Bedsore mattress
The bedsore mattress - also anti- decubitus mattress - is used in nursing and is a (support) mattress that is used for the prophylaxis or therapy of decubitus ulcers in patients primarily by reducing the maximum support pressure. This reduction can take place either locally through a larger contact surface or temporally through an alternating pressure system in which parts of the body are temporarily stressed and relieved, or through micro-stimulation .
The functioning of these aids is based on the reduction of the extrinsic factors that cause pressure ulcers or, in the case of micro-stimulation, on promoting the microcirculation of the skin.
Areas of application
Decubitus mattresses are mainly used in intensive care medicine and in geriatric care , in short: wherever immobility of patients (be it due to coma , prolonged sedation or paralysis ) poses the risk of bed sores due to poor oxygen supply to the body's support area. Since lying times of two hours can lead to the development of pressure sores, these systems also play an important role in pressure ulcer prophylaxis in the operating room .
Alternatives
As an alternative (and in addition) to bedsore mattresses, bedridden and immobile patients only have the option of frequent repositioning (as a guideline approximately every two hours), which is often not possible or not often enough in hospitals and old people's homes for personnel reasons. Attention must be paid to repositioning and transport techniques that are gentle on the skin and tissue. The responsible nursing staff should keep a positioning plan for each patient that precisely documents all transfers.
Since the active mattresses often work unnoticed by the patient, patients who lie on pressure ulcer mattresses are not disturbed as often by such positioning maneuvers, which can support healing . But that does not mean that they should not be repositioned on such a mattress.
Types of mattresses
There are different types of anti-decubitus mattresses and pads. For the inpatient area, especially the intensive care unit, there are also complete bed systems, but these should only be used for very heavy patients.
Alternating pressure systems
functionality
These systems consist of several air chambers, which are alternately filled with air and deflated again by an automatic control, so that different body regions are alternately loaded and relieved of pressure. For work on the patient, you can switch to static pressure (all chambers filled), for emergencies ( resuscitation , CPR) all the air can be removed from the mattress very quickly. There are both complete alternating pressure mattress systems as well as pads that are placed on normal mattresses. Older systems in particular transmit vibrations caused by the system's pumping function to the patient's bed, which is often perceived as annoying. Here you have to distinguish whether the system is a two-chamber or a three-chamber alternating pressure system. With the latter, three chambers are blown alternately, which greatly reduces the patient's contact surface. Blowing the chambers off and on is usually not perceived by the user as as annoying as with a three-chamber alternating pressure system.
Not every alternating pressure system can keep the pressure in the chambers constant over a longer period of time in the event of a power failure, which sometimes leads to problems in the home user sector.
advantages
- very easy to use
- very easy to transport
disadvantage
- very annoying noise from fan
- Contraindicated in patients with pre-existing body awareness disorders
- Contraindicated for surgical extensions (leg extension)
- The alternating pressure also stresses a part of the body, which inadvertently leads to a short-term reduced blood flow.
- with prolonged use, the mattress leads to a body perception disorder (patient loses body boundaries)
- Pain patients can experience additional pain from the peak pressure these systems build up
- Cleaning mostly problematic
Static soft storage systems
functionality
Here you can differentiate between two possible variants. Either you lay the patient on a foam mattress or on a motorized air cushion system. Foam mattresses: By using a soft foam (both "normal" and viscoelastic foams are used) the patient sinks into the mattress. The pressure decreases by increasing the contact surface. Viscoelastic foams become soft when they are heated and cling to the body geometry even more closely than other foams. It should be noted that while deep sinking the pressure is well distributed, the patient's own movements are significantly reduced. The chosen mattress should therefore offer good pressure relief and only minimally restrict the patient's own movements. Some mattresses have different foams with adapted properties for the head, sacral (pelvic) and foot area. The scope of use is limited to the slightest reddening and prophylaxis.
However, air chamber cushions and mattresses are much better, in which air in the cushions standing upwards balances the weight. In intensive medicine, in particular, this system is usually combined with airflow therapy. The degree of application of this therapy is usually not limited to low-grade pressure ulcers .
The subtype of static soft positioning can be understood as pulsation, which is often wrongly referred to as alternating pressure. With pulsation therapy, the individual cushions are filled with additional air in a specific cycle starting from the foot end; thus a pulsation wave is generated. This has a similar effect to an alternating pressure system, but without the unpleasant effect of a peak pressure.
advantages
- Airflow therapy
- very easy to transport
disadvantage
- very annoying noise from fan
- Contraindicated in patients with pre-existing body awareness disorders
- Contraindicated for surgical extensions (leg extension)
- with prolonged use, the mattress leads to a body perception disorder (patient loses body boundaries)
- Cleaning mostly problematic
Micro-stimulation
A micro-stimulation system (MiS for short) is a dynamic system for stimulating micro-movements and has its theoretical roots in the fundamentals of basal stimulation . Micro-stimulation systems should promote and maintain the patient's own movement and perception through the feedback of the system.
Gel mattresses
functionality
These are primarily used in the operating theater and less on wards. They are filled with viscous gel (mostly dry polymers / polyurethanes ). Gel mats are the classic perioperative aids. In addition, gel mats can be heated and can thus prevent the patient from cooling down. There are also other aids made from gel materials (seat cushions, etc.).
advantages
- cheap prophylaxis
- no annoying noises - no motor required
disadvantage
- By covering the mattresses in the inpatient area, ulcers tend to be promoted
- no therapy
- very heavy support, which leads to problems with the motors in adjustable hospital beds and to increased effort by the staff
Glass ball beds
In the case of large, liquid-secreting wounds such as burns , the patient can be placed in a special bed (" Air Fluidised Therapy "). It is filled with a mass of glass microspheres that is swirled from below by a stream of air so that it behaves like a liquid. At the top, a tightly fitted sheet made of synthetic fabric prevents this mass from escaping, which macroscopically represents a fine dust. At the same time, the sheet allows the glass microspheres to absorb liquid dispensed by the patient. The patient lies on it with minimal contact pressure, which serves to prevent and treat bedsores. Because of the high costs and the necessary maintenance, these beds are rented by hospitals from the manufacturer if required. Their empty weight is 870 kg, which places minimum requirements on the building statics and the accessibility of the patient room. Such beds are therefore unsuitable for home care.
literature
- Gessmann, Hans-Werner: A Correlation Between Micro-Movements and Sleep Stages. A contribution to pressure ulcer prophylaxis. Writings on sleep psychology and sleep medicine. Publishing house of the Psychotherapeutic Institute Bergerhausen, Duisburg, 2013, ISBN 978-3-928524-71-1 .
- M. Versluysen: How elderly patients with femoral fracture develop pressure sores in hospital. In: British Medical Journal . Volume 292, pp. 1311-1313, PMC 1340317 (free full text).
Web links
- Expert standard pressure ulcer prophylaxis in nursing (2017), German network for quality development in nursing (DNQP)
- International guideline pressure ulcer prevention. A Brief Guide to the European Pressure Ulcer Advisory Panel (EPUAP) & National Pressure Ulcer Advisory Panel (NPUAP), 2009
Individual evidence
- ↑ Versluysen, 1986
- ↑ Insa Lüdtke: Micro-stimulation systems in practice. In: Care magazine. No. 4, 2008, p. 197 f. ( archive.org ).
- ↑ Sigrid Schäfer and a .: Specialist care ventilation . Elsevier / Urban & Fischer Verlag, 2008, ISBN 978-3-437-25183-2 , pp. 271 f .