Support Surface Considerations for Pressure Ulcers
(Also Called 'Decubitus Ulcers', 'Ischemic Ulcers', 'Neurotrophic Ulcers')
Support surfaces are the special mattresses, mattress overlays, seat cushions, and specialty beds that support your body in bed or in a chair. Specifically, these support surfaces are used to reduce or relieve pressure that the weight of your body, and especially your bones, exert on your skin as it presses against the surface of a bed or seat of a chair. By relieving or reducing this pressure, existing pressure ulcers can heal and the chance that new pressure ulcers will develop can be reduced.
A number of different types of support surfaces are available and no single support surface has been shown to consistently perform better than all others under all circumstances. The type of support surface best for you will depend on a number of factors such as your general health, your ability to change positions, and your body build, as well as the condition, number, and location of your pressure ulcer(s). Your health care provider will make the appropriate choice for you during any needed hospital stay and can recommend support surfaces for use at home. Additional support surface selection considerations for the home will include the ease of use of the support surface, maintenance requirements, personal preferences, insurance coverage, and availability.
Categories of support surfaces
Before discussing the specific types of support surface devices, it is helpful to have a general understanding of the categories of support surfaces. Support surfaces can be categorized according to whether the support is "dynamic" or "static." Dynamic devices usually use electricity or a battery pack to alter the level of support (through inflation and deflation of air or movement of fluid) provided in the different chambers within the support device. The intent of this type of product is to constantly change the pressure of the support surface against the skin, particularly at the body's pressure points. Static devices reduce pressure by spreading the weight of the body over a larger area. Static devices mold to the contours of the body and maintain a constant level of inflation.
The types of support surface devices available include overlays, replacement mattresses, and specialty beds.
These are devices that are applied to the top of a bed mattress and are filled with air, water, gel, or foam, or a combination of these products. Overlays can be dynamic or static.
These are mattresses that replace the standard hospital or home mattress. Replacement mattresses vary in design and are made of a combination of foam or gel, or layers of different foam densities.
These replace hospital or home beds, require electricity or a battery pack, and are the most costly of all support surfaces. Several types of specialty beds exist, including air-fluidized beds, low-air-loss beds, and a combination of air-fluidized/low-air-loss beds. These types of beds will be briefly described below. Important to note: Even if a specialty bed is being used, the patient still needs to be repositioned at least every two hours.
- Air-fluidized beds — Air-fluidized beds consist of a bed frame containing silicone-coated beads. This type of bed uses both air and fluid to provide support. Beads in the bed behave like a liquid when air is pumped through them. On this type of bed, the body is immersed in the warm, dry fluidized beads. Air-fluidized beds are recommended for patients with multiple large pressure ulcers. They are not recommended for patients with pulmonary disease or unstable spines or for patients who are ambulatory. Because so much air is needed to fluidize the total bed, dehydration (from heat escaping from the body) is a risk.
- Low-air-loss beds — A low-air-loss bed consists of a bed frame with a series of connected air-filled pillows with or without minute holes that allow air to escape. The amount of pressure in each pillow is controlled and can be changed to provide maximum pressure reduction for the individual patient.
- Combination air-fluidized/low-air-loss beds — Some beds are a combination of an air-fluidized and low-air-loss bed. The lower half of the bed contains the air-fluidized component while the upper half of the bed contains the low-air-loss component. This bed is similar in size to a hospital bed and the head is adjustable (allowing the bed to be raised), but it is lighter than a total air-fluidized system.
Air-fluidized and low-air-loss beds are designed to conform to the body contours. In addition to providing pressure relief, these specialty beds also eliminate shear and friction and, decrease moisture. (It is important to keep the intact skin around the pressure ulcer dry to prevent it from breaking down and to prevent the development of additional pressure ulcers.)
Note about controlling moisture. Consider a support surface that provides airflow — such as air-fluidized and low-air-loss beds — if you have an incontinence issue. These types of beds help intact skin "dry," which keeps the skin around the pressure ulcer from breaking down and prevents the development of additional pressure ulcers. When lying on these types of support surfaces, it's important not to wear incontinence briefs (because they block the airflow to the skin). Instead, follow the manufacturer's instructions for using linen and underpads.
Does Medicare and/or private insurance cover the cost of these support surface products?
Your health care provider might be able to answer your questions or provide you with information about Medicare coverage for support surfaces (which are reviewed and updated from time to time). Check your policy or call your insurance agent to determine if support surfaces are covered under your private health care insurance.
It is important to remember that support surfaces are only one component of a pressure ulcer treatment plan. If the ulcer does not heal, the entire treatment plan should be reviewed before any decision is made to change the support surface.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/29/2005...#12222