Pressure sores pose a special threat to mobility patients, because those patients are always subject to pressure — when they are not in bed, and then when they are sitting in a wheelchair.
Moreover, sitting in a wheelchair with no cushion or the incorrect cushion exacerbates that constant pressure, which cuts off more blood flow and increases the risk of pressure sores, or the likelihood that existing pressure sores will get worse. That constant pressure, combined with factors such as moisture, and shear force, can help touch off a pressure sore.
Serious, stage four and unstageable pressure wounds can get so bad that they require surgery in order to repair, which can entail lengthy post-surgery bed rest. That, of course, can impact the mobility patient’s therapy and daily living.
Complications with pressure sores can actually become life threatening. If a pressure sore continues to get worse, it can become infected and that infection can spread to the bloodstream, and from there, the heart and the bones.
There are multiple ways HME providers can work with physicians and other caregivers to help prevent pressure wounds in mobility patients. Here are some key considerations:
Cushions factors. A cushion should be mandatory for a patient when her or she is in the chair. There are three main types: gel and foam cushions; non-powered adjustable cushions; and powered cushions.
Gel and foam seat cushions work very well for patients who need them for their wheelchairs and other seating. The gel type can sometimes be more preferable to foam, because the foam can break down over time and might raise bacterial concerns.
Non-powered, adjustable cushions also work well for both wheelchair and standard seating. These types of cushions contain a honeycomb of air cells that are first fully inflated, placed under the patient and then partially deflated via a release valve so that it better conforms to the patient’s body. The result is that the patient essentially floats on an approximately 1.5-inch cushion of air while sitting in the chair. These come in both high- and low-profile variations.
Powered seat cushions function like the non-powered adjustable cushions, but they include a motorized blower to circulate the air in the cushion. The motor is either plugged into an outlet or powered via battery. Powered cushions are extremely effective devices, but they’re also expensive. As a result, the majority of private insurance providers and Medicare do not cover the powered variety.
However, while there are various cushion types, with different support systems, the cushion must still mesh with other patient needs. Make sure one need is not at odds with another.
Power mobility patients have special needs. The needs of power mobility patients are highly specialized, and their seating and cushioning needs are case in point. One of the main differences is that, usually with power mobility, patients have decreased strength in the torso or the upper extremities. Power mobility patients might have more complex seating needs and require a more supportive seating system due to that upper-body weakness. Make sure these needs are accommodated when trying to negate pressure sores.
Tilt and recline. Chairs that offer the ability to tilt or recline or both help patients take relieve areas that are subject to regular pressure when the patient is seated in the chair. Whether one or the other or both is appropriate for the patient depends on various therapeutic considerations, but they can relieve pressure that can cause pressure sores.
Transfers. If the patient transfers in and out of the chair a great deal, that motion causes shear, which can cause pressure sores. So the patient needs cushion material that lets them slide more easily without too much shear.
Contributing factors. Don’t forget to address other variables that can cause pressure sores. Mobility patients can suffer an increased likelihood of pressures sores as a result of other conditions, including decreased circulation, such as diabetes or vascular disease, incontinence, bad nutrition, age, and decreased sensation.
A group approach. Ensuring proper seating that negates pressure sores in addition to serving other care needs in mobility patients requires that everyone involved in a patient’s care work together. The team must work with the patient to understand their daily living patterns and needs to ensure the seating addresses those concerns in such a way as to minimize the likelihood of a pressure sore.
This group should review the patient’s past, current and anticipated condition and needs, as well to ensure that whatever solutions are used to fight pressure sores jibe with the patient’s past, and anticipated future condition and treatment.
Points to take away:
- Mobility patients are susceptible to pressures sores for many reasons.
- The correct cushion is key in preventing them.
- Work with the patient, family, physician and other caregivers to determine the right solution.
- Power mobility patients can have special cushion needs.
The National Pressure Ulcer Advisory Panel provides complete guidelines on staging pressure sores at npuap.org. Here is a summary of the panel’s guidelines:
- Suspected Deep Tissue Injury. A purple or maroon area of intact skin or blister.
- Stage 1. Intact skin with non-blanchable redness of a localized area.
- Stage 2. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, but without slough.
- Stage 3. Full thickness tissue loss with visible subcutaneous fat. Slough might be present and the wound might include undermining and tunneling.
- Stage 4. Full thickness tissue loss with exposed bone, tendon or muscle; slough or eschar might be present; and will often include undermining and tunneling.
- Unstageable. Full thickness tissue loss in which the base of the ulcer is covered by or eschar in the wound bed.