Influence of support surfaces on the distribution of body interface pressure in surgical positioning

Oliveira, Karoline Faria de; Pires, Patrícia da Silva; De-Mattia, Ana Lúcia; Barichello, Elizabeth; Galvão, Cristina Maria; Araújo, Cleudmar Amaral de; Barbosa, Maria Helena

doi:10.1590/1518-8345.2692.3083

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 26 • 2018 • https://doi.org/10.1590/1518-8345.2692.3083 copy

Influence of support surfaces on the distribution of body interface pressure in surgical positioning^* * Paper extracted from doctoral dissertation “Superfícies de suporte para prevenção de lesões por posicionamento cirúrgico: um estudo experimental”, presented to Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, grant #2015-309102/2015-4. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences.

Method:

a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data.

Results:

the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg).

Conclusion:

IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.

Descriptors:
Patient Positioning; Patient Safety; Perioperative Care; Perioperative Nursing; Perioperative Period; Pressure Ulcer

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author:
Maria Helena Barbosa E-mail: mhelena331@hotmail.com

Region	Mean peak interface pressure (mmHg)		Support surfaces
Region	Mean peak interface pressure (mmHg)		SOT*	Viscoelastic polymer	Density 28 sealed	Density 33 sealed	Density 45 sealed	Density 18 soft	Density 28 soft
Occipital	F^†= 31.76 p^§ = 0.001	Mean	23.40	32.80	13.65	12.80	29.94	11.70	14.35
		SD^‡	5.43	7.80	3.39	3.91	15.29	3.26	4.42
		Minimum	15.00	22.00	10.00	9.00	9.00	9.00	7.00
		Maximum	33.00	48.00	25.00	26.00	23.00	21.00	24.00
Subscapular	F^†= 34.83 p^§ = 0.001	Mean	21.65	32.30	11.00	10.80	12.60	9.95	11.95
		SD^‡	12.14	12.82	3.58	5.36	3.10	4.06	4.85
		Minimum	12.00	12.00	7.00	7.00	9.00	5.00	7.00
		Maximum	68.00	63.00	22.00	31.00	20.00	21.00	22.00
Sacral	F^†= 53.87 p^§ = 0.001	Mean	25.65	42.90	12.15	10.90	12.10	11.80	12.85
		SD^‡	9.83	17.45	1.66	2.71	2.59	2.39	3.18
		Minimum	14.00	24.00	9.00	6.00	10.00	7.00	9.00
		Maximum	48.00	94.00	16.00	18.00	20.00	16.00	23.00
Right calcaneus	F^†= 33.87 p^§ = 0.001	Mean	23.80	31.35	15.10	12.55	14.35	12.75	15.30
		SD^‡	8.63	12.77	4.35	3.46	3.83	3.75	4.59
		Minimum	7.00	16.00	6.00	7.00	8.00	7.00	8.00
		Maximum	45.00	60.00	24.00	21.00	24.00	21.00	27.00
Left calcaneus	F^†= 41.37 p^§ = 0.001	Mean	27.85	36.55	14.75	13.65	15.35	13.05	15.30
		SD^‡	9.09	14.52	3.68	2.85	3.27	3.56	4.21
		Minimum	11.00	19.00	8.00	6.00	10.00	7.00	9.00
		Maximum	47.00	77.00	22.00	19.00	24.00	19.00	24.00

