Mattresses Provide Pressure Relief
Janet Kelly, RN, was caring for a critically ill patient on Shapiro 6 in January when she saw that his skin had turned deep purple on parts of his back. “Turning a patient with an open chest cavity is challenging,” said Kelly. “I was able to do a full turn and saw significant welts on his back.”
Kelly said an order had been placed for an overlay for his bed. Before it arrived, she spoke with Diane Bryant, MSN, RN, CWOCN, one of three wound-ostomy clinical nurse specialists at BWH, about the patient’s condition and the plan of care for the skin breakdown. When assessing the patient’s skin the next day, Kelly noticed that the patient’s skin was maintaining itself and was not worsening.
“We decided at that point that there was no need for an overlay,” Bryant said. “The new AtmosAir mattresses are really beneficial to patients in preventing and treating skin breakdown. Now, patients rarely need overlays.” (See Chart)
Last spring, BWH purchased the AtmosAir 9000 mattresses to provide every patient in the hospital with pressure redistribution. Made by Kinetic Concepts, Inc., of San Antonio, Texas., the mattresses feature a self-adjusting technology designed to reduce the incidence of pressure ulcers. Nine air cylinders inside the mattress and a system of chambers and valves enable the mattress to automatically adjust to body weight and evenly distribute pressure.
Kelly noted that vigilance on the part of nurses in turning patients is still vital to preventing skin breakdown. “Repositioning, even if only small shifts, and skin inspection are all part of really good nursing care,” she said.
View the sidebar for comparison of Atmos-Air 9000 mattress to First Step Overlay including description and patient indications.
Criterion |
AA 9000 Mattress |
First Step Overlay |
Description |
Nine separate air cylinders with cut-off valves that automatically “self adjust” mattress pressure |
Three sections; requires manual pressure adjustment. |
Indications |
Prevention / treatment of pressure ulcers at all stages. |
Prevention / treatment of pressure ulcers at all stages PLUS severe excess moisture: Extensive skin disorders: e.g., Stevens-Johnson syndrome, GVHD, Extensive new flaps or skin grafts, Severe anasarca, Severe or extensive burns |
Pt. weight limit |
Up to 500 lb. (limit of regular hospital bed frame). |
Up to 250 lb. Use First Step Select Heavy Duty for up to 650 lb. |
Pressure mapping tests |
Average 18.4 mm Hg pressure (Capillary pressure = 32 mm Hg) |
Average 20 mm Hg pressure (Capillary pressure = 32 mm Hg) |
Electrical power requirement |
None needed |
Essential - deflates immediately if unplugged. |
Set-up |
None needed – standard mattress on all BWH beds (except some ICUs) |
Requires written order, wait for delivery, removal/cleanings/storage of bed mattress, application of 3” foam base to bed frame, connection of blower unit to overlay. |
Initial settings |
None needed |
Default settings assume 5’10”, 175 lb patient. For optimal function, patient height and weight need to be programmed. |
Effect of elevated HOB |
Automatically adjusts to reduce pressure to coccyx |
Pressure to coccyx increased unless mid-section pressuer adjusted |
Pressure relief during transport |
Remains consistent |
None |
Effect of ceiling lift sling or bed linen |
Effect on pressure relief unclear. May increase risk of tissue injury due to wrinkling, moisture collection, friction/shear |
Same as AA 9000. Also, ANY material between patient and Gore-Tex cover (except Dry-Flo pads) negates air loss effect on moisture management. |