Support Surfaces Guide

Often lost in the ongoing conversation about how best to treat pressure ulcers, is a very important concept: prevention. There are many factors that make up a complete pressure ulcer prevention plan, including proper skin treatment and good nutrition. But if pressure is the major cause of pressure ulcers, it makes sense that any prevention plan would address the relief of that pressure.

One way to achieve that is by constantly rotating or repositioning the patient. Equally important, however, is the actual support surface on which the patient is sitting or lying. An effective pressure reducing support surface will allow your body to sink into it. In doing so, the pressure between your body and the surface is distributed over a wider area. In general, the more of your body that is in contact with the support surface, the better.

The following overview will give you a good idea of the surfaces available today, and highlight some of their advantages and disadvantages. How advanced a system you need will depend on your particular medical situation. Will an overlay surface that rests on top of a standard mattress be sufficient? Or will you need an entire mattress replacement? Is cost an issue? Are you in a home care environment? Those are all considerations for your health care professional. Working together you should be able to fond the right system.

Overlays & Mattresses

One decision you and your care provider will have to make is whether to purchase an overlay system or pursue a mattress replacement solution.

Overlays do exactly what their name suggests; they "lay over" a standard mattress to provide increased pressure reduction and protect the bony areas of your body which are most vulnerable to pressure ulcers. In general, they are more portable and less expensive than other options, but there can be issues with "bottoming out", or sinking in so far that your body surface rests against the firmer standard mattress underneath.

In some cases, your nurse or doctor may recommend a replacement mattress made of a pressure reducing material or an actual support system, that replaces the mattress and frame, and may include other components. While replacement mattresses tend to provide greater pressure reduction, they are pricier and bulkier.

Most of the materials below can function as either an overlay or a complete mattress solution.

Types of support surfaces

Foam

The most portable surface type, foam can also be cut into numerous shapes, which makes it a possible solution for wheelchairs or other smaller areas. Foam can also be used as a mattress material. It is very important that the height, density and firmness of the overlay be sufficient to support the weight of the patient, while preventing them from bottoming out. For example, softer foams will envelop a patient's body better, but must be made thicker. Some foam products are even combined with gel, to make them conform even better. Some consider foam overlays a safety concern in that it raises the mattress height even further.

Viscoelastic (Visco)

Viscoelastic is a type of foam support surface that is temperature sensitive. As such, it becomes softer, conforms better and distributes pressure more evenly when in contact with a warm body surface. This is an advantage over traditional, stiffer foam surfaces. In addition, viscoelastic support surfaces gradually mold to the shape of the body lying on the surface, rather than returning to its original shape. This increases the amount of foam in contact with the body, further reducing pressure.

Low-air loss

Low-air loss surfaces are composed of interlocking air pockets or cells that conform to your shape and help take pressure off of the bony areas of your body. An air pump pushes a steady flow of air throughout the device, and replaces any air that may leak out through the surface. It is critical that the overlay is inflated with the right amount of air, which will vary based on the weight of the patient. Some systems will allow different section of the mattress or overlay to be inflated to different pressure levels. Too much air in any one are will only increase the pressure felt by the patient and too little air put the patient at risk of bottoming out.

Dynamic or Alternating Pressure

Dynamic or alternating pressure support surfaces consist of longer air cells arranged side-by-side in columns. The overlay or bed is hooked up to an air pump that alternately inflates certain rows of the overlay. The theory behind the alternating motion is that it shifts pressure to different parts of the body, thereby not allowing any one body area to remain under pressure for a prolonged period. It is also believed that the alternating pressure helps improve lymphatic flow. Some patients find the alternating motion makes them feel uneasy.

Fluid-filled (Gel or water)

These overlays or mattresses are made up of large and small compartments filled with gel or water. The fluid helps disperse the pressure around the bony areas of the patient's body. Both materials are meant to provide pressure reduction for the patient, while not allowing them to bottom out. Most are covered in a vinyl shell, which makes them relatively easy to clean. One concern that occasionally rises for water and gel overlays built without compartments is that when the head of the bed is raised, gravity will cause the water to move down and pool under the patients back and backside.

Air-fluidized

These beds have been available for over 40 years. They consist of about one ton of glass beads sealed in a sheet made of a synthetic material (like polyester or Gore-tex). Warm, high-pressure air is then forced through the beads, causing them take on a fluid state. Air-fluidized beds allow the greatest level of immersion of any surface currentlt available. As much as two-thirds of your body can sink into the bed, which takes pressure off of the bony parts of your body and distributes it adjacent areas. Because of the high cost of air-fluidized systems, you should check with your health care provider to be sure their use is covered under your plan.

Resources:

Krasner, Kane; Chronic Wound Care: A clinical Source Book for HEalthcare Professionals , 1997 
Carol Dealy; Managing Pressure Sore Prevention , 1997
Morrison, Moffat, Bridel-Nixon, Bale; Nursing Management of Chronic Wounds , 1997
Brienza, Geyer; Advances in Skin and Wound Care : "Understanding Support Surface Technologies", 2000

Our service area covers most of Southern California including Los Angeles and surrounding cities.
To see a full list of cities covered in our service area please .

Agoura Hills
Alhambra
Altadena
Arcadia
Arleta
Artesia
Avalon
Azusa
Baldwin Park
Bel Air
Bell
Bell Gardens
Bellflower
Beverly Hills
Bradbury
Brentwood
Burbank
Cahuenga Pass
Calabasas
Camarillo
Canoga Park
Carson
Cerritos
Chatsworth
Claremont
Commerce
Compton
Covina
Cudahy
Culver City
Diamond Bar
Downey
Duarte
Eagle Rock
El Monte
El Segundo
Encino
Gardena
Glendale
Glendora
Granada Hills
Hawaiian Gardens
Hawthorne
Hermosa Beach
Hidden Hills
Huntington Park
Industry
Inglewood
Irwindale
Kagel Canyon
La Canada
La Crescenta
La Habra Heights
La Mirada
La Puente
La Tuna Canyon
La Verne
Lake Balboa
Lake View Terrace
Lakewood
Lancaster
Lawndale
Lomita
Long Beach
Los Angeles
Lynwood
Malibu
Manhattan Beach
Marina Del Rey
Maywood
Mission Hills
Monrovia
Montebello
Monterey Park
Montrose
NoHo Arts District
North Hills
North Hollywood
Northridge
Norwalk
Oak Park
Olive View
Oxnard
Pacific Palisades
Pacoima
Palmdale
Palos Verdes
Panorama City
Paramount
Pasadena
Pico Rivera
Pomona
Porter Ranch
Redondo Beach
Reseda
Rolling Hills
Rosemead
San Dimas
San Fernando
San Gabriel
San Marino
Santa Barbara
Santa Clarita
Santa Fe Springs
Santa Monica
Sepulveda
Shadow Hills
Sherman Oaks
Sierra Madre
Signal Hill
Simi Valley
South El Monte
South Gate
South Pasadena
Stonehurst
Studio City
Sun Valley
Sunland
Sylmar
Tarzana
Temple City
Thousand Oaks
Toluca Lake
Toluca Woods
Topanga
Torrance
Tujunga
Valencia
Valley Glen
Valley Village
Van Nuys
Ventura
Vernon
Walnut
Warner Center
West Covina
West Hills
West Hollywood
West Toluca
Westlake Village
Westwood
Whittier
Winnetka
Woodland Hills