Choosing a Therapeutic Support Surface
for Your Patients Pressure Ulcer

by Timothy M. Demers, L.P.N.,
Hill-Rom® Home Care, Nurse Consultant
1-800-638-2546

When your patient succumbs to the misfortune of developing a pressure ulcer, a chain of events systematically takes place. You, the nurse, are faced with several factors to initiate and begin treatment of the wound. After cause is determined and assessment completed, a plan for treatment is approached. In many instances, it is the responsibility of the nurse to order a therapeutic surface appropriate for the particular wound a patient has developed. With literally hundreds of support surfaces available today, the nurse is faced with many and sometimes difficult decisions. It is important to choose the right product to promote healing and prevent the wounds from worsening. Choosing an inappropriate support surface could cause further damage to the wound and potentially complicate the patient's condition. Some "claims to fame" is the statement: "We have one product that will treat all pressure ulcers. Stage I through IV, this one will treat them all". The analogy that comes to mind with these statements is: would you treat a gunshot wound with a bandaid? Or claim that one antibiotic can treat all infections ? These statements should be taken with great caution.

Regardless of the product or manufacturer, following some general guidelines will assist you in selecting the right product for your patient.

To help with your decision, begin with the cause. Four mechanical forces contribute to formation of pressure ulcers: pressure, shear, friction and moisture -- but these forces act upon tissue in very different ways. Pressure and shearing forces operate from the bone out to the dermal layer, while friction and moisture tend to operate from the skin surface inward. A pressure ulcer caused by pressure or shear can often present as a small surface wound, but be much more extensive under the skin. Pressure relief is paramount in these cases, so any product selected should deliver the greatest degree of pressure reduction possible. An air fluidized bed is the optimal choice, or if not available, a low air loss product may be used. Both of these technologies address moisture by providing a constant flow of air past the skin, which helps keep the skin dry. Alternating pressure, gel, water, and air pads and mattresses do not address the moisture problem adequately, so should be avoided where maceration is a contributing cause of an ulcer.

A general rule to remember is to look at the product and ask yourself (or the representative), "How does this support surface address:

  1. Pressure: How does the product adjust to the patient's body weight ? Does the product distribute the patient's body weight evenly and adjust to any movement ?
  2. Shear and Friction: If my patient has his or her head elevated, moves, or slides down a lot, how does the product help to prevent shearing and friction ?
  3. Maceration: Is the cover permeable to moisture ? Does the support surface allow for air to escape near the patient's skin ? "

Another consideration is the type of follow-up provided by the supplier of the chosen product. If you're in a hospital, nursing home, or home health care, how does the company support the use of the support surface? Do they simply place the patient on the surface and drop the bill in the mail? If your patient isn't healing, how does the product distributor support the nurse, patient, and family members ? As with any medical equipment, the nurse, family, and care givers need to be taught how to use the surface to ensure proper use. Don't hesitate to ask questions.

Choosing the right product for your patients wounds can:

  1. Promote a quicker healing rate.
  2. Improve patient comfort.
  3. Decrease patient time spent in the hospital.
  4. Decrease nursing time spent at the bedside.
  5. Decrease costs.

A little investigative work on behalf of the nurse could uncover inappropriate products not worthy of your patient's treatment plan. It is your responsibility to choose the right product.

© 1996 Timothy M. Demers, Nurse Consultant, Hill-Rom® Company Inc.