Living with Equipment in 2011: “Understanding tissue circulation and support surface testing through PRI and PAI testing as a means of assessing patients for the selection of pressure redistribution and relieving mattresses and seating” Phil Morrisey: Pressure Injury: Pressure Injury: Aetiology Aetiology International NPUAP-EPUAP Pressure Ulcer Definition “A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.” October 2009.”
13
Embed
Understand tissue circulation supp surface testing through ... · Microsoft PowerPoint - Understand tissue circulation supp surface testing through PRI PAI.ppt Author: HalesS Subject:
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Living withEquipment in 2011:
“Understanding tissue circulation and support surface testing through PRI and PAI testing as a means of assessing patients for the selection of pressure redistribution and relieving mattresses and seating”
Phil Morrisey:
Pressure Injury:Pressure Injury:
AetiologyAetiology
International NPUAP-EPUAP Pressure Ulcer Definition
“A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.”October 2009.”
The microcirculationThe microcirculation
Artery
120mmHgArteriole32 mmHg
MetarteriolePrecapillary
Arterial capillary
20 mmHg
Venous capillary
Venule12 mmHg
Sensorynerve ending
Sebaceous gland
Hair follicle
Epidermis
Dermis
Subcutaneouslayer
Capillaries
Erector pilimuscle
Cross section of the skinCross section of the skin
• Or self-repositioning regimens 3-4 x per hour Assisted positioning: effective, but labour intensive, and with a risk of injury to the patient and carer.
Pressure Relief IndexMeasuring interface pressure in
Alternating Pressure
support surfaces
Pressure relief is related to design
•Pressure = periodic removal, sufficient to restore blood flow
•Time = frequency and duration similar to ‘normal’spontaneous movement
Alternating cellsHeadHead
sectionsection
PRI Techniques•Simple to do…..easy to get wrong!
•Standardise test methods
•Sensor positioning•Bony prominence•Apex of the cell
•Sensor calibration………and much more…..
Alternating support surfaces
HeadHeadsectionsection
Alternating cellsAlternating cells
Made up of interconnected air cells that cyclically inflate and deflate to periodically
remove pressure from soft tissue
1 in 2 Cell 1 in 2 Cell CycleCycle
Alternating cellsHeadsection
Alternating cellsHeadsection
1 in 3 Cell 1 in 3 Cell CycleCycle
1 in 4 Cell 1 in 4 Cell CycleCycle
Alternating cellsHeadsection
50% Pressure Relief=50% Body Contact
66% Body Contact = 33% Pressure Relief
25% Pressure Relief=75% Body Contact
Alternating cell cycles
Interface pressure on heel of 69kg, 1.73m male subject
0
30
60
90
120
150
180
210
240
0 4 8 12 16
Nimbus 3
Note: This example represents test results from one individual only and different results may occur with different subjects. Only large scale tests can determine true performance differences.
Interface pressure on sacrum of 52kg, 1.61m female subject supine
0
10
20
30
40
50
60
0 2 4 6 8 10
Nimbus 3
Note: This example represents test results from one individual only and different results may occur with different subjects. Only large scale tests can determine true performance differences.
When movement is inappropriate or impossible…..Active therapy simulates turning SEVERAL times each hour!
Mimics spontaneous movement and reperfuses the tissue.
Highly effective even in the most vulnerable populations
Can be adapted for those with extreme risk e.g.
• Critical limb ischaemia
• Peripheral vascular disease
1 min
Watch the cells under the sacrum as indicated by the arrow
2 min
3 min
4 min
Complete or near-complete off-loading over the sacrum
•Public are increasingly aware that pressure ulcers are preventable
•Viewed as evidence of a failure to provide a reasonable standard of care
•Patients and relatives complain and may sue for compensation
•Nursing records are crucial to the defence of the nurse Tragic, unnecessary, painful, expensiveTragic, unnecessary, painful, expensive……………… BUT (MOSTLY) PREVENTABLEBUT (MOSTLY) PREVENTABLE
Statue of a sleeping Maenad, lying on a panther skin spread on a rocky surface; the type in known as the reclining Hermaphrodite; http://commons.wikimedia.org/wiki/User:Marcus_Cyron
A rocky surface?
Or an early example of an active therapy surface!!
2,000 years ago…….maybe the Ancient Egyptians were on to something!