Document Detail


Are pressure redistribution surfaces or heel protection devices effective for preventing heel pressure ulcers?
MedLine Citation:
PMID:  19920740     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Heel pressure ulcers are recognized as second in prevalence only to pressure ulcer (PU) on the heel among hospitalized patients, and recent studies suggest their incidence may be higher than even sacral ulcers. OBJECTIVES: We systematically reviewed the literature to identify and evaluate whether pressure redistribution surfaces or heel protection devices are effective for the prevention of heel ulcers. SEARCH STRATEGY: We searched CINAHL and MEDLINE databases, using the keywords "pressure ulcer" and "heel," which we also searched the Cochrane Library, using the key terms "pressure ulcer," "heel," and "support surface." We hand searched the ancestry of pertinent research reports and review articles in order to identify additional studies. Inclusion criteria were (1) any study that compared one or more pressure redistribution surfaces or heel protection devices designed specifically to prevent heel PU and (2) any study comparing 2 or more pressure redistribution surfaces designed to prevent PU that specifically reported differences in the incidence of heel PU. Exclusion criteria were (1) studies that did not measure heel PU incidence as an outcome, (2) studies without an English language abstract, and (3) studies that reported overall PU incidence but did not analyze heel PU incidence separately. RESULTS: Clinical evidence concerning the efficacy of pressure redistribution surfaces or heel protection devices is sparse. Existing evidence suggests that pressure redistribution surfaces vary in their ability to prevent heel pressure ulcers, but there is insufficient evidence to determine which surfaces are optimal for this purpose. A single study suggests that a wedge-shaped viscoelastic foam cushion is superior to standard foam pillows for preventing heel PU, but further research is needed before a definitive conclusion concerning this issue can be reached. There is insufficient evidence to determine whether heel protection devices are more effective than a standard hospital foam pillow for the prevention of heel PU. Research is urgently needed to determine the effectiveness of available heel protection devices for the prevention of heel PU. Studies should address efficacy among the available products and compare efficacy to standard foam pillows. IMPLICATIONS FOR PRACTICE: Given the paucity of clinical evidence, clinical decisions about the selection of an optimal device for preventing heel PU rely on a combination of existing evidence and clinical experience. While pressure redistribution devices may reduce tissue interface pressures at the heels, expert opinion and clinical experience concur that elevation of the heel is indicated to both reduce pressure and prevent shear and friction caused by frequent movement of the heel due to restlessness, reflex movements of the legs, or voluntary movement. A variety of heel protection devices are available that are designed to both relieve tissue interface pressure and protect the heel from shear and friction. Considerations for selecting an optimal heel protection device include its ability to elevate the heel off the underlying support surface while preventing foot-drop and rotation of the leg, the boot's ability to wick away temperature, its ability to be cleaned, whether it allows patient ambulation, its ability to remain in place despite patient movement, and its ability to remain in place without causing pressure to other surfaces of the foot.
Authors:
Joan Junkin; Mikel Gray
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN     Volume:  36     ISSN:  1528-3976     ISO Abbreviation:  J Wound Ostomy Continence Nurs     Publication Date:    2009 Nov-Dec
Date Detail:
Created Date:  2009-11-20     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9435679     Medline TA:  J Wound Ostomy Continence Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  602-8     Citation Subset:  N    
Affiliation:
The Healing Touch, Inc, Lincoln, Nebraska, USA.
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MeSH Terms
Descriptor/Qualifier:
Female
Follow-Up Studies
Heel / physiopathology*
Hospitalization / statistics & numerical data
Humans
Incidence
Long-Term Care
Male
Pressure Ulcer / epidemiology*,  nursing,  prevention & control*
Primary Prevention / instrumentation*,  methods
Protective Devices / utilization*
Randomized Controlled Trials as Topic
Risk Assessment
Treatment Outcome
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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