of pressure sores increased from 6.8% (1986) to 14.2% (1989) while the available stocks of PR mattresses increased from 69 (1987) to 186 (1989). Our results appear to question the common assumption that successful pressure sore prevention can be achieved through expanding the stocks of PR mattresses. Five possible reasons why the increase in mattress provision was matched with an increased prevalence of pressure sores are forwarded. The use of measures of prevalence rather than incidence rates to monitor the effects of clinical initiatives is discussed.     

A review of the Medical Agency Services Confor-Med range

Medical Agency Services Ltd (MAS) has, since 1994, been involved in the design and development of mattresses and overlays manufactured from visco-elastic polymer foam, which is currently utilized in the manufacture of domestic, automative and specialist bedding and seating products. The foam is fire retardant and satisfies the BS 5852 (Part 2) ignition source 5. The foam is a heat and weight sensitive, visco-elastic polymer, giving a high performance, pressure redistributing surface that 'moulds' to the patient giving simultaneous muscular/skeletal support and allowing the patient to feel comfortable. The Confor-Med mattress offers a sensible alternative for patients with high Waterlow scores who have no pressure sores, but require early intervention to prevent pressure sores developing. A case study is included in this review of the products.     

Mechanical effects of airway humidification devices in difficult to wean patients

OBJECTIVE: To evaluate the influence of airway humidification devices on the efficacy of ventilation in difficult to wean patients. DESIGN: A prospective, randomized, controlled physiologic study. SETTING: A 22-bed medical intensive care unit in a university hospital. PATIENTS: Chronic respiratory failure patients. INTERVENTIONS: Performances of a heated humidifier and a heat and moisture exchanger were evaluated on diaphragmatic muscle activity, breathing pattern, gas exchange, and respiratory comfort during weaning from mechanical ventilation by using pressure support ventilation. Eleven patients with chronic respiratory failure were submitted to four pressure support ventilation sequences by using the heated humidifier and the heat and moisture exchanger at two different levels of pressure support ventilation (7 and 15 cm H(2)O). MEASUREMENT AND MAIN RESULTS: Compared with the heated humidifier and regardless of the pressure support ventilation level used, the heat and moisture exchanger significantly increased all of the inspiratory effort variables (inspiratory work of breathing expressed in J/L and J/min, pressure time product, changes in esophageal pressure, and transdiaphragmatic pressure; p <.05) and dynamic intrinsic positive end-expiratory pressure (p <.05). Similarly, the heat and moisture exchanger produced a significant increase in Paco(2) (p <.01) responsible for severe respiratory acidosis (p <.05), which was insufficiently compensated for despite a significant increase in minute ventilation (p <.05). This resulted in respiratory discomfort for all patients with the heat and moisture exchanger (p <.01). Adverse effects were partially counterbalanced by increasing the pressure support ventilation level with the heat and moisture exchanger by >or=8 cm H(2)O. CONCLUSIONS: The type of airway humidification device used may negatively influence the mechanical efficacy of ventilation and, unless the pressure support ventilation level is considerably increased, the use of a heat and moisture exchanger should not be recommended in difficult or potentially difficult to wean patients with chronic respiratory failure.     

Efficacy and cost-effectiveness of the Thermo contour mattress

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that 'patients with Waterlow scores of 23 can be nursed safely on this product' were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.     

Preventing pressure ulcers: an evaluation of four operating-table mattresses.

Pressure is a major factor in the development of pressure ulcers. This research focused on assessing the pressure-reducing effects of operating-table mattresses. Five mattresses were tested: a standard operating-table mattress, a foam mattress, a gel mattress, a visco-elastic polyether mattress, and a visco-elastic polyurethane mattress. Four intraoperative postures were evaluated: supine, lateral, fossa, and the Miles-Pauchet position. Interface pressure measurements were performed on 36 healthy volunteers. The foam mattress and the gel mattress seem to have little or no pressure-reducing effect; the polyurethane mattress and the polyether mattress reduce interface pressure significantly better (p < .001); but none of the mattresses reduce pressure sufficiently to prevent the occurrence of pressure ulcers.     

The new QUATTRO PLUS mattress replacement system

Since the early development of alternating pressure air mattresses (APAMs) there have been regular alterations in design. These designs have led to improved reliability and performance. This article outlines the changes made by Talley Medical to the QUATTRO PLUS replacement mattress. Improved safety features and design modifications continue the process commenced many years ago which has seen the use of alternating pressure air mattresses become widespread throughout the UK.     

Establishing the cost of comfort. Effectiveness of mattresses in pressure sore prevention.

The treatment of pressure sores exerts a significant drain on NHS resources. Identifying mattresses which help to prevent pressure sores can result in substantial long-term savings.     

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.     

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.     

The Theracute alternating pressure replacement mattress

The use of alternating pressure mattresses is still acknowledged as an effective adjunct in the prevention and treatment of pressure damage; however, with the plethora of equipment now available, there is an increasing need to provide information that supports the practitioners' decisions ensuring individual patients' clinical needs are met. This article reviews a new addition to the Talley Medical range of alternating pressure mattresses, the Theracute mattress replacement system.     

Effects of absorbent incontinence pads on pressure management mattresses

AIM: The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses. BACKGROUND: Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads. METHODS: An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition. RESULTS: There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads. CONCLUSIONS: Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care.     

