Risk Factor Modification

The primary goal is to reduce pressure, shear, and friction over high-risk bony prominences (Table 4-9). This can be accomplished by frequent turning and repositioning while in bed (every 2 hours), frequent repositioning while sitting (every hour), and use of a support device to lower surface pressure, such as foam, static air, alternating air, gel, or water mattress. Positioning devices such as pillows or foam wedges should be used to keep bony prominences (e.g., knees, ankles) from touching each other or high-risk areas from contacting the bed (e.g., heels). Donut-type devices should be avoided because the tissue within the ring can become necrotic from increased venous congestion.

Massage should be avoided over bony prominences because it can lead to deep tissue trauma. When positioning on the side, avoid pressure directly on the trochanter. To decrease the effect of shear forces, maintain the head of the bed at the lowest degree of elevation. To decrease the effect of friction lubricants, use protective films, dressings, or padding. Also, lifting devices such as a trapeze can be used to assist patients with limited mobility in transfers and repositioning (AHCPR, 1994; Bergstrom, 1997; Blues-tein and Javaher, 2008; Reddy et al., 2006; Remsburg and Bennett, 1997).

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