Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 56

56

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Table 4. Support Surfaces
Characteristics of Support Surface

Reactive (static)
A powered or nonpowered support surface
that changes its load
distribution properties only
in response to an applied
load, such as a patient lying,
sitting, or moving on it
Examples: foam, air,
combination foam/air
surfaces.

Foam:
* Conforms to bony
prominences to redistribute
pressure and reduce shear
* Viscoelastic foam is
temperature-sensitive
conforming to the body only
when the temperature of
the foam gets close to body
temperature

Foam:
* Individuals able to reposition
themselves
* Individuals at risk of pressure
ulcer development
* Multiple Category/stage II
pressure ulcers

Foam:
* Tends to increase skin
temperature
* Foam degrades and loses
resilience over time
* Lacks airflow and can allow
moisture to accumulate
between an individual's
body surface and the
support surface

Air- or gel-filled:
* Low surface tension
* Conforms to bony
prominences to redistribute
pressure and reduce shear
* Airflow is delivered in a
continuous pattern
* Easy to clean

Air- or gel-filled:
* Individuals able to
reposition themselves
* Individuals at risk for
pressure ulcer development
* Individuals who are heavy or
rigid and difficult to reposition
* Multiple Category/stage II
pressure ulcers

Air- or gel-filled:
* Ineffective if overinflated,
underinflated, or punctured
* Inflation must be checked
daily

Low air-loss (LAL):
* Connected air-filled pillows
across the support surface
* Cover is porous to allow
leaking of air to the
patient's skin surface
* May be powered with a
pump to provide continuous
airflow
* Calibrated according to the
Aatient's height and weight
* Easy to clean
* Cover is impermeable to
bacteria

Low air-loss (LAL):
* Used to manage heat and
humidity (microclimate)
of the skin
* Pressure ulcer prevention
* Multiple Category/stage II
pressure ulcers

Low air-loss (LAL):
* Contraindicated for Individuals
with an unstable spine
* If support surface is not
calibrated with an
individual's height and
weight or if mattress and
bed frame size do not
match, there is a risk of
entrapment of individual
between the edge of the
support surface and bed
side rails
* Powered support surfaces
may be noisy

Air Fluidization or High air-loss:
* Bed contains silicone-coated
beads covered by a porous
sheet and when air is
pumped through the beads,
the surface behaves like a
liquid on which an
individual floats
* Some hybrid beds have the
upper portion as a low airloss surface and the lower
portion as a high air-loss
surface

Air Fluidization or High air-loss:
* After myocutaneous flap
reconstructive surgeries
* Multiple pressure ulcers on two
or more turning surfaces such
as the sacrum and trochanter
* For re-warming Individuals who
are experiencing hypothermia
* Individuals with severe
debilitating pain who cannot
be repositioned
* Category/stage III or IV Pressure
Ulcers

Air Fluidization or High air-loss:
* Ensure that the support
surface is pressurized at
all times
* Individuals still need to be
repositioned laterally at 30
degrees every 2 hours with
head raised up no more
than 30 degrees

Alternating Pressure Mattress:
* Chambers or pillows are
arranged throughout the
entire length of the mattress
* A powered pump fills the
pillows with air in periodic
cycles of inflation and
deflation, thus redistributing
pressure by shifting the
pressure points and actively
shifting the body weight
* This may be combined with
pulsating pressure

Alternating Pressure Mattress:
* Individuals at high risk for
pressure ulcer development
* Any category/stage of
pressure ulcer
* Category/stage III or IV on
trunk or pelvis
* History of pressure ulcer and
potential for recurrence
* Acutely ill and immobile
Individuals
* Worsened wounds with
reactice surface
* After myocutaneous flap
reconstructive surgeries

Alternating Pressure Mattress:
* Individuals still need to be
repositioned laterally at 30
degrees every 2 hours with
head raised up no more
than 30 degrees

Reactive (static)
A powered or non-powered
support surface that
changes its load distribution
properties only in response
to an applied load, such as a
patient lying, sitting, or
moving on it

Active (dynamic)
Powered support surface
with the capability to
change its load distribution
with or without an applied
load. It is intended to
change the magnitude and
duration of the applied load

Indications

Precautions, Contraindications,
and Disadvantages

Type of Support Surface
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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