An observational study of the maintenance of the 30° side‐lying lateral tilt position among aged care residents at risk of developing pressure injuries when using the standard care pillow and a purpose‐designed positioning device

Abstract

The aim of the study was to evaluate the maintenance of the 30° side‐lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose‐designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated‐measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

“…83 Flattening or sliding off of the original position 84 slowly compromises the desired surgical position and, importantly, applies kinetic frictional forces on skin and resulting tissue distortions in shear because of the movement of the supported areas. 83 Forces applied during surgery, for example, by surgical tools, may further contribute to these sliding movements and hence to the build-up of shear loads in soft tissues. Consistent with the above, linen layers added on top of pressure redistribution surfaces have been shown in laboratory experiments to cause increases in peak body pressure magnitudes, indicating that effective contact areas for body support are reduced by the placed linen.…”

“…Use of pillows, rolled towels, sheets, and blankets as positioners in the OR remains a clinical practice but is considered unsafe, not only because linen are made of flammable materials but also because these linen have not been designed for conforming to the body contours and maintaining shape thereafter and will tend to flatten under bodyweight forces 83 . Flattening or sliding off of the original position 84 slowly compromises the desired surgical position and, importantly, applies kinetic frictional forces on skin and resulting tissue distortions in shear because of the movement of the supported areas 83 . Forces applied during surgery, for example, by surgical tools, may further contribute to these sliding movements and hence to the build‐up of shear loads in soft tissues.…”

“…Additional tissue protection can be provided to specific anatomical sites, for example, the occiput and heels in supine surgery or the breasts, knees, genitalia, and dorsal feet in prone surgery, by means of shape memory positioners, also known as fluidised positioners 88,100,102 . These are positioners made of viscoelastic composite materials that can be manually moulded into any shape—often the mirror shape of the body surfaces—and will maintain that shape, even under continuous bodyweight forces 83 . Furthermore, fluidised positioners relax rapidly under bodyweight forces, as opposed to the push back that is applied by foams on tissues because of the inherent elastic recoil behaviour of foams 88 .…”

“…88,100,102 These are positioners made of viscoelastic composite materials that can be manually moulded into any shape-often the mirror shape of the body surfaces-and will maintain that shape, even under continuous bodyweight forces. 83 Furthermore, fluidised positioners relax rapidly under bodyweight forces, as opposed to the push back that is applied by foams on tissues because of the inherent elastic recoil behaviour of foams. 88 The OR nursing team shapes each fluidised positioner manually in preparation for surgery, moulding the positioners to conform to the body surfaces that are expected to be at high risk in the desired surgical position.…”

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

“…Maintenance of the position of the body is usually undertaken with equipment such as pillows, foam wedges, and rolled towels 11 . Pillows and foam wedges are typically placed along the patient's back to support the side‐lying lateral tilt position 12 and towels are typically rolled and applied on the sides of the neck to maintain the head and neck in a neutral alignment when lying in the supine position 6 . It is recognised that equipment typically used for turning and positioning has not been designed for this purpose, and there is evidence to suggest that usual care equipment is associated with poor maintenance of body position and, potentially, pressure injury development 12,13 …”