Complete
offloading using devices such as the Heelift Suspension Boot
(DM Systems) reduced heel pressure ulcers in patients with post-hip fractures
and may be a viable treatment option pending results of further studies,
according to a study published in the Journal of Wound Care.
“All older acutely ill immobile patients should be nursed on a
pressure redistributing support surface, from the moment of hospital admission
to discharge; this includes accident and emergency, as well theatre and the
ward,” said lead researcher Jeannie Donnelly, PhD, BSc, MCGI, RGN, ONC,
lead nurse of tissue viability and teaching fellow assistant in the School of
Nursing at Queens University Belfast, United Kingdom.
Heel elevation has been shown to result in fewer pressure ulcers, but
the method by which this is done has been under investigation.
“Our literature and practical experiment did not identify one
device or method that could be viewed as reliable or acceptable to a large
majority of patients,” Donnelly told O&P Business News.
“At this time, we are unable to determine the best way to achieve this in
clinical practice.”
Preventing pressure ulcers
Donnelly and colleagues conducted a prospective, randomized, controlled
trial to establish an effective way of preventing pressure ulcers on the heels
of older patients with fractured hips.
Patients aged 65 years and older who were admitted to the fracture
trauma unit of the Royal Group of Hospitals in Belfast, Ireland, randomly
received the commercially-available foam splint Heelift Suspension Boots on
both lower limbs (n=120) or standard care (n=119). All patients additionally
received pressure-redistributing support surfaces, which included cut foam
mattresses, mattress overlays or alternating mattresses based on risk
assessments.
After preoperative and postoperative assessment for the occurrence of
new pressure damage, the researchers found that 26% of patients in the control
group developed pressure ulcers compared with 7% of those in the intervention
group (P < 0.001). Additionally, none of the patients in the intervention
group developed a pressure ulcer on their ankles, feet or heels; however, 29
patients in the control group did (P < 0.001).
“The results of the main study indicated that subjects in the
control group developed more pressure ulcers than those in the intervention
group,” Donnelly said. However, “compliance with the Heelift boot was
relatively poor.”
Patients also completed a satisfaction questionnaire and 59% believed
this offloading device to be comfortable.
Overall, regardless of the device and procedure used, Donnelly stressed
that “older people with a fractured hip should have their heels elevated
until they are able to reposition their legs independently.”
These results need to be replicated and additional studies are warranted
to “determine if a heel elevation device is effective in different
settings and acceptable to patients before one can make strong recommendations
for practice,” Donnelly said. — by Tara Grassia
For more information:
Donnelly J, Winder J, Kernohan WG, et al. An RCT to determine the
effect of a heel elevation device in pressure ulcer prevention post-hip
fracture. J Wound Care. 2011;20(7):309-318.
Disclosure:Donnelly has no relevant
financial disclosures.
