Q: What is a Pressure Ulcer?
A: A
pressure ulcer is a localised area of dead tissue. It is
primarily caused by unrelieved pressure, for example when a
patient lies in one position for too long, although there are
many other factors which influence their development, such as
incontinence and poor nutrition. The areas of the body most at
risk of pressure ulcer development are the bony prominences,
such as the ischial tuberosities and sacrum.
Q: Who is Most at Risk of Pressure
Ulcer Development?
A: The elderly, people with
neurological conditions, and orthopaedic patients are most at
risk, as they frequently have reduced mobility, and are
therefore less able to change their position. Hospitals use
Risk Assessment scores in order to determine which patients
are most at risk of pressure ulcer development. The most
commonly used score is the Waterlow Score (1985).
Q: When Should a Patient have a
Waterlow Risk Assessment?
A:All patients should have
their pressure ulcer assessed on admission, for example in A
& E, and should be reassessed whenever their condition
changes, for example if their condition deteriorates.
Q: How Can Pressure Ulcers Be
Prevented?
A: The most effective method of
preventing ulcers is the provision of suitable
pressure-reducing equipment, such as a mattress and seat
cushion. These support the maximum surface area of the body,
which therefore lowers the pressures under the bony
prominences.
Q: When Should Pressure-Reducing
Equipment be Provided?
A: Pressure-reducing
equipment should be provided as soon as the patient is deemed
to be at risk. Trolleys in A & E, and Operating Tables
should therefore be used in conjunction with suitable
pressure-reducing mattresses, in addition to the mattress on
the patient's bed. It is essential that the patient's seat be
also provided with suitable equipment, as they can spend many
hours per day in a sitting position.
Q: Why is Provision of Suitable
Seating Equipment so Important?
A: At-risk patients
are more vulnerable in a seated position than when in a lying
position, due to the small surface area of the body being
supported. The buttocks and thighs support 75% of the body
weight, and so there is an increased risk of damage to tissues
due to pressure compared to lying.
The shape of the pelvis makes it difficult to achieve
stability when sitting, due to the rounded shape of the
ischial tuberosities.
Gravity continually causes the body to slide down in the
chair, and this results in shear forces and friction, which
cause damage to internal tissues.
Q: What are the Requirements of a
Pressure-Reducing Cushion?
A: It should allow the
ischial tuberosities to be accommodated, thereby allowing the
thighs to support the body weight.
It should promote a symmetrical, stable sitting position.
It should provide comfort.
Q: What is the Mediform-Visco
Cushion?
A: The Mediform-Visco Cushion is a
pressure-reducing cushion that has been manufactured from a
visco-elastic foam, "Intellifoam". This type of foam is
sensitive to the heat of the body, and as the foam is
gradually warmed, it conforms to the bosy shape. The cushion
therefore reduces peak pressure points by supporting the load
over the maximum surface area possible. As a consequence, the
Mediform-Visco cushion can be safely used with patients who
are at medium to high risk of developing pressure ulcers.
The cover of the Mediform-Visco cushion is constructed from
a multi-stretch fabric that is waterproof and vapour
permeable. The cover allows the patient to easily contact with
the cushion, and prevents hammocking.
Due to the high degree of conformity achieved with the
Mediform-Visco Cushion, the effects of shear forces and
friction are reduced.
The conformity of the Mediform-Visco Cushion means that
patients find it extremely comfortable and stable.
Q: Is the Mediform Visco suitable for
use as a Wheelchair cushion?
A: Yes. This product is
widely used as a wheelchair cushion and comes in various sizes
to suit individual needs.
Q: Can the MediformVisco Cushion be
integrated into an Armchair?
A: Yes, Mediform
pressure reducing cushions can be easily integrated into
existing ward chairs / armchairs.
Seating manufacturers should contact SAREO Healthcare for
further details on integration of Mediform Visco cushions into
their existing ward chairs.
Q: Can the Mediform Visco cushion be
used on an existing Ward Chair?
A: Yes. Where
possible it is preferable to remove existing foam seat bases
before placing the Mediform Visco cushion on the chair.
Q: What is the Correct Sitting
Position?
A:The correct sitting position should
allow the ischial tuberosities to support body weight evenly,
thereby providing a symmetrical sitting position.
The hips and knees should be flexed to 90°, and the feet
should be placed flat on the floor (feet take 19% of the body
weight in sitting).
Q: Do patients Require Regular
Repositioning on the Mediform-Visco Cushion, if at Risk of
Pressure Ulcer Development?
A: All patients who are
expected to sit for long periods of time should be regularly
repositioned, and research has demonstrated that mobilisation
of patients every two hours will reduce the incidence of
pressure ulcers.
If seated patients are not regularly repositioned, then
their posture will become adversely changed, which will load
areas of the body which are unable to withstand it, for
example the sacrum and heels.
Q: What Should I do if the Patient
has Reddened Areas?
A: Firstly the frequency of
re-positioning should be increased. The patient should be
reassessed, and if necessary provided with an alternating
pressure-relieving cushion.
Q: Does the Conformity of the
Mediform Visco Cushion Inhibit Patient Transfers?
A:
Not normally. However, moving and handling equipment such as
sliding boards and sheets can easily be used with the cushion.
Q: How Should the Mediform-Visco
Cushion be cleaned?
A:The cushion can be simply
cleaned between patient use with soap and water, providing
that there has been no spillage of bodily fluids.
See recommended cleaning instructions with each MediForm
cushion.
REFERENCES: Waterlow, J. (1985) A Risk Assessment Card,
Nursing Times, 81: 49 - 55
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