Medical Devices and Pressure Ulcers

This article was published in AUGUST 2012 by ©2012 ECRI Institute PSO

This is an interesting article which supports concerns I have raised over the past few years. It seems that their is little interest in Pressure Ulcer Prevention in the Respiratory Community. As this article points out it is an issue that should be addressed and I expect it will be, just not in a time frame I would likely set.

“Pressure ulcers found on the head or neck are typically associated with devices, while non-device-related pressure ulcers are generally found else-where (e.g., coccyx, buttocks) (Apold and Rydrych). Th e National Pressure Ulcer Advisory Panel (NPUAP) has stated that mucous membranes are “especially vulnerable to pressure from medical devices, ” including oxygen tubing, endotracheal tubes, and bite blocks (NPUAP).”

I suspect much of the reason could be due to some ambiguity as to who’s responsibility these fall under as they are “Respiratory Products” so nursing leaves them alone whole wound prevention and treatment is typically a Nursing issue so Respiratory does not aggressively pursue this. Thus article alludes to some kind of scenario like this in the following statement.

“one study noted that many staff members were unsure of who to contact regarding an incorrectly fitting device or were unaware of what a correctly fitted device looks like (Apold and Rydrych).”

I think the most obvious issues I saw when working in acute care was due poorly fitting CPAP masks used in attempts to avoid intubating patients (a philosophy I still believe in). Unfortunately the facility would routinely purchase “cheap” masks which required too much tension to maintain a proper fit. I was always looking for douderm to prevent the tissue breakdown which would inevitably occur. I suspect a cost analysis would have shown the cheap masks were far more expensive in the long run. The next most common issue I probably noticed was skin breakdown around the mouth due to endotracheal tubes and less than ideal tube fixation devices. As for cannula I paid little attention unless a nurse or patient specifically expressed a concern. At that time the only option I knew was to pad the cannula with some kind of wrapping or padding, after that I left it to nursing. Today there are much better options I have discussed in other posts but despite more and more literature coming out this does not seem to gain much traction. It is a mystery to me why there seems to be such apathy towards this in the Respiratory Community. Until this changes I will continue to address the subject, write posts and talk to those who will listen.

Medical Devices Pressure Ulcers

Declaration: I sell products that address these issues such as the WestMed soft cannula, Tracoe Tracheostomy Products, IPI ETT Fixation Devices, and B&B Tracheostomy products.