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Pressure Reduction and Relief


Surface Selection for Pressure Redistribution

The Pressure Ulcer Prevention Plan (Section 1.7) identifies the need for pressure offloading/redistribution surfaces or devices for both bed and seating arrangements. In addition, there are times that the patient will be outside of their own environment, in visits to clinics or laboratories, and admissions and procedures in hospitals. Patients undergoing surgery are immobile and have a greater risk of pressure ulcer development, particularly if they are already determined to be at risk. The use of pressure-redistribution devices during surgery may help reduce their incidence. The use of pressure redistribution surfaces is important in Emergency Rooms, where the limited mobility of at-risk patients may go unrecognized when the focus is on acute care rather than skin issues1.


Therapeutic Support Surfaces Selection Tool

Instructions: Use this tool to determine if an OT assessment is needed to order the appropriate surface (Chair or bed surface). Validated Risk Assessment Category (Braden)+/ or Pressure Ulcer Description2
At Risk or Redness present which fades very quickly when pressure removed Moderate Risk or One Pressure Ulcer present (excluding the heels) where the client can be positioned off the area High Risk or One Pressure Ulcer present (excluding the heels) and redness over another area Very High Risk or Multiple Pressure Ulcers (excluding the heels) or the client cannot be repositioned off of an ulcerated area
Ability to change position in bed (i.e. bed mobility)
Total Assistance to change position in bed Reactive Support Surface (e.g. gel, air, foam overlay) Reactive Support Surface (e.g. gel, air, foam overlay) Active Support Surface Multizoned Surface (e.g. alternating pressure mattress, rotational surface) or Powered Reactive Support (e.g. Low Air loss) Active Support Surface Multizoned Surface (e.g. alternating pressure mattress, rotational surface)
Moderate assistance with bed mobility required Reactive Support Surface (e.g. gel, air, foam overlay or high density foam mattress) Reactive Support Surface (Non-powered) (e.g. gel, air, foam overlay with air section insert in area of the wound) Reactive Support Surface (Non-powered) (e.g. gel, air, foam overlay with air section insert in area of the wound) Active Support Surface Multi-zoned Surface (e.g. alternating pressure mattress, rotational surface)
Client independent with or without a device with bed positioning (light assistance may be required) Reactive Support Surface (e.g. high density foam mattress) Reactive Support Surface (Non-powered) (e.g. gel, air, foam overlay with air section insert in area of the wound) Reactive Support Surface (e.g. gel, air, foam overlay) Powered Reactive Support (e.g. Low Air loss)if the controls can be placed within the client’s reach , Support surface products

Interventions to Prevent Pressure Ulcers with Devices

Medical devices that are known to cause pressure sores include devices such as CPAP, bidirectional positive airway pressure, oxygen tubing and masks, percutaneous endoscopic gastrostomy tubes, endotracheal tubes, nasogastric tubes, pelvic binders, pulse oximetry probes, tracheostomy faceplates and ties, sequential compression devices, external fixators and limb mobilizers. Preventing device-related pressure ulcers can be a complex challenge because of the absolute necessity of using the device or equipment in spite of the inherent risk created by the equipment. The following interventions should be implemented when using medical devices or equipment that will be in close proximity to the skin:

  • Correct positioning and care of the equipment, including appropriate fixation and stabilisation of the device
  • Use of thin hydrocolloids, film or foam dressings, silicone mesh or barrier products underneath the device to reduce pressure, moisture, friction and shear
  • Use of thin hydrocolloids to reduce pressure on the nares from endotracheal or nasogastric tubes
  • Never tape tubing directly to skin; always pinch tape under the tubing so that it is not pressed into the skin (see image right)
  • Where available, pressure-reducing dermal gel pads (E.g. KerraPro [Crawford Healthcare] - see image right) can be cut and fitted to cover the bridge of the nose, between fingers and toes, on/or behind the ears, the Achilles tendon and heel, down the spine etc.

To help prevent damage, the device should be loosened at least once per shift (if compatible with the medical condition) to allow for a thorough skin assessment.

Maximize Nutrition and Hydration
  1. LAMMICO Risk Management and Patient Safety Department. Tips to Enhance Your Hospital’s Pressure Ulcer Prevention Program. The Central Line: Hospital and Facility Newsletter Vol 2(2). Fall/Winter 2012 http://www.lammico.com/CMS400Min/800/theletter.aspx?id=5036
  2. Norton, L., Coutts, P., Sibbald, R. G. (2011). Beds: Practical Pressure Management for Surfaces/Mattresses. Advances in Skin & Wound Care, 24(7), 324-332.

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