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- Title
405 Can Prevention Strategies Increase Risk for Pressure Injuries?
- Abstract
Introduction: An increased incidence of sacral pressure injuries in our adult burn center prompted a review of practice. Reducing the risk of hospital acquired pressure injuries (HAPIs) in burn patients presents a significant challenge. A variety of techniques are used to offload the sacrum including pressure redistributing mattresses, repositioning, monitoring nutritional status and early intervention. As heel pressure injuries also occur in the burn population, specialized soft foot boots are utilized to reduce heel pressure by floating it above the mattress surface. In response to the ongoing development of sacral HAPIs, a multidisciplinary team set out to determine if elevating the heel increased pressure to the sacrum. Methods: A pressure mapping device measureed sacral pressure of a staff member in the standard pressure redistributing bed used in the burn unit. The sacral pressure measurements obtained are detailed in the table below. The fluidized gel positioner used to obtain these measurements is intended to reduce pressure to the sacrum. The gel positioner was placed on the posterior thigh, below the buttocks, and molded to the patient's lateral thigh, per manufacturer instructions. All measurements were taken and recorded by the pressure mapper. The device was operated by a trained user. Results: Measurements taken demonstrate increased sacral pressure when utilizing the soft foot boot. However, this pressure is reduced when the boots are used in conjunction with pillows under the legs and the fluidized gel positioner. The results are summarized below. Conclusions: The pressure mapper device clearly demonstrates that using the soft foot boots increases pressure to the sacrum (from 11.3 mmHg to 24.2 mmHg) when used alone. While the literature does not support a specific pressure required to cause a pressure injury in burned or grafted skin, increased pressure is correlated with an increased risk for pressure injuries. As a result, efforts to reduce the incidence of HAPI to the heel may, in fact, cause an increased risk of pressure injury to the sacrum. Applicability of Research to Practice: While it is vital to offload the heel to reduce the likelihood of pressure injuries, practitioners must be mindful of the impact this intervention may have on the sacrum and other areas of the body.In patients at high risk for pressure injuries it may be prudent to consider avoiding the use of the soft foot boots alone in favor of combining them with other interventions. Sacral pressure Heel offloading device Sacral Pressure (mmHg) none 11.3 folded pillows 22.6 unfolded pillows 22.6 soft foot boots 24.2 unfolded pillows with soft foot boots 22.2 unfolded pillow and fludized gel positioner with soft foot boots 16.5 soft foot boots with fluidized gel positioner 16.5
- Subjects
PRESSURE ulcers; BURN care units; BURN patients; SACRUM injuries; ULCER prevention; DISEASE risk factors; HEEL injuries; PATIENT positioning
- Publication
Journal of Burn Care & Research, 2019, Vol 40, pS174
- ISSN
1559-047X
- Publication type
Abstract
- DOI
10.1093/jbcr/irz013.304