Ulrika Källman

Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting

OBJECTIVES: The aims of this study were to examine and compare the predictive validity of 4 risk assessment scales used for the prediction of pressure ulcer (PrU) development and to identify risk factors. DESIGN: Cross-sectional descriptive study. SETTING: A general hospital in Sweden. PARTICIPANTS: Patients (all aged ≥18 years) admitted to medical, surgical, orthopedic, oncology, and rehabilitation wards. Of 412 patients available, a total of 346 patients participated in the study. METHOD: Data were collected using the Swedish version of the European Pressure Ulcer Advisory Panel minimum data set as well as the Norton, Modified Norton, Braden, and Risk Assessment Pressure Sore (Ulcer) (RAPS) scales. The predictive validity was estimated by measuring sensitivity, specificity, positive predictive value, and negative predictive value. Multiple logistic regression analysis was used to determine risk factors associated with PrUs. RESULTS: The RAPS scale reached best balance between sensitivity and specificity at the recommended cutoff level of ⩽29, followed by the Braden scale and the Norton scale at recommended cutoff levels ⩽18 versus ⩽16, respectively. The modified Norton scale also reached an acceptable balance between sensitivity and specificity but at the cutoff level of ⩽23, which is a higher cutoff level than recommended. General physical condition, physical activity, moisture, friction, and shear emerged as significant risk factors. CONCLUSIONS: The results support that the recommended cutoff levels of the RAPS, Norton, and Braden scales are valid in a general hospital setting. However, the recommended cutoff level of the modified Norton scale (⩽20) has to be increased when used in this care context.

Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients

AIM To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. BACKGROUND To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. DESIGN Descriptive comparative design. METHODS From March-October 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. RESULTS The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30° lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. CONCLUSION The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents

Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored. Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents. Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30° supine tilt and 0° supine positions and over the trochanter major in 30° lateral and 90° lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry. Results: Interface pressure was significantly higher in the 0° supine and 90° lateral positions than in 30° supine tilt and 30° lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30° supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions. Conclusion: The 30° supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

Pressure‐induced Vasodilation and Reactive Hyperemia at Different Depths in Sacral Tissue Under Clinically Relevant Conditions

To characterize PIV and RH at different sacral tissue depths in different populations under clinically relevant pressure exposure.

Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses

OBJECTIVE The aim of this study was to explore the interaction between interface pressure, pressure-induced vasodilation, and reactive hyperaemia with different pressure-redistribution mattresses. METHOD A cross-sectional study was performed with a convenience sample of healthy young individuals, and healthy older individuals and inpatients, at a university hospital in Sweden. Blood flow was measured at depths of 1mm, 2mm, and 10mm using laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses. RESULTS There were significant differences between the average sacral pressure, peak sacral pressure, and local probe pressure on the three pressure-redistribution mattresses, the lowest values found were with the visco-elastic foam/air mattress (23.5 ± 2.5mmHg, 49.3 ± 11.1mmHg, 29.2 ± 14.0mmHg, respectively). Blood flow, measured as pressure-induced vasodilation, was most affected in the visco-elastic foam/air group compared to the alternating pressure mattress group at tissue depths of 2mm (39.0% and 20.0%, respectively), and 10mm (56.9 % and 35.1%, respectively). Subjects in all three groups, including healthy 18-65 year olds, were identified with no pressure-induced vasodilation or reactive hyperaemia on any mattress (n=11), which is considered a high-risk blood flow response. CONCLUSION Interface pressure magnitudes considered not harmful during pressure-exposure on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared with the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow. Healthy young individuals were identified with the high-risk blood flow response, suggesting an innate vulnerability to pressure exposure. Furthermore, the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible, but assessment of pressure-induced vasodilation and reactive hyperaemia could be a new way to assess individualised physiological measurements of mechanisms known to be related to pressure ulcer development.

Swedish translation and validation of the international skin tear advisory panel skin tear classification system

The aims of this study were to translate the International Skin Tear Advisory Panel (ISTAP) classification system for skin tears into Swedish and to validate the translated system. The research process consisted of two phases. Phase I involved the translation of the classification system, using the forward‐back translation method, and a consensus survey. The survey dictated that the best Swedish translation for “skin tear” was “hudfliksskada.” In Phase 2, the classification system was validated by health care professionals attending a wound care conference held in the spring of 2017 in Sweden. Thirty photographs representing three types of skin tear were presented to participants in random order. Participants were directed to classify the skin tear types in a data collection sheet. The results indicated a moderate level of agreement on classification of skin tears by type. Achieving moderate agreement for the ISTAP skin tear tool is an important milestone as it demonstrates the validity and reliability of the tool. Skin tear classification typing is a complex skill that requires training and time to develop. More education is required for all health care specialists on the classification of skin tears.

Blood flow responses over sacrum in nursing home residents during one hour bed rest

To describe individual BF responses in a nursing home resident population for one‐hour periods of bed rest.