[GingerSue]

how to protect a patient's heels on those feet that lie for hours on the bed and now have discoloured areas - diabetic feet, recent cellulitis

what can be used to prevent heel decubitus ulcers? BEFORE the heels turn purple with those blistered-looking areas that become deep decubitus ulcers.

I remember the use of sheepskin either on the bed, or the sheepskin heel protectors - is there a reason why these might not be used currently?

And for elbows that are now getting purple and skin is breaking down - what helps protect these area?

[ginger58]

We aren't allowed to use sheepskin and I think it has to do with washability and that it traps moisture. Now that sounds hokey! I'll do some looking around and get back to you.

We use "Skin Prep" to wipe the heels once a shift although I'm not sure this always gets done. Also we "float the heels" with a pillow under the legs keeps the heels off the bed. There are also heel and elbow protectors, and turning.

[GingerSue]

what are the heel and elbow protectors made of ? - I remember spongy material with a sticky surface (cut a hole to size for the elbow, ankle, or heel) - is it still used?

how will skin prep keep the pressure off the heels? I can imagine that it'll remove the pressure during the brief time that it takes to apply the prep, but then the feet/elbows go right back where they were

I'm thinking of something soft/gentle - like a sponge with pillow case over it, or a rolled flannel under the ankles (painful feets/legs) - I saw that the pillow was tried under the legs, but that raised the legs to uncomfortable height and flexion of hips & the person can't stand straight up anymore

turning is what I would have thought to be done, but it isn't being done

[SCRN1]

I always wondered about those heel elevators that were made out of a hard box & lined with sheepskin. To me, it would seem the heels would still be resting on a hard surface. At first, it may feel soft, but after a little while, I'm sure you can feel the hardness of the box underneath.

When I float heels off the bed by raising the legs with pillows, I only use one or two (if MD orders 2 pillows). I turn them longways so that the pillow doesn't end under the knee. Of course, I also turn the patient frequently too. This also gives the heels a rest from touching anything in the same spot for a long time. And I put a pillow between the knees so they won't rub against each other. I bend the knees a little with the top knee a little more forward from the bottom knee. I use pillows to prop arms in a comfortable position.

We use the blue disposable sponge heel protectors that velcro across the top of the foot and put those socks with the rubber that helps prevent patients from slipping on the feet first.

[P_RN]

We used something like this that had a hard plastic loop thingy behind the heel so the heel was suspended with no pressure. The name escapes me-I think it starts with an L

We also used a foam boxy thingy that had circles cut out so most pressure points were suspended.

We also used a foam circle that was wrapped about the lower tibia so the heel was suspended.

I haven't seen sheepskin used except on Thomas traction splints in a long, long time.

[erroridiot]

PRAFO Boots

[gwshrimp]

The skin prep prevents friction between the bed and the heels. It also slightly toughens the skin.

Podus boots can work very well if used correctly. If left on for extended periods of time it can create new pressure ulcers.

The best thing you can do for heel ulcers is to completely alleviate any pressure and keep it dry. Dry intact eschar on heels should not be debrided. If localized signs of infection are present or develop debridement is probably your next step.

[meownsmile]

We use a waffle boot. Similar to the waffle matress, made by the same company. Inflated with velcro strips to keep in place. They make one that goes up to the knee now and we use those occasionally. A rolled blanket under the calf of the leg works too.
For elbows we have the knit padded sleeve. It keeps direct pressure off of the boney prominence and helps prevent any sheet shear.
I havent ever seen the sheepskin used in my facility but not sure about LTC. I would think it would be a sanitation issue that would keep them from using them.

[Wise Woman RN]

Offload the heels... the boots, devices, waffle things all cause pressure to other areas of the leg.. I have seen patients who were using the "bunny boots" or waffle protectors that had developed stage II and III ulcers from the pressure of the devices... the best way to prevent pressure ulcers is to be assiduous about relieving pressure...

[GingerSue]

thanks for these ideas, they are helping me think of what would help this individual (now during the Christmas break, the person won't get ANY physiotherapy - they were getting him up every day, but now the person will be immobile in bed for these 4 or 5 days - with nothing, they do put a pillow under the legs now, but the elbows are breaking down now)