What is the purpose of positioning a patient at the 30 degree lateral position?
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The 30° tilt position vs the 90° lateral and supine positions in reducing the incidence of non- blanching erythema in a hospital inpatient population: a randomised controlled trial
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ShareShare Cited ByCite https://doi.org/10.1016/S0965-206X(04)43004-6Get rights and content Manual repositioning of patients by nursing staff is a recognised technique for preventing pressure ulcer formation. The 30° tilt is a method of positioning patients that, in the laboratory setting, reduced the contact pressure between the patient and the support surface. A randomised controlled trial was used to examine the effects of the 30° tilt position in reducing the incidence of non-blanching erythema (i.e. established pressure damage) in a hospital inpatient population (n= 23) when compared to the use of the 90° lateral and supine position (n= 23). The primary outcome of the trial was the incidence of pressure damage, defined as non-blanching erythema. In this study no subject developed pressure damage that presented with visible breaks in the epidermis, but all damage was restricted to areas of non-blanching erythema (five of the 39 subjects who completed the study exhibited such injury). The main findings of this study were that patient positioning using the 30° tilt method did not reduce the incidence of pressure damage compared with either the 90° lateral or supine positions. This study also investigated the feasibility of using the 30° tilt position with medical inpatients; it found that 78% of subjects experienced difficulty in adopting and maintaining the position. This finding seriously questions the practicality of using the 30° tilt method with a predominantly ill population. References (0)
Research article Journal of Tissue Viability, Volume 24, Issue 2, 2015, pp. 51-61 Show abstractNavigate Down To describe the 3D anatomy and deformation of the buttocks during sitting. The buttocks of 4 able-bodied individuals and 3 individuals with spinal cord injury were scanned sitting in a FONAR Upright MRI. T1-weighted Fast Spin Echo scans were collected with the individuals seated on a custom wheelchair cushion to unload the ischial tuberosities (ITs) and seated on a 3 inch foam cushion. Multi-planar scans were analyzed, and the muscle, bone and adipose tissue was manually segmented for 3D rendering and analysis of the quantity, geometry, and location of tissues. The gluteus maximus was positioned lateral and posterior to the IT, covering the inferior portion of the IT for only 2 able-bodied participants. Adipose thickness directly under the IT did not differ by diagnosis, nor did it have a consistent response to loading. However, the envelopment of the IT by the surrounding adipose tissue was much greater in two of the participants with spinal cord injuries. These two subjects also had the most curved skin surface as the tissue wrapped around the IT. Tissue strains around the ischium were most visible in the adipose and connective tissue. The gluteus maximus displaced and distorted upwards, posterior and lateral, away from the inferior IT. Multi-planar imaging is necessary to investigate anatomy and deformation of the buttocks. 5 out of 7 participants did not sit directly on muscle. The tissue beneath their ITs was predominantly composed of fat and connective tissue, suggesting that these tissues might be most vulnerable to injury. Research article Journal of Tissue Viability, Volume 29, Issue 2, 2020, pp. 125-129 Show abstractNavigate Down Patient repositioning is a recommended intervention to prevent or treat pressure ulcers (PUs). One option under consideration is the tailored repositioning according to patient characteristics, but more knowledge is needed on how different repositioning patterns influence on skin pressure. To determine what degree of inclination of the body in bed generates more pressure in the trochanteric region. Additionally, to analyze the influence of factors such as gender, age and anthropometric characteristics in the variations of this pressure. Analytical cross-sectional study. Body Mass Index (BMI), lean mass and fat mass were measured in healthy volunteers subject to different inclinations (90°, 60° and 30°) in right lateral decubitus. Pressure was measured with a capacitive surface. In total, 146 subjects were included, of which 45 were men and 101 women. The results showed pressure differences due to the inclination according to gender and anthropometric values, being statistically significant in men at 90° and 60°, and in women at 30°. (hombres 90° p = 0,026, 60° p = 0,049; mujeres 30° p = 0,036) según prueba Brown-Forsythe. There are differences in the pressures of the trochanteric zone depending on anthropometric factors and by gender, in different body positions. Obese people exerted a higher pressure in the trochanter area at 30° of body inclination than overweight, normal weight and underweight people, respectively. From the clinical point of view, these findings invite to consider a possible differentiation