Skin Blood Flow Response to 2-Hour Repositioning in Long-term Care Residents: A Pilot Study

PURPOSE: The purpose of this noninvasive pilot study was to examine the changes in transcutaneous oxygen (tcO2), skin temperature, and hyperemic response in the heels, sacrum, and trochanters in a 2-hour loading-unloading condition in nursing home residents who are positioned in supine and lateral positions. DESIGN: A 1-group, prospective, repeated-measures design was used. SUBJECTS AND SETTING: Nine subjects (5 males, 4 females) with a mean age of 85.3 ± 10.86 years (mean ± SD) who required help in turning and positioning at a skilled nursing facility participated in the study. METHODS: Oxygen and temperature sensors were placed on the heels, trochanters, and sacrum. The subject was (1) positioned lateral for 30 minutes (preload); (2) turned to the supine position with head of the bed at 30° for 2 hours (both sacrum and heels were on the bed surface) (loading); and (3) positioned lateral for 2 hours (unloading). Subjects were turned to either the right or the left side. RESULTS: Friedman test showed no statistical differences in tcO2 or skin temperature on the sacrum, heels, or trochanters during preload, supine, and lateral positioning (P > .5). Individual data revealed that hyperemic response was seen in 6 of the 9 subjects when the position was changed from supine to lateral. Only one-third of the subjects attained a sacral tcO2 of 40 mm Hg or more at the end of the 2-hour lateral positioning. tcO2 on both heels decreased within the first 30 minutes of loading. CONCLUSION: Two hours of staying in the supine position lowered sacral oxygenation to less than 40 mm Hg, in some subjects, regardless of whether there was adequate tcO2 at preload. Repositioning to a lateral position after 2 hours of placement in a supine position did not cause the tcO2 to return to preload level. The efficacy of a 2-hour repositioning schedule requires further investigation. Since heel tcO2 was reduced after 30 minutes of loading, further work is needed to determine whether the heels should be offloaded with more frequent repositioning.