LAYERS OF LINEN USED IN CONJUNCTION WITH PRESSURE ULCER

PREVENTIONKELLY SUTTLE BSN, RN, CWOCN

REDUCE THE PRESSURE, REDUCE THE RISK

EXCESSIVE PRESSURE ON TISSUES

Pressure is the major causative factor for pressure ulcers. These factors determine if the pressure is enough to cause a pressure ulcer:

• Intensity of Pressure

• Duration of Pressure

• Tissue Tolerance

EXCESSIVE PRESSURE ON TISSUES

• Intensity of pressure

• Capillary closing pressure 30-40mmHg

• Interface pressures

EXCESSIVE PRESSURE ON TISSUE

• Duration of pressure

• Inverse relationship between duration and intensity of pressure

• High pressure for short periods of time

• Low pressure for long periods of time

EXCESSIVE PRESSURE ON TISSUE

• Tissue tolerance

• Redistribution of pressure

• Tissue that is already damaged is higher risk for pressure ulcer

• Blue= lower pressure

Green Yellow Red= high pressure

• PORTABLE PRESSURE MAPPING SYSTEM WAS USED ON TOP OF LINENS TO DEMONSTRATE HOW EXCESS LAYERS OF LINEN CAN CAUSE HIGHER INTERFACE PRESSURES

ONE LAYER REUSABLE CHUX HOB FLAT

flat side

ONE LAYER REUSABLE CHUX HOB 30

Flat Side

2 LAYER REUSABLE CHUX HOB FLAT

Flat Side

2 LAYER REUSABLE CHUX HOB 30

Flat side

3 LAYER REUSABLE CHUX

HOB flat Hob 30 side view

Ambulatory• Fitted sheet atop regular mattress

• DO NOT use underpad

• Place top sheet, tuck into foot of bed and miter corners

UAB HospitalBed Making Standard

Standard Items on all beds: Items as needed:

Needing Assistanceor Bed Bound

• Fitted sheet atop regular mattress

• Draw sheet folded in half placed over center of bed to assist with turning/positioning/lifting

• 1 of appropriate underpad**DO NOT layer - Change underpad as needed

• Place top sheet, tuck into foot of bed and miter corners

Low Air Loss Surface• NO fitted sheet

• 1 Driflo (blue back) disposable underpad

Bariatric on Low Air Loss

• 1 flat sheet for positioning

• 1 Driflo (blue back )disposable underpad

Pillowcase Blanket/Spread

Pillow

Fitted Sheet Flat Sheet

Underpads (choose 1 of appropriate pad) Reusable Disposable underpad Disposalbe Driflo underpad

Draw Sheet

CONCLUSIONS

• These pressure maps show that excess linen can be a cause of pressure ulcers

• We are not really saving any time by “padding” our beds

• Excess linen on beds can increase linen costs

• This should be a component of a pressure ulcer prevention program

REFERENCES

Messer, M. S. (2010). Pressure Ulcer Risk in Ancillary Services Patients. Wound Ostomy Continence Nursing, 153-158.Pieper, B. (2000). Mechanical Forces: Pressure, Shear, and Friction. In R. A. Bryant, Acute and Chronic Wounds: Nursing Management (pp. 221-64). St Louis: Mosby.Suttle, K., & Dockery, J. (2013, September). Using Shared Governance to Evaluate Appropriate Use of Underpads for Pressure Ulcer Prevention. Birmingham.