You’ve probably heard enough about skin to last a lifetime. It’s THE thing that health care professionals hammer on the most. And with good reason – skin breakdown remains one of the leading complications spinal cord injury (SCI) survivors have. It accounts for countless days of missed work, school, and fun. It results in costly surgery, and its complications can even end in death. It is a big deal. The purpose of this article is to talk about your sleeping surface. As with anything related to your injury, learning the vocabulary to talk with your healthcare team is the first step. Words like “bed” and “mattress” are often used interchangeably in the real world. But, in the medical world, they mean two very different things. A “bed” refers to the frame the mattress sits on. A “mattress” is what you sleep on. In the medical world, a “mattress” is often referred to as a “specialty surface” or “support surface.” An overlay is a thin support surface that lies on top of the standard mattress.
The bed or frame that the sleeping surface rests on will vary depending on your needs. You will need to decide if you need to raise and lower the head and feet of the bed. You will also need to decide if you need to adjust the height of the bed. The height of the bed is often important if you get help with positioning, turning, or getting dressed. It can also be used to allow downhill transfers (both ways) if you have difficulty or pain with transferring. The ability to raise and lower the bed will make your caretaker’s work easier and decrease back strain. When deciding on your mattress or support surface, consider your needs. Do you have a skin sore that needs to heal? Do you need help turning or getting dressed? Do you transfer yourself in and out of bed or do you have a caretaker help you? Will you be sleeping with anyone else in bed with you? Medicare has developed guidelines to categorize support surfaces based on your individual needs. Level 1 – Pressure Reduction These sleeping surfaces reduce pressure on bony prominences.
Payment by insurance companies for these support surfaces usually requires a patient to be completely immobile or have limited mobility, have a skin sore on the trunk or pelvis and one of the following: impaired nutritional status, fecal or urinary incontinence, or altered sensory perception. Examples of support surfaces in this category include : Level 2 – Pressure Relief These sleeping surfaces relieve pressure usually by submersion into something soft or by alternating pressure. Payment by insurance companies for these support surfaces usually requires a patient working with a wound care specialist on multiple or significant, non-healing open skin sores. Examples of support surfaces in this category include : Level 3 – Fluid These surfaces are rarely used at home because they are extremely heavy and your home will need to be evaluated to see if it is able to sustain the weight of the bed. They are very expensive. Examples of support surfaces in this category include Hill Rom Clinitron and KCI Air Fluidized bed.
If you are lucky enough to not have significant skin problems and it’s time to replace your mattress, buying one from a retailer may work for you. Keep in mind, insurance will rarely assist with buying a mattress from a retailer but if that is not an issue for you, consider these options: Many retailers offer a trial period of their mattresses in your home. If the mattress does not work for you then you can return it within the trial period for a full refund (you may still be responsible for delivery and pick up charges). For specialty support surfaces or if insurance will be used to help pay, consider renting the mattress or frame before you buy it. Hill Rom Home Care Division is a major supplier of specialty support surfaces and frames and they can help you identify what you need. They also help with the paperwork needed by insurance. Renting before you buy is a cost effective way to make sure you don’t get stuck with an expensive mistake. Getting the right mattress and frame is a small part of your overall skin care regimen.
Just because you have a fancy mattress does NOT mean you can skimp on monitoring your skin, turning, or padding. Check your skin every morning and night Routine skin inspection is a way of finding skin problems early. Look at your skin or have your attendant look at your skin for any changes in skin color, blisters, bruises, cracked or dry skin. Use a mirror to check your back, bottom and heels. Feel for any hardness, or swelling or warmth that may signal skin breakdown. Any change in your skin is a signal of trouble. Inspecting your skin must become routine each morning, evening and any other time you think you might need to. Practice regular turns while in bed Using a regular turning schedule during the night will also keep your skin healthy. Depending on your body size and skin tolerance, your turning schedule may vary from 2 to 6 hours. Adding 30 minutes in a given position and then checking for redness can gradually increase the length of time between turns and build skin tolerance.
Anytime you make a change to your sleeping surface (new mattress, new overlay, hotel, friend’s house, etc), decrease your turn times to every 2 hours. Gradually add 30 minutes in a given position and then check for redness to increase the length of time between turns and to build tolerance to the new surface. If redness or breakdown is noted, reduce turn times and keep off the area until it returns to normal. Don’t sit in bed for long periods of time. Raising the head of bed or propping your head up with pillows puts pressure on your tail bone putting you at increased risk for developing a pressure sore. If you need to sit up, get out of bed and into your wheelchair. Practice padding in bed Placing pillows and pads to relieve pressure can protect the bony prominences of your body. One rule of thumb to follow is to place padding above and below the bony prominences. Aging of the skin is a fact of life for all individuals. With aging, our skin becomes thinner, dryer, has a decreased blood supply and is more fragile (especially to shearing forces).