The Research Of Gel Cushions On Prevention Of Pressure Ulcers In The Ischial Tuberosity Of Elderly Confined Wheelchair

Objective To investigate the impact of the gel cushion on pressure ulcers prevention in elderly confined wheelchair and to discuss the better frequency of repositioning for them by using objective index.Methods The self-controlled study method was designed for this research.32 elderly wheelchair users who are not able to self-change body position were chose to be the study subject.At the first,the researcher helped subject lay on the bed with lateral position,used Laser Doppler(Peri Flux5000)and infrared thermometer to exam the values of Tc PO2,LDP and skin surface temperature at ischial tuberosity of the upper leg in order to get the basic data after observed the skin integrity.Second,the researcher helped the subject seat on the standard wheelchair with the gel cushion for 30 minutes,then re-test the Tc PO2,LDP and skin surface temperature as same part with lateral position to get the evaluate data.Third,Subjects had a rest for 24 hours.Repeat the first step for getting the same basic data,then the researcher helped the subject seat on the standard wheelchair for 30 minutes,repeat the second step in order to get the same evaluate data.All data were entered into SPSS21.0 for statistical analysis.Results 1.The total of 32 elderly wheelchair users with risk of pressure ulcers were taken with average age was 82.09±8.77 and there were 13 male subjects that account 40.6%,19 female subjects that account 59.4%.The major diagnoses of the subjects who include hypertension(56.3%),coronary heart disease(37.5%)and diabetes(34.3%).2.The Tc PO2 was 40.75±16.40 mm Hg after sitting on the standard wheelchair with the gel cushion.The Tc PO2 was 35.06±16.67 mm Hg after sitting on the standard wheelchair.Without the gel cushion the difference was statistically significant(P=0.005).The LDP was 5.50(3.25,9.00)PU after sitting on the standard wheelchair with the gel cushions.The LDP was 6.00(4.25,8.75)PU after sitting on the standard wheelchair without the gel cushions.There was no statistically significant(P=0.621).3.The skin surface temperature of ischial tuberosity was 31.16±1.70 ℃ after sitting on the standard wheelchair with the gel cushion that is lower than the temperature after sitting on the standard wheelchair without the gel cushion.32.06±1.87℃.The difference was statistically significant(P=0.01)4.In 32 subjects,there were 6 subjects with non-blanchable erythema both the gel cushion and standard wheelchair.There were 12 subjects with non-blanchable erythema after sitting on standard wheelchair while they were without non-blanchable erythema after sitting on the gel cushion.The difference was statistically significant(P=0.024).5.The Tc PO2 were not restored to baseline for 8 subjects who had used the gel cushion and standard wheelchair.The Tc PO2 of 17 subjects were not restored to baseline after sitting on standard wheelchair while it restored to baseline after sitting on the gel cushion.There was no statistically significant(P=1.000).Conclusion The gel cushion can reduce the temperature of skin surface and it might improve the microcirculation of compressed tissue.However,the gel cushion cannot restore microcirculation completely of tissue after decompressing.Therefore it cannot completely depend on the gel cushion to prevent pressure ulcers during taking care of the elderly confined to wheelchair.Our study showed that there were reactive hyperemias in 30 min with using gel cushion and reduction of Tc PO2 after decompression.Therefore,the sitting time of elderly people who are confined to wheelchairs,should be reduced.Repositioning the body of elderly confined to wheelchair every 30 min may better.