Laboratory performance of alternating pressure air mattresses component and sequelae

The performance of three different alternating pressure air mattresses with different geometries of air cell were compared (Nimbus 3, Heritage, Tamora Plus), using simple performance indices based on pressure mapping. The aim of this study was to examine the effect on performance of elevating the backrest and thigh section of the bed into sitting position. Ten healthy volunteers of various sizes were pressure-mapped over the full pressure cycle on three alternating pressure air mattresseses with differing cell geometries. This was then repeated with the beds profiled to a sitting position. Performance of the alternating pressure air mattresses in terms of their ability to redistribute pressure dynamically was assessed in the different positions. The different alternating pressure air mattresses performed similarly with the bed in the lying flat position, but smaller cells appeared to be more effective in the sitting position. A conclusion was made that cell geometry may have an effect on the ability of the mattress to achieve alternating behaviour in the sitting position.     

Relieving the pressure in the radiology department

Interventional radiological procedures can be complex, requiring patients, many of whom already have compromised arterial circulation, to lie immobile for significant periods. X-ray table mattresses are designed to avoid radiation attenuation, which could degrade image quality or increase patient dose. Consequently, most mattresses do not have pressure redistribution properties. Skin changes, noted after lengthy radiological procedures, would appear to indicate that this unrelieved pressure places vulnerable patients at risk of sustaining pressure damage that could potentially initiate pressure ulcer development. This article examines the biomedical basis of pressure ulcer development, and discusses the suitability of alternative support devices for radiological examinations in an apparently under-researched environment.     

A Phantom-Based Method to Assess X-Ray Table Mattress Interface Pressures

BackgroundPressure redistribution performance of x-ray table mattresses can influence the development of pressure ulcers in at-risk populations. Interface pressure analysis, with human participants, is a common method to assess mattresses. This approach has limitations that relate to the lack of standardisation between and within humans.AimThis study aimed to develop and validate an anthropomorphic phantom-based method to assess x-ray table mattress interface pressures as an index of mattress performance.MethodsA three dimensional phantom simulating an adult’s head, pelvis, and heels was printed from x-ray computed tomography image data and attached to a metal frame 175 cm in length. Dry sand was added to the phantom head, pelvis, and heels to represent a range of human weights. Pressure distribution was assessed using XSensor. Phantom validation was achieved by comparing phantom mattress interface pressure characteristics, for five human equivalent weights, against 27 sets of human mattress interface pressure data.ResultsUsing the correlation coefficient R, phantom and human pressure data showed good correlation for the five phantom weights (R values: head = 0.993, pelvis = 0.997, and heels = 0.996).ConclusionA novel method to test x-ray mattresses for interface pressure was developed and validated. The method could have utility in the testing of x-ray mattresses that are in routine use and for new mattress development. Phantom interface pressure data could be provided by manufacturers to help inform procurement decisions when matching mattress characteristics to medical imaging demands and the underlying patient populations.     

大型压力蒸汽与臭氧消毒床垫的效果比较

目的比较大型压力蒸汽消毒法和臭氧消毒法对医院床垫的消毒效果。方法选择100张床垫,分为两组,各50张,采用压力蒸汽消毒法和臭氧消毒法,对两组床垫的表面细菌和深部载体定量菌的杀灭率进行对照研究。结果蒸汽消毒法对床垫表面细菌的杀灭率为99.92%,臭氧消毒法为94.86%,二者差异无统计学意义(P>0.05);蒸汽消毒法对床垫深部白色念珠菌的杀灭率为100%,高于臭氧法的98.03%(P<0.01)。结论两种消毒方法消毒效果肯定,但蒸汽消毒法穿透性能好、效率高、环保,值得推广。     

Support surfaces: beds, mattresses, overlays-oh my!

The prevention and treatment of pressure ulcers are major concerns for health care providers across the care continuum. The selection of a support surface is an important component of a comprehensive pressure ulcer prevention program. The accepted standard in clinical practice for pre-venting pressure ulcers and other complications of immobility is to either turn patients manually at frequent intervals or to use a pressure-reducing device. The longer a patient is immobilized, the more profound will be the systemic complications. The costs associated with the complications of immobility are staggering in terms of human suffering, physiologic damage,and real dollars. A variety of specialty beds, mattresses, and overlays have been designed to address pressure, shear, friction, and moisture.Limited data exist regarding the efficacy of these products. Clinicians want to choose a support surface for their patients on the basis of product performance. With the push toward establishing standards for testing methods and reporting information, clinicians can look forward to making support surface decisions based on the evidence and outcome data resulting from controlled clinical studies and expert opinion and consensus.     

Changing pressure-redistributing mattress stocks: costs and outcomes

There remains considerable confusion regarding the selection of appropriate pressure-redistributing support surfaces, although it is accepted that use of low-pressure foam mattresses is likely to reduce the incidence of pressure ulcers compared with standard hospital mattresses. In this study, a 650- hospital replaced its mattress stock with low-pressure foam mattresses with over pounds sterling 100 000 cost savings in the first year after implementation. Incidence and prevalence data were recorded but given the challenges of interpreting apparent trends in the data (due to the lack of robust data collection methodologies and no case-mix adjustment) these data were not included.     

Pressure ulcer prevention in intensive care patients: guidelines and practice

Background  Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention.
Design  The design of this study was a cross-sectional study (point prevalence).
Setting  The study setting was intensive care units. The sample consisted of 169 patients – 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards.
Results  The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients.
Conclusions  The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines.     

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.