How patient migration in bed affects the sacral soft tissue loading and thereby the risk for a hospital‐acquired pressure injury

International Wound Journal

Krämer

Brehm³

et al. 2020

Self Cite

In this work, we developed an experimental‐computational analysis framework which facilitated objective, quantitative, standardised, methodological, and systematic comparisons between the biomechanical efficacies of two fundamentally different dressing technologies for pressure ulcer prevention: A dressing technology based on cellulose fibres used as the core matrix was evaluated vs the conventional silicone‐foam dressing design concept, which was represented by multiple products which belong in this category. Using an anatomically‐realistic computer (finite element) model of a supine female patient to whom the different sacral dressings have been applied virtually, we quantitatively evaluated the efficacy of the different dressings by means of a set of 3 biomechanical indices: The protective efficacy index, the protective endurance, and the prophylactic trade‐off design parameter. Prior rigorous experimental measurements of the physical and mechanical behaviours and properties of each tested dressing, including tensile, compressive, and friction properties, have been conducted and used as inputs for the computer modelling. Each dressing was evaluated for its tissue protection performances at a new (from the package) state, as well as after exposure to moisture conditions simulating wet bedsheets. Our results demonstrated that the dressing with the fluff core is at least as‐good as silicone‐foams but importantly, provides the best balance between protective performances at its “new” condition and the performance after being exposed to moisture. We conclude that preventative dressings are not equal in their prophylactic performances, but rather, the base technology, the ingredients, and their arrangement in the dressing structure shape the quality of the delivered tissue protection.

Section: Discussionmentioning

confidence: 99%

“…5 5 A COF of the backing film which is too low may contribute to migration of patients in their bed and thereby, to an increase in the tissue shearing levels at body regions not protected by the dressing, 38 for example, when the heels, not protected by dressings, slide towards the foot of the bed. …”

mentioning

confidence: 99%

The biomechanical efficacy of a dressing with a soft cellulose fluff core in prophylactic use

International Wound Journal

Krämer

Brehm³

et al. 2020

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“…This position is used in head and neck procedures or to provide better visualisation in laparoscopic procedures in the upper abdomen. Both the Trendelenburg and the Reverse Trendelenburg positions cause intensified frictional forces and elevated soft tissue distortions in shear under the scapulae (shoulders), sacrum, and calcanei (heels) as gravity pulls the tilted patient body downward, similar to migration in bed 5 …”

Section: Common Surgical Positions and Medical Considerations For Thementioning

confidence: 99%

“…Both the Trendelenburg and the Reverse Trendelenburg positions cause intensified frictional forces and elevated soft tissue distortions in shear under the scapulae (shoulders), sacrum, and calcanei (heels) as gravity pulls the tilted patient body downward, similar to migration in bed. 5 Another common variant of the supine position is the lithotomy position, which is used for gynaecological, rectal/anal, and urological procedures. In the lithotomy position, the upper torso is placed in the supine position, and the legs are raised and secured.…”

Section: Key Messagesmentioning

confidence: 99%

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

International Wound Journal

Creehan²,

Black

2020

Self Cite

An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning‐related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.

“…In particular, the tissue stress levels may change when some dressing materials alter their mechanical behaviour and stiffness properties, from the time point when the dressing is new ('straight from the package') and over the period of use, as the dressing 'ages' or accumulates wear and tear mechanical damage. Body movements, repositioning or the patient sliding in bed, 30 as well as moisture exposure, for…”

Section: Computer Modelling and Simulations To Determine The Efficacymentioning

confidence: 99%

Pressure ulcer prevention dressing design and biomechanical efficacy

2020

J Wound Care

Self Cite

The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure ulcer (PU, also known as pressure injury) prevention eventually determine the associated clinical and cost-benefit outcomes. The article specifically describes a bioengineering algorithm for quantitative evaluation of the biomechanical efficacy of different prophylactic dressing designs, which is exemplified for two fundamentally different dressing technologies, one based on superabsorbent cellulose core versus the conventional silicone-foam dressing design. A set of three biomechanical indices is described and employed for the above comparative evaluation, namely, the protective efficacy index, the protective endurance and the prophylactic trade-off design parameter. It is demonstrated that the dressing with the superabsorbent cellulose core is at least as good as silicone-foams but, importantly, provides a good balance between its protective performance in its ‘new’ condition, as opposed to its ‘used’ condition, i.e., after being exposed to moisture. Most notably, we show that preventative dressings are never equal in their performances; the underlying structure and the dressing ingredients together determine the extent of the delivered tissue protection and its durability.