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Prevention of Heel Pressure Ulcers

Pressure ulcers are frequently seen, expensive to treat and distressing for all concerned. The medical risk factors for ulceration are well recognised and when these are combined with undesirable mechanical effects - namely pressure and shear pressure ulcers arise. Pressure and shear effects can and should be managed just as diligently as the medical risk factors. In this presentation we look at heel pressure ulcers and how the PRAFO range can eliminate pressure and shear at the heels of at risk persons - whether recumbent or ambulant

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Prevention of Heel Pressure Ulcers

  1. 1. PREVENTION OF HEEL PRESSURE ULCERSDerek Jones PhD, MBA ANATOMICAL CONCEPTS (UK) LTD
  2. 2. SUMMARY OF CONTENTS OUR MAIN TOPICS TODAY • Defining Pressure Ulcers • Medical Status + Mechanical Factors • Where on the Body Do Pressure Ulcers Occur? • What are the Cost Implications? • Medical Risk Factors? • Pressure and Shear - Mechanical Environment • Diabetic Foot Disease • Pressure Sore Development • How Should We Protect the Heel? • The PRAFO Range Features Anatomical Concepts (UK) Ltdh
  3. 3. Anatomical Concepts (UK) Ltd DEFINING PRESSURE ULCERS Pressure Ulcers - also sometimes known as pressure sores, bedsores, decubitus ulcers - are commonly seen in situations where persons are "at risk" due to their medical status. Here is a Definition from Clinical Practice Guidelines "Any skin lesion, usually over a bony prominence, caused by unrelieved pressure resulting in damage of the underlying tissue"
  4. 4. Medical status of the patient is such that risk of pressure sores is elevated due to the presence of one or more risk factors The body is in contact with support surfaces which apply loads to the body tissues. The nature of these loads can elevate the risk of ulceration MEDICAL STATUS MECHANICAL ENVIRONMENT PRESSURE ULCER RISK IS SHAPED BY.. Anatomical Concepts (UK) Ltd +
  5. 5. WHERE DO PRESSURE ULCERS OCCUR?AREAS AT RISK Most pressure ulcer locations are at bony prominences Anatomical Concepts (UK)Ltd
  6. 6. Anatomical Concepts (UK) Ltd COST IMPLICATIONS 412,000 INDIVIDUALS WILL DEVELOP A NEW PRESSURE ULCER ANNUALLY IN THE UK Total Cost Estimated at £1.4 to £2.1 Billion "The cost of pressure ulcers in the UK" Bennett, G et al Age and Ageing 2004, Vol 33: No.3, 230- 235 Focus should be on prevention AS POPULATION AGES T HE INCIDENCE OF ULCERAT ION IS EXPECT ED TO INCREASE
  7. 7. PRESSURE ULCERS THERE ARE MANY MEDICAL RISK FACTORS • Diabetic Foot Disease - with Neuropathy & Arterial Narowing • Any Chronic Condition Requiring Bed Rest • Lower Limb Fractures and Mulitsystem Trauma • Combinations of Immobility, Dehydration, Immunosupression, Malnutrition • Spinal Cord Injury • Critical Care Situations - Immobility • Significant Obesity or Thinness • Degenerative Neurological Disease such as Dementia • Cardiovascular compromise • History of Previous Ulceration • Compromised Nutritional Status Anatomical Concepts (UK) Ltd
  8. 8. GLOBAL BURDEN OF DIABETIC FOOT DISEASE AN AMPUTATION EVERY 30 SECONDS DUE TO DIABETIC FOOT DISEASE MANY OF THESE ARE PREVENTABLE Anatomical Concepts (UK) Ltd
  9. 9. HIGH "PRESSUR E" IS BAD "FRICTION & SHEAR" ARE VERY BAD Anatomical Concepts (UK) Ltd
  10. 10. WHAT DOES THAT MEAN? HOW DO PRESSURE AND SHEAR EFFECTS ARISE? Anatomical Concepts (UK) Ltd
  11. 11. At Risk A R E A Let's Imagine Pressure Mechanical Shear Inappropriate Equipment, Poor Patient Transfer and Positioning will Elevate the Risk Anatomical Concepts (UK) Ltd
  12. 12. Anatomical Concepts (UK) Ltd EXTERNAL PRESSURE Pressure occludes capillary flow. If this persists blood supply to cells is cut off PRESSURE PERSISTS Cell has not oxygen supply (Ischemia) and as this persists cells die (Necrosis) NECROSIS Necrosis spreads due to poor waste removal from damaged tissue area ULCERATION Ulceration occurs due to combination of applied pressure and time. Process is accelerated if Shear is present and or elevated tissue temperatures PRESSURE ULCER DEVELOPMENTA CHAIN OF EVENTS
