Using High Volume Low Air Loss Support Surface as Part of a Skin Treatment Bundle for Patients with Full Thickness Sacral/Coccyx Pressure Injuries and Multiple Comorbidities

Heather A. Heale BSN, RN-BC, CWOCN; Janet S. Johnsen, BSN, RN, CWOCN; Emma Kovacs BSN, RN-BC, CWOCN

Background/Significance

Chronic or acute full thickness pressure injuries (PIs) are painful, costly to heal, and are associated with increased complications and increased length of stay (NPIAP, 2019). Full thickness PIs on the sacral/coccyx area are among the most difficult to heal. Friction, shear, moisture, and pressure are difficult variables to mitigate and are known factors in the development of PIs (NPIAP, 2019).

Method

A high-volume low air loss (LAL) support surface was used to manage moisture at the skin/surface interface as part of a new skin treatment bundle. This support surface was chosen for increased pressure redistribution and the ability to reduce friction and shear through a high-tech polyurethane top cover.

A skin treatment bundle was developed and implemented at a large upstate New York facility to address and heal full-thickness PIs to lessen the personal and financial burdens. The new skin treatment bundle included: a high volume LAL support surface, repositioning every two hours while in bed and hourly when out of bed, nutritional assessment and interventions, moist wound healing, preventive foam dressings, protective barrier creams, urine and fecal diversion when appropriate, offloading heels, and an offloading chair cushion. Four patients with existing PIs were chosen to trial the specialty support surface in the new bundle. All four patients had full thickness sacral/coccyx wounds.

Outcomes/Results

Incorporating the LAL support surface in the skin prevention treatment bundle allowed the existing PIs to heal and no other PIs developed during the trial.

Patient 1

Warning: Graphic Images.
Click to reveal.

12/10/2020

8/3/2021

85-year-old female, admitted with cervical myelopathy. History and comorbidities include: T2DM, HTN, obesity, chronic heart failure, asthma, HLD, arthritis, and anxiety.

Admitted to 11/27/20 for laminectomy. LOS 426 days. Wound debrided and NPWT started.

Patient 2

6/12/2018

12/10/2019

29 year-old admitted initially with gunshot wound resulting in short gut syndrome, chronic TPN, anoxic encephalopathy, chronic trach and tube feeding

Multiple admissions from 6/10/18 6/20/2020: Admission 1: 10 days, Admission 2: 232 days, Admission 3: 394 days

Patient 3

5/6/2021

1/11/2022

71-year-old male

Hospitalized from 5/4/2021-1/24/2022, 264 days total

PMHx: TIA, HTN, HLD, Anemia, GERD, chronic kidney disease, respiratory failure, and depression

Patient 4

6/6/2021

1/31/2021

81-year-old female

Admitted 6/5/2021 stage 4 pressure injury of the sacrum

PMHx: HTN, A Fib, GERD, Anemia, CVA

Patient 1

Warning: Graphic Images.
Click to reveal.

12/10/2020

8/3/2021

85-year-old female, admitted with cervical myelopathy. History and comorbidities include: T2DM, HTN, obesity, chronic heart failure, asthma, HLD, arthritis, and anxiety.
Admitted to 11/27/20 for laminectomy. LOS 426 days. Wound debrided and NPWT started.

Patient 2

Warning: Graphic Images.
Click to reveal.

6/12/2018

12/10/2019

29 year-old admitted initially with gunshot wound resulting in short gut syndrome, chronic TPN, anoxic encephalopathy, chronic trach and tube feeding
Multiple admissions from 6/10/18 6/20/2020: Admission 1: 10 days, Admission 2: 232 days, Admission 3: 394 days

Patient 3

Warning: Graphic Images.
Click to reveal.

5/6/2021

1/11/2022

71-year-old male
Hospitalized from 5/4/2021-1/24/2022, 264 days total
PMHx: TIA, HTN, HLD, Anemia, GERD, chronic kidney disease, respiratory failure, and depression

Patient 4

Warning: Graphic Images.
Click to reveal.

6/6/2021

1/31/2022

81-year-old female
Admitted 6/5/2021 stage 4 pressure injury of the sacrum
PMHx: HTN, A Fib, GERD, Anemia, CVA

Discussion/Conclusion

While four patients is not a large number. The trial did allow the facility to purchase/rent more LAL support surfaces as part of the new skin treatment bundle.

Recommendations For Practice

The patients in the trial and future patients with PIs will benefit from better clinical outcomes. The LAL surface is now part of the new comprehensive skin bundle. The LAL surface can support these challenging patients with low air loss and immersion technology.

About the Authors

Heather A. Heale BSN, RN-BC, CWOCN
Heather is board certified in Med-Surg, Cardiovascular, Geriatric, and Psych/Mental health nursing. Prior to working as a CWOCN, she worked as a bedside nurse on a cardiac med-surg floor and became a Clinical Nurse Leader for a general med-surg unit.

Janet S. Johnsen, BSN, RN, CWOCN
Prior to becoming a CWOCN, Janet worked in supervision, informatics, and as the manager and director of the general medicine, oncology, and respiratory units at Unity Hospital.

Emma Kovacs BSN, RN-BC, CWOCN
Emma has been a nurse for 11 years. She began at Unity Hospital as a patient care tech, then to RN on a cardiac stroke unit. In 2015, she became the Clinical Nurse Leader for a med-surg unit. She is currently secretary for Central Western New York WOCN.

References:
  1. Haesler, E. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline: The international guideline 2019. EPUAP, NPIAP, PPPIA.

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