Increasing Heel Skin Perfusion by Elevation

Introduction

Pressure ulcers (PrUs) can affect patients receiving either acute or chronic treatment and could be costly in the long term due to prolonged hospital stay. Only a few studies have been conducted to estimate the prevalence of PrUs. This essay examines the paper “Increasing heel skin perfusion by elevation.” This particular study investigates the protective effects of elevation and pressure redistribution of the heel.

Methodology of the study

This was a prospective study, approved by an Ethics committee. Four groups were used in the study. One group consisted of 20 normal subjects who were tested using a α Xcell bed of Huntleigh Health care. Second group consisted of 10 subjects with peripheral vascular disease, and were also tested using a α Xcell bed of Huntleigh Health care as the control device. Third group consisted of 20 random subjects (both normal and those with peripheral vascular disease). These subjects were tested using a standard medical-grade lamb’s wool overlay. The fourth group also consisted of 20 random subjects (both normal and those with peripheral vascular disease) who were tested with a viscoelastic gel overlay (Huber & Huber, 2008).

The device

A new device (33 cm long), and fitted with a foam surround was used. This device is capable of raising the heel entirely off the bed (holds the ankle 5-10 cm off the bed). A LD (Laser Doppler) device was used to assess the arteriolar/capillary blood fluxes at ulcer risk sites. This enables a noninvasive real-time measurement of the local tissue blood flow. A surface adhesive was used to fix the LD probe in a foam donut on the point of the heel (Huber & Huber, 2008).

Measurements

The same treatment sequence was assigned to each of the subjects without any time lag between LD measurements. The Wilcoxon signed rank test for paired observations was used to analyze the median differences between in the flux between the four groups (Huber & Huber, 2008).

Results of the study

The LD charts, which described the flux, concentration, and speed of the RBCs within the heel with respect to time, showed a significant increase in median heel blood perfusion while wearing the prosthesis after the hyperemic phase. The Wilcoxon signed rank test showed that the prosthesis enhanced RBC flux to a great extent when compared to other devices. The median RBC flux using the prosthesis was greater than the controls (Huber & Huber, 2008).

Significance of this study towards nursing practice

This study showed that with the use of the prosthesis, the flux to the heel is significantly higher than with other devices, and heel elevation increases tissue blood flow more effectively. This can be applied to current pressure ulcer prevention practice for a more effective primary prevention of PrUs. In addition, even in patients with established heel or foot PrUs, an improvement in blood flow using elevation could increase the rate of ulcer healing. All this could reduce the cost of prolonged hospital stay. The prosthesis is also more refined and user-friendly, which could increase patient compliance (Huber & Huber, 2008).

Background information and statistical results and analysis

The background information is found in the introductory section at the beginning of the article, and the statistical results and analysis is found in the results section.

Conclusion

The paper “Increasing heel skin perfusion by elevation” is a prospective study, which used four groups of patients. The device used in the study is capable of raising the heel entirely off the bed. A laser doppler device was used to assess the arteriolar/capillary blood fluxes at ulcer risk sites, which enabled a noninvasive real-time measurement of the local tissue blood flow. The Wilcoxon signed rank test for paired observations was used to analyze the median differences between in the flux between the four groups. The LD charts, showed a significant increase in median heel blood perfusion while wearing the prosthesis after the hyperemic phase. The Wilcoxon signed rank test showed that the prosthesis enhanced RBC flux to a great extent when compared to other devices.

This study showed that with the use of the prosthesis, the flux to the heel is significantly higher than with other devices, and heel elevation increases tissue blood flow more effectively. This can be used for a more effective primary prevention of PrUs and increase the rate of ulcer healing in patients with established heel or foot PrUs. This could reduce prolonged hospital stay and cost. In addition, the prosthesis could increase patient compliance.

References

Huber, J., & Huber, D. (2008). Increasing heel skin perfusion by elevation. Advances in Skin & Wound Care, 21 (1).