  13. 13. At Risk A R E A High Pressure for a short time or Low Pressure for a longer time can lead to ulceration Shear Effects even more destructive than pressure Anatomical Concepts (UK) Ltd Pressure related to size of force applied and inverse of the contact area Heel exhibits a small contact area over a bony prominence
  14. 14. It's not just a Tissue Surface effect Anatomical Concepts (UK) Ltd
  15. 15. Severe Ulceration - Diabetic Neuropathy Resolved at 56 Weeks Anatomical Concepts (UK) Ltd
  16. 16. Severe Ulceration - Diabetic Neuropathy Refused Amputation Anatomical Concepts (UK) Ltd
  17. 17. Severe Ulceration - Diabetic Neuropathy Refused Amputation Almost healed 156 WEEKS LATER Anatomical Concepts (UK) Ltd
  18. 18. THESE EXAMPLES WERE SUCCESSFULLY MANAGED WITH A PRAFO PRESSURE RELIEF ANKLE FOOT ORTHOSIS An Orthosis to provide total relief from pressure at the heels whether the patient is immobile and in bed or ambulent Anatomical Concepts (UK) Ltd
  19. 19. To Deal With the Mechanical Environment (Pressure and Shear) as well as the Medical Risk Factors - We can't say ANY amount of pressure will always be safe ALWAYS REMEMBER Anatomical Concepts (UK) Ltd
  20. 20. Pixelast | Design and Tech HOW SHOULD WE PROTECT THE HEEL? WHAT ELSE SHOULD WE THINK OF? • Is the patient at risk of developing a plantarflexion deformity which will delay early mobilisation (ie: Acute Stroke)? • Will protected mobility be required? • Special needs? ie: Bariatric • How are the toes being protected? • Are there deformities to be managed? • Avoid Friction During Transfers ZERO! PRESSURE AND SHEAR Anatomical Concepts (UK) Ltd
  21. 21. PRAFO FAMILY Pressure Relief Ankle Foot Orthosis 650SKG The "original" design with Kodel liner 652SKG Adjustable Dorsiflexion/Plantarflexion 653SKG Valgus/Varus and Dorsiflexion/Plantar Flexion Anatomical Concepts (UK) Ltd
  22. 22. "STANDARD" PRAFO 650SKG 650SKG The "original" design with Kodel liner Adjustments • Dorsiflexion/Plantarflexion • Calf Height • Foot length • Toe Protection • Rotation Bar Prevents Internal/External Rotation Anatomical Concepts (UK) Ltd
  23. 23. "STANDARD" PRAFO 650SKG 650SKG The "original" design with Kodel liner Metal Upright Structure Maintains foot and ankle positioning whether recumbent or ambulant Intrinsic Walking Base Ensures that ambulation can take place whilst maintaining heel protection Liner Systems Supplied with Kodel liner or Pad and Strap kit giving space for wound dressings Anatomical Concepts (UK) Ltd
  24. 24. PRAFO FAMILY 652SKG Adjustable Dorsiflexion/Plantarflexion 653SKG Valgus/Varus and Dorsiflexion/Plantar Flexion The 652SKG features all the benefits of the PRAFO family with easy adjustment of the dorsiflexion/plantarflexion angle of the posterior upright The 653SKG extends adjustment possibilities even further by including valgus/varus Anatomical Concepts (UK) Ltd
  25. 25. Anatomical Concepts (UK) Ltd PAD & STRAP CONFIGURATION When greater control of the foot and ankle is required during ambulation the Pad & Strap liner can be used
  26. 26. Anatomical Concepts (UK) Ltd ZERO PRESSURE OR SHEAR Correct fitting ensures no contact between the vulnerable heel and the support surface
  27. 27. Anatomical Concepts (UK) Ltd ROTATION BAR The rotation bar prevents any tendancy to internal or external rotation of the limb
  28. 28. Anatomical Concepts (UK) Ltd HOW TO FIT A PRAFO https://vimeo.com/209633671
  29. 29. BARIATRIC VERSION 752SKT 140 KG WEIGHT LIMIT Anatomical Concepts (UK) Ltd See our website for other variations ANATOMICALCONCEPTS.COM
  30. 30. Be Aware of the Medical Factors that Influence Risk of Ulceration and Eliminate or Manage These. MEDICAL Ideally Eliminate Pressure and Shear at Areas of Risk such as the Heels. This is True for Protection/Prevention as well as for Wound Healing MECHANICAL If Early Mobilisation is Intended Then Choose a Device that Maintains Protection During Ambulation SCOPE OF REHABILITATION ISSUES TO CONSIDER Anatomical Concepts (UK) Ltd
  31. 31. ANATOMICAL CONCEPTS (UK) LTD Unit 18, Block 6, Third Road, Blantyre Industrial Estate, Blantyre G72 0XA anatomicalconcepts.com info@anatomicalconcepts.com UK & IRELAND Anatomical Concepts Inc. 1399 E. Western Reserve Rd. Poland, OH 44514-3250 anatomicalconceptsinc.com UNITED STATES

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