S - SKIN INTEGRITY
Ensure proper bed positioning by using devices and techniques that are appropriate for the type of support surface and mattress and the individual's health status. Use pillows, cushions, and positioning aids to:
- Bridge contacting tissues, including bony prominences
- Unload bony prominences
- Protect pressure injuries and vulnerable areas of skin. Do not use closed cut-outs in mattresses or donut-type cushions.
Protect the heels of all individuals with SCI while supine or reclined and while using adaptive devices (e.g., soft silicone gel sheet, soft padded anke foot orthosis (AFO)). (Adapted from PU-ONF 2013, p.89; Level C)
Use a side-lying position at a 30° angle from supine that does not position the individual directly on either hip. (PU-ONF 2013, p.90; Level C)
Avoid elevating the head of the bed above 30°. If raising the head of the bed is medically necessary, raise the foot of the bed before the head and limit the amount of time in this position as much as possible. (Adapted from PU-ONF 2013, p.92; Level C)
Avoid sitting in bed. Transfer the individual to a sitting surface that is designed to distribute pressures properly in the seated position. (PU-ONF 2013, p.93; Level C)
Turn and reposition individuals who require assistance at least every 2 hours initially. Adjust the repositioning schedule based on the individual's skin response, determined by frequent skin checks, until an appropriate repositioning schedule is established. (Adapted from PU-ONF 2013, p.94; Level C)
Use repositioning techniques that prevent injury to the caregiver and reduce friction and shear of soft tissues when the individual with SCI is moved. (Adapted from PU-ONF 2013, p.95; Level C)
Avoid bed rest to treat pressure injuries in individuals with SCI. If necessary, use bed rest to offload pressure completely for a specific and limited time, such as after surgical repair of pressure injuries. (Adapted from PU-ONF 2013, p.96; Level C)