in the repositioning interventions of the patients, according to gender and BMI, as a preventive strategy for PUs. Research article Applied Ergonomics, Volume 90, 2021, Article 103259 Show abstractNavigate Down Repositioning patients in bed is the most common patient handling activity and is associated with musculoskeletal disorders in caregivers. Hospital bed features may mitigate the risk of injury. The current study investigated the effect of bed features on the physical stress on caregivers. Ten nurses were recruited to perform three repositioning activities. Hand forces were recorded, and spine loading was estimated using a dynamic biomechanical model. Results demonstrated that except for the peak L5/S1 compressive load in the turning task, the use of assistive features significantly reduced the physical stresses for all repositioning activities. However, recommended thresholds for injury were still exceeded in many conditions. Compared with spinal load, hand force was much higher relative to the injury thresholds, suggesting a greater risk of shoulder and upper extremity injuries than low back injury. Mechanical lift equipment remains the safest and most robust way to reposition a patient. Research article Heart & Lung, Volume 45, Issue 3, 2016, pp. 237-243 Show abstractNavigate Down Continuous Lateral Rotation Therapy (CLRT) is a therapy used in ICUs for early mobilization of ventilated patients. CLRT is believed by some in health care to not be sufficient to allow for capillary re-perfusion, and may lead to tissue damage. To determine if there are differences in skin interface pressures, skin integrity, or perceived discomfort across three positioning scenarios. A Hill-Rom Total Care SpOrt® bed was equipped with a pressure mapping device. Ten healthy volunteers were placed in each positioning scenario for 30 minutes; interface pressures were recorded. CLRT alone demonstrated statistically lower interface pressures on ischial tuberosities (p < 0.05) as compared to the scenarios with static wedge. Higher pressures were noted on the heels in CLRT alone (p < 0.05). One subject noted pain with CLRT. No erythema or breakdown noted. This feasibility study supports the use of CLRT to decrease pressure on capillary beds and decrease patient discomfort. Research article Journal of the American Academy of Dermatology, Volume 81, Issue 4, 2019, pp. 893-902 Show abstractNavigate Down Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and in the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article focuses on pressure ulcer prevention and management, with an emphasis on the evidence for commonly accepted practices. Research article International Journal of Medical Informatics, Volume 84, Issue 10, 2015, pp. 725-736 Show abstractNavigate Down The incidence and costs for pressure ulcer (PU) treatment remain high even though preventive methods are applied. Approaches that use software to support the prevention of PU are presented in the literature to make it more effective. Identify the state of art of the approaches that use software to support the prevention of PUs. A systematic literature review was performed to analyze approaches that use software to support the prevention of PU. ACM, IEEE, PubMed, Scopus, CINAHL and Embase databases have been searched with a predetermined search string to identify primary studies. We selected the ones that met the established inclusion criteria. Thirty-six articles met the inclusion criteria. To support prevention, most approaches monitor the patient to provide information about exposure to pressure, temperature level, humidity level and estimated body position in bed providing risk factor intensity charts and intensity maps. The main method to perform patient's monitoring is using sensors installed on the mattress, but recently, alternative methods have been proposed such as electronic sensors and tactile sensory coils. Part of the approaches performs automated management of the risk factors using ventilation tubes and mattresses with porous cells to decrease body's temperature and movable cells to automatically redistribute the pressure over the body. Matters as cost of the approach, patient comfort and hygiene of the monitoring equipment is only briefly discussed in the selected articles. No experiments have been conducted to evidence the approached may reduce PU incidence. Currently, approaches that use software to support the prevention of PU provide relevant information to health professionals such as risk factor intensity charts and intensity maps. Some of them can even automatically manage risk factors in a limited way. Yet, the approaches are based on risk factor monitoring methods that require patient's contact with the monitoring equipment. Therefore, some matters need to be considered such as patient's comfort and the hygiene or replacement of the equipment due to the risk of infection. With the emergence of new alternative methods of monitoring, new technologies that do not require contact could be explored by new researches. Randomized Control Trials could also be conducted to verify which approaches are really effective to reduce PU incidence. |
