Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - xiv

xiv

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Pressure
Redistribution and
Support Surfaces
Bed Positioning
21. Use bed positioning devices and techniques
that are compatible with the bed type and the
individual's health status.




Avoid positioning individuals directly on
pressure ulcers regardless of the pressure
ulcer anatomical location (trochanter,
ischium, sacrum, and heel) unless such
position is necessanry for performance of
ADLs, such as eating or hygiene.
Use pillows, cushions, and positioning aids
to reduce pressure on existing pressure
ulcers or vulnerable skin areas by elevating
them away from the support surface.



Prevent contact between bony prominences.



Elevate the head of the bed no higher than
30 degrees unless medically necessary.



Reposition individuals in bed at least every
2 hours.

23. Prescribe wheelchairs and seating systems
specific to the individual that allow that individual
to redistribute pressure sufficiently to prevent the
development of pressure ulcers.


Obtain specific body measurements for
optimal selection of seating system
dimensions (postural alignment, weight
distribution, balance, stability, and pressure
redistribution capabilities).



Prescribe a power weight-shifting wheelchair
system for individuals who are unable to
independently perform an effective pressure
relief.



Use wheelchair tilt-in-space and/or
recline devices effective enough to offload
tissue pressure.



Use standing wheelchairs to remobilize
individuals with existing pelvic pressure
ulcers.



Full-time wheelchair users with pressure
ulcers located on a sitting surface should
limit sitting time and use a gel or air surface
that provides pressure redistribution.



Maintain an offloaded position from the
seating surface for at least 1 to 2 minutes
every 30 minutes.

Avoid closed cutouts or donut-type cushions.



Wheelchair Positioning - Pressure
Redistribution Surfaces

Bed Support Surfaces
22. Use pressure-redistribution bed support surfaces
for individuals who are at risk for or who have
pressure ulcers (see Table 1: Support Surfaces).






Select a reactive support surface for
individuals who are able to reposition
themselves enough to avoid weight bearing
on all areas at risk for pressure ulceration
and who have a stable spine.
Select an active support surface for
individuals who are unable to reposition
themselves.
Select an active support surface or a high
air-loss (air-fluidized) reactive support
surface for individuals who have pressure
ulcers on multiple turning surfaces and/or
are status post flap/skin graft within the
past 60 days.

24. Prescribe wheelchair seating systems for each
person with a spinal cord injury individualized
to anthropometric fit, to provide optimal
ergonomics, and to provide maximal function.
Prescribe wheelchair seating systems that-


Redistribute pressure



Minimize shear



Provide comfort and stability



Reduce heat and moisture



Enhance functional activity



Inspect and maintain all wheelchair
cushions at regular scheduled intervals.



Replace wheelchair seating systems that
are no longer effective.

25. Prescribe padded toilet and bathing durable
medical equipment items for pressure
redistribution and skin protection during use.
26. Prescribe skin protection devices and pressure
redistribution seating systems for use with
recreational equipment, other motorized or
manually powered vehicles, and specialty
wheelchairs.
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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