Layers of linen used in conjunction with pressure ulcer prevention Kelly 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 Blue= lower pressure Green Yellow Red= high pressure

One layer reusable chux HOB flat side

One layer reusable chux HOB 30 Flat Side

2 layer reusable chux HOB flat Side

2 layer reusable chux HOB 30 Flat side

3 layer reusable chux HOB flat Hob 30 side view

Bariatric on Low Air Loss UAB Hospital Bed Making Standard Standard Items on all beds: Items as needed: Low Air Loss Surface NO fitted sheet 1 Driflo (blue back) disposable underpad Underpads (choose 1 of appropriate pad) Reusable Disposable underpad Disposalbe Driflo underpad Draw Sheet Fitted Sheet Flat Sheet Pillowcase Blanket/Spread Pillow Ambulatory Fitted sheet atop regular mattress DO NOT use underpad Place top sheet, tuck into foot of bed and miter corners Needing Assistance or 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 Bariatric on Low Air Loss 1 flat sheet for positioning 1 Driflo (blue back )disposable underpad

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.