A person will typically have a variety of needs and so it would inappropriate to use a single measure, such as a risk assessment score, to determine mattress selection. Mattress choice should be based upon a holistic assessment covering a range of factors and take into account:
- A person’s overall condition, including their independent mobility, time spent in bed and assessed risk of pressure injury/ulcer
- Regular assessment of the skin and the skin’s response to the mattress/repositioning regimen
- Specific therapy goals such a pressure ulcer prevention, healing and/or comfort
- The care environment and whether the person has access to caregivers for supplementary interventions, such as assistance with standing and turning
- Personal preferences.
Understanding the potential benefits and limitations of the different mattresses, and matching these to individual circumstances, can guide appropriate selection with the following caveat:
- Pressure redistribution mattresses may help to individualise repositioning intervals, but they do not replace the need for regular repositioning.
Reactive mattresses (static):
Mattresses such as foam, air or a combination of the two, provide a soft immersive surface. As the body sinks into and is enveloped by the surface, bodyweight is spread over a wider contact area and pressure is reduced over vulnerable tissue. The greater the immersion and envelopment properties, the better the pressure is redistributed, for example – memory foam (visco-elastic) or cube-cut foam is more immersive than standard foam.
Indicated: Foam, gel, air or foam/gel/air hybrid mattresses or mattress overlays are indicated for those who are at risk of pressure ulcers and are either able to reposition themselves, or have access to caregiver support for regular repositioning.
Considerations: Although tissue pressure may be lowered, residual pressure is constant and may be sufficient to occlude the circulation, particularly over bony areas such as the heel.
Active mattresses (powered, alternating pressure):
These mattresses consist of a powered mechanical pump that alternately inflates and deflates air cells across the surface of the mattress, in order to regularly off-load pressure from areas vulnerable to tissue damage. In hybrid mattresses, the cells are encased in foam providing both an alternating and immersive surface.
Indicated: For all those vulnerable to pressure ulcers, including those with existing tissue damage, who may or may not be able to reposition frequently. An active mattress may enable repositioning intervals to be extended, which may be of benefit where a person has limited access to caregivers for assisted repositioning, or because their condition requires greater periods of rest e.g. for sleep, pain control, personal preference.
Considerations: Active mattresses require a reliable power supply and may raise the height of the bed in relation to side rails. Extra support may be needed during bed-chair transfer.
- Surfaces with soft edges may compress during patient transfer bed-chair – extra care is needed.
- To reduce the risk of falls and entrapment, care should be taken to ensure the mattress is fitted correctly to the bed and that side rail use is justified.
- Heel off-loading boots can protect these especially vulnerable areas, irrespective of mattress type.
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