Region	Support surfaces	SOT*	Viscoelastic polymer	D28^† sealed	D33^‡ sealed	D45^§ sealed	D18^ǁ Soft	D28^† soft
Occipital	SOT*	-	<0.001	<0.001	<0.001	1.00	<0,001	<0,001
	Viscoelastic polymer	<0.001	-	<0.001	<0.001	1.00	<0.001	<0.001
	Sealed D28^†	<0.001	<0.001	-	1.00	0.03	0.12	1.00
	Sealed D33^‡	<0.001	<0.001	1.00	-	0.02	1.00	0.66
	Sealed D45^§	1.00	1.00	0.03	0.02	-	0.001	0.007
	Soft D18^ǁ	<0.001	<0.001	0.12	1.00	0.001	-	0.13
	Soft D28^†	<0.001	<0.001	1.00	0.66	0.007	0.13	-
Subscapular	SOT*	-	0.022	0.030	0.015	0.071	0.003	0.011
	Viscoelastic polymer	0.022	-	<0.001	<0.001	<0.001	<0.001	<0.001
	Sealed D28^†	0.030	<0.001	-	1.00	1.00	1.00	1.00
	Sealed D33^‡	0.015	<0.001	1.00	-	1.00	1.00	1.00
	Sealed D45^§	0.071	<0.001	1.00	1.00	-	0.102	1.00
	Soft D18^ǁ	0.003	<0.001	1.00	1.00	0.102	-	0.084
	Soft D28^†	0.011	<0.001	1.00	1.00	1.00	0.084	-
Sacral	SOT*	-	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
	Viscoelastic polymer	<0.001	-	<0.001	<0.001	<0.001	<0.001	<0.001
	Sealed D28^†	<0.001	<0.001	-	0.368	1.00	1.00	1.00
	Sealed D33^‡	<0.001	<0.001	0.368	-	0.398	1.00	0.009
	Sealed D45^§	<0.001	<0.001	1.00	0.398	-	1.00	1.00
	Soft D18^ǁ	<0.001	<0.001	1.00	1.00	1.00	-	1.00
	Soft D28^†	<0.001	<0.001	1.00	0.009	1.00	1.00	-
Right calcaneus	SOT*	-	0.057	0.001	<0.001	<0.001	<0.001	0.006
	Viscoelastic polymer	0.057	-	<0.001	<0.001	<0.001	<0.001	<0.001
	Sealed D28^†	0.001	<0.001	-	0.425	1.00	0.363	1.00
	Sealed D33^‡	<0.001	<0.001	0.425	-	1.00	1.00	0.027
	Sealed D45^§	<0.001	<0.001	1.00	1.00	-	1.00	1.00
	Soft D18^ǁ	<0.001	<0.001	0.363	1.00	1.00	-	0.492
	Soft D28^†	0.006	<0.001	1.00	0.027	1.00	0.492	-
Left calcaneus	SOT*	-	0.041	<0.001	<0.001	<0.001	<0.001	<0.001
	Viscoelastic polymer	0.041	-	<0.001	<0.001	<0.001	<0.001	<0.001
	Sealed D28^†	<0.001	<0.001	-	1.00	1.00	1.00	1.00
	Sealed D33^‡	<0.001	<0.001	1.00	-	0.089	1.00	0.651
	Sealed D45^§	<0.001	<0.001	1.00	0.089	-	0.293	1.00
	Soft D18^ǁ	<0.001	<0.001	1.00	1.00	0.293	-	0.587
	Soft D28^†	<0.001	<0.001	1.00	0.651	1.00	0.587	-

Variables	Nutritional status		SOT*	Viscoelastic polymer	Density 28 sealed	Density 33 sealed	Density 45 sealed	Density 18 soft	Density 28 Soft
Mean peak interface pressure (mmHg) F^†=0.29 p^‡=0.87	Underweight	Mean	29.80	42.80	10.60	8.20	11.20	9.40	11.80
	Underweight	Standard deviation	14.81	29.07	1.14	1.30	0.84	1.82	1.48
	Normal weight	Mean	25.40	41.60	12.20	12.40	13.20	11.40	12.80
	Normal weight	Standard deviation	11.63	13.05	1.30	3.36	3.96	1.52	3.77
	Overweight	Mean	24.00	45.00	12.40	10.00	11.20	12.20	12.00
	Overweight	Standard deviation	7.65	18.71	1.14	0.71	1.30	0.84	1.22
	Obese	Mean	23.40	42.20	13.40	13.00	12.80	14.20	14.80
	Obese	Standard deviation	3.85	8.53	1.95	1.73	3.11	2.49	4.82