Journal of Rehabilitation Research & Development (JRRD)

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Volume 50 Number 4, 2013
   Pages 477 — 488

Abstract — Patient repositioning and pressure ulcer risk—Monitoring interface pressures of at-risk patients

Matthew J. Peterson, PhD;1* Nikolaus Gravenstein, MD;2 Wilhelm K. Schwab, PhD;2 Johannes H. van Oostrom, PhD;1 Lawrence J. Caruso, MD2

1J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida College of Engineering, Gainesville, FL; 2Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL

Abstract — Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4–6 h. All participants had specific skin areas (206 +/– 182 cm2) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/– 184 cm2) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.

Key words: decubitus ulcer, interface pressure, patient repositioning, pressure, pressure sore, pressure ulcer, pressure ulcer risk, prevention, standard of care, triple-jeopardy area.

Note: The authors would like to dedicate this article to the memory of their colleague Dr. Schwab.


View HTML  ¦  View PDF  ¦  Contents Vol. 50, No. 4
This article and any supplementary material should be cited as follows:
Peterson MJ, Gravenstein N, Schwab WK, van Oostrom JH, Caruso LJ. Patient repositioning and pressure ulcer risk—Monitoring interface pressures of at-risk patients. J Rehabil Res Dev. 2013;50(4):477–88.
http://dx.doi.org/10.1682/JRRD.2012.03.0040
ResearcherID/ORCID: Johannes H. van Oostrom, PhD: B-1407-2008
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