RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Assessment & Management of Stage I to IV Pressure UlcersAppendix F: Support Surface ConsiderationsCompiled by L. Norton (2006)When choosing a support surface for a client, the clinician should consider not only its pressuremanagement characteristics but also:■■■■The impact on the client (comfort, bed mobility, transfers, functional activities such as dressing in bed, etc.)The impact on the caregiver (skill required to properly set up and maintain the device, impact oncaregiver burden)The environment (Where will the surface be used? Is it compatible with the bed or space within the room?)The product (fail safety, need for a power supply, need for specialized linens, etc.)CategoryStandard (hospital bed orclient’s regular bed at home)Foam Overlay (4 inch egg-crateor convoluted foam)Foam Mattress (replaces thestandard hospital mattress)Static Flotation (air cells, gel,fluid overlays/mattresses)Alternating Air (large airbolsters alternately over-inflateand under-inflate in sequence)Low Air Loss (air constantlyescapes through the bladders,reducing surface tension)Turning/Rotation (assists theclient to change position)Air Fluidized (client is “floating”in silicone beads)Clinical considerations in addition to interface pressure■ Client does not have to accommodate to a new surface■ No additional costs incurred■ May require frequent replacement (who will do this and when?)■ Deteriorates when exposed to moisture■ Can be warm■ Can often be adapted with foam or gel in high risk areas■ May be less expensive than active support surfaces■ Generally do not impact transfers or bed mobility■ May be less expensive than active support surfaces■ May require less maintenance (gel, fluid)■ Air mattresses/overlays may require some maintenance■ Noise of the pump and movement of the mattress may be disturbing■ Can decrease bed mobility and make transfers more difficult■ Noise of the pump and movement of the mattress may be disturbing■ Can decrease bed mobility and make transfers more difficult■ Low air loss mattresses may be better able to manage excessive moisture, but theclient's fluid balance should be monitored■ Motion of the bed can disrupt sleep■ Client may not be well positioned after the turn related to position on surface,contractures, etc.■ Noise, ease of transfers and bed mobility remain issues■ Client may find the gradual turning on the mattress more comfortable and lessdisruptive that being turned by caregivers■ Client is unable to transfer/decreased independence with bed mobility■ Care is more difficult■ Usually requires a hospital admission86