PROCEDURE 123 The purpose of pressure redistribution surface (i.e., support surface) is to assist in the reduction of pressure over areas of the body and reduce the development of pressure ulcers and other skin breakdown.9 Continual lateral rotation therapy provides dynamic rotation of a support surface to enhance mobilization and removal of pulmonary secretions for pulmonary benefit and to assist in preventing and treating physiologic complications of immobility. The RotoRest™ Lateral Rotation Surface is a unique kinetic therapy surface that can be perceived to be technically challenging to use. This surface is ideal for patients with traumatic injury, unstable spine, and traction and for patients who need aggressive rotation therapy. • Principles of prevention of pressure-induced injury should be understood, including high-risk areas for tissue injury in the critically ill patient.12,13 High-risk areas of pressure injury include the occiput, coccyx, and heels.11 Prolonged external pressure over bony prominences, shear and friction forces, and excessive moisture increase the risk of pressure ulcers. • With use of a validated pressure ulcer risk assessment tool such as the Braden Scale, a patient’s risk for a pressure ulcer should be assessed on admission to the intensive care unit (ICU), and at least every 12 to 24 hours thereafter, or with changes in patient condition. Interventions to prevent pressure ulcer development should target characteristics that put the patient at risk.1,2 • Redistribution of pressure includes frequent repositioning and use of support surfaces.4,6 • A pressure redistribution support surface is defined as a device designed for management of tissue loads, microclimate, or other therapeutic functions.9 • The many types of pressure redistribution surfaces range from the standard acute care foam mattress to air-filled or fluid-filled surfaces. Generally, the more specialized surfaces are indicated for certain wounds or patient conditions that result in excessive moisture, posterior grafts or wounds, flaps, etc. Because the technology in pressure redistribution surfaces changes rapidly, practitioners should investigate the specific properties of available specialty mattresses to choose the correct surface for a patient. • Bariatric pressure reduction surfaces provide similar properties to all special bed surfaces; however, they are wider, and the frame and surface are designed to accommodate heavier patients. • Principles of wound healing should be understood and include evaluation of the patient’s: • Understanding of the pathophysiology of tissue ischemia is an important assessment parameter of the integumentary system in the complex critically ill patient. Tissue ischemia may be caused by direct pressure applied to tissues and by disease processes and medications (i.e., vasoactive medications). • The terms continual lateral rotation therapy (CLRT) and kinetic therapy are often loosely used in a similar context.5 CLRT is defined as the continuous turning of a patient from side to side with a less than 40-degree rotation; kinetic therapy is a 40-degree or greater rotation.5 • Support surfaces used to provide CLRT should have dynamic features to assist in pressure reduction over bony prominences. Special features may include: • RotoRest™ (KCI Licensing, Inc, San Antonio, TX) lateral rotation surface is a kinetic therapy surface that does not incorporate low air loss into its technology, but if the patient is in continuous motion (rotation), pressure over bony prominences may be relieved during the continuous turning therapy. However, because of the aggressive degree of the turn, possible shear and friction injuries of the skin can occur during rotation. • Knowledge is needed concerning the physiologic effects of immobility on body systems, including factors that contribute to impaired circulation. Potential complications in the critically ill patient include: • Principles for successful use of CLRT therapy include clinician appreciation of the goals of therapy. For maximal benefit, the support surface should be in rotation more than 18 hours per day and at optimal rotation.5,6
Pressure Redistribution Surfaces: Continual Lateral Rotation Therapy and RotoRest™ Lateral Rotation Surface
PREREQUISITE NURSING KNOWLEDGE
Pressure redistribution support surfaces may be powered or nonpowered.
Newer acute care mattresses incorporate pressure reduction technology.
For maximal effects from pressure reduction therapy (low air loss, etc.), the weight of the patient must be tolerated by the surface.
Overall risk as assessed with a valid risk assessment tool (i.e., Braden score)2
Nutritional status, including endpoint goals
The presence of incontinence-associated moisture and effective management of diarrhea and urine
Low air loss to assist in management of excessive moisture
Alternating pressure that provides pressure redistribution in a cyclic fashion to offload tissues
The support surface should provide continuous rotation at varying degrees.
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123: Pressure Redistribution Surfaces: Continual Lateral Rotation Therapy and RotoRest™ Lateral Rotation Surface
