Pressure Mapping: The Underwear Case

Wednesday, March 23, 2011 | 0

By Yvonne Guibert
Total Medical Solutions

Working with complex care patients can be a challenge. All of a sudden, a patient can develop an ulcer wound or several wounds that can get out of hand very quickly and lead to many other complications. This is not only an issue with paralyzed patients. Any patient who is bed ridden or confined to a wheelchair for a few weeks, like with a broken bone, could be susceptible to ulceration wounds. When you know a patient will be immobile for any length of time, getting a pressure mapping image on file is a good idea.

What is pressure mapping?

Pressure  mapping provides a graphic image of surface pressure, where the skin comes into contact with a surface such as a wheelchair cushion or a mattress. Listen to a podcast by Rehab Management, The Interdisciplinary Journal of Rehab Medicine to learn more about it. The podcast is just under 11 minutes in length.

Zack Craft, vice president of rehabilitation technology and complex care at Total Medical Solutions, says, "Pressure imaging is an essential and handy tool to use any time you have a patient that may be immoble for more than a couple of weeks." Zack recommends pressure mapping on any file where a home visit presents potential issues. "It is especially critical when you are aware of other existing issues with a patient. For example, if the patient has diabetes or obesity, any change in pressure on certain parts of the body could lead to wound development right away." Providing a pressure mapping image at the onset of an injury or surgery is prudent.

Change Your Undewear, Man!
a.k.a. Zack's Underwear Case

Pressure mapping is just one piece of a complex puzzle, but can play a critical role when considering how new wounds have developed. Consider Zack's "underwear case." Zack used pressure imaging on a case once to rule out wheelchair cushion problems, mattress problems and a host of other potential issues. When a long-time paraplegic patient developed wounds all of a sudden, Zack was called in for a home visit. The patient was otherwise healthy and there seemed to be no visible changes that would have caused the wounds. After the home visit and quite a bit of sleuthing, Zack figured out that the patient's underwear was the cause.

Yep, that's right, his underwear. You see, through a detailed series of questions and answers, Zack discovered the wife had recently started buying her husband silk briefs as opposed to cotton ones. In complex care, we get real up close and personal. You have to. Subtle changes like a change in fabric can cause major differences in friction or shear between the patient's skin and the surfaces it touches.

So, while pressure mapping didn't solve Zack's underwear case, it defintely played a crucial role. Zack was able to use pressure mapping images to rule out a lot of other causes. Often, wheelchair cushions are thought to be the blame, or mattresses, etc. and new ones are ordered without consideration. This can add up to hundreds, or thousands of dollars on a claim, and in many cases is completely unnecessary.

Does Your DME Provider Offer Pressure Mapping?

Any time you have a patient who is immobile, whether your patient is paralyzed, or has a short-term injury, it is a good idea to ask your DME provider for a pressure mapping image as soon as possible. Establish a baseline image on the file, then, consult with your complex care specialist to determine how often a new image should be taken.

Kathy Guibert is marketing consultant with Total Medical Solutions, a complex-care management firm based in Lake Mary, Fla. This column was reprinted with the firm's position from its blog, at http://www.workcompcomplexcare.com/