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Choosing the Perfect Table Pad for Pressure Injury Prevention
Match your Surgical Table with Replacement Pads:
Why are there so many choices? How do I know it is the right fit? How thick should the pads be? Does this meet the requirements to prevent pressure injuries? How do I clean the pads?
We have been manufacturing surgical table pads for over 30 years; these are questions I am asked almost every day.
My goal in this article is to provide you with the information and tools needed to choose the perfect table pad every time.
Before we start matching the perfect pad to your surgical table – I am going to attempt to give you the needed information about pressure ulcers, different foam types, and the pad covering.
Understanding Pressure Ulcers.
If you’re a Perioperative Nurse, you probably know more about pressure ulcers or pressure injuries than I do. But we both have the same goal; to protect the patient from any pressure injuries or sores. We also know that it is easier and more cost effective to work on preventing the development of pressure ulcers than to treat them after the fact.
A pressure ulcer is an injury to the skin and underlying tissue resulting from prolonged pressure. Most frequently, they develop on the skin in areas that cover the more bony parts of the body, such as the heels, ankles, hips, and tailbone.
These pressure related injuries most commonly are found on patients with limited mobility, such as the elderly, nursing home patients, patients in a coma, patients with reduced pain perception, and any patients unable to move specific parts of their body.
The Three Main Causes of Pressure Injuries are:
- Sustained pressure. Prolonged contact between skin and underlying tissue against a surface, creates pressure that can lead to insufficient oxygenation and damaged cells. This often happens in parts that lack sufficient padding from muscle or fat, like heels, hips, shoulder blades, elbows, and the tailbone.
- Friction. When skin is dragged across a surface, most scenarios result when a patient changes position or a care provider moves them. This injury is worsened if the skin is moist.
- Shear. Strain caused when two surfaces are laterally shifted in relation to each other, creating pressure. This can take place when a hospital bed is elevated for example, and a patient slides down, straining bones and skin by pulling them in a different direction.
The above caues are why I always believe we should air on the side of caution. AORN suggests all surgical patients should be considered at-risk for pressure ulcer development.
First, you should think of the surgical patients’ weight. If the surgical table has a weight capacity of 1,000 pounds it is important to have a table pad that can support that patient without bottoming out.
Second, it is important to keep in mind the average length of surgery. Susan Scott, MSN, RN, says all patients can be at risk for pressure ulcers because of the length of surgeries. It is important that the table pad conforms to the surgical patient, supporting their whole body. In longer procedures, the risk of the pad bottoming out increases. We recommend pads with a layer of Pressure Relief Memory Foam to conform to the patient and a layer of High Density Base Foam to support the patient without bottoming out.
Finally, you need to think of the surgical patients age. Susan Scott, MSN, RN, also talks about how some patients have an increased risk (62 years or older, with lower albumin levels). For older or fragile patients, we might recommend pads with a Gel layer, which will not only protect against bruises or sores, but it will prevent the pad from bottoming out.
If you want to learn more about Pressure Ulcers I found these articles helpful:
AORN: Prevention of Perioperative Pressure Injury
Nurse.com | Susan Scott, MSN, RN: Best practices can prevent pressure ulcers in perioperative setting
MD at Home: Pressure Ulcers: A “Never Event” with Devastating Outcomes
AORN Journal: Prevention of Pressure Ulcers in the Surgical Patient (members only)
MD at Home: How to Recognize the 4 Stages of Pressure Injuries
Finding the Right Foam/Pad Type for your Procedure.
Now that we understand pressure ulcers we need to figure out what types of foam will meet the requirements of the procedure.
Below I listed three types of foam and the combinations. Keep in mind; when it comes to different layers of foam – more is not always more. For a 2" or 3" pad I would recommend no more then three layers of foam or gel. This is because, each layer needs to be glued together and we find that glue can prevent the pad from properly conforming to the patient.
I broke it out into three tiers (Tier 1 to Tier 3 – Tier 3 providing max support).
Tier 1 – High Density Standard Foam Table Pads:
High Density Standard Foam: is an open cell, polyurethane foam that makes for a resilient and long-lasting pad. Its high density allows for a cost-effective solution for short-term procedures. This foam offers support against bottoming out; for this reason, it is often used as the base layer for multi-layered pads.
Pads are available in 2", 3", or 4" inches thick and made specifically for each surgical table. All pads are cleanable and covered with a black, 4-Way Stretch, Soft Skin Conductive Cover. This offers extra flexibility and increases pad longevity.
Below, is a diagram from a Pressure Point Test performed on a Tier 1: 2" High-Density Standard Foam Pad. As you can see there are some pressure points; mostly where the patients bones are close to the skin (head, ankles, shoulders, etc.).
Frame: 4846
Range 10.0 to 200.0 mmHg
Avg/Peak: 27.8 / 172.54 mmHg
Area: 319.50 in^2
Test completed using Patient Mapping & Pressure Monitoring equipment from Xsensor Technology Corporation.
"Tier 1 Standard Foam Table Pads are your economical choice for use in short-term procedures."
Tier 2 - Pressure Relief Table Pads:
The Pressure Relief Table Pads were designed with multiple layers of foam, each playing its role to protect the patient from pressure sores. This pad aims to end patient discomfort and ischemia during long-term procedures.
Ultra Dense Base Foam: depending on your pad thickness, this 1-1/4", 2-1/4", or 3-1/4" pad functions as the bottom layer. This foundational foam is used because of the protection the Ultra Dense foam provides from bottoming out and the even support it offers in both short-term and long-term surgeries.
High Density Standard Foam: the middle layer is an open cell, polyurethane foam making for a resilient and long-lasting pad. The high-density foam supports the pad from bottoming out while distributing weight across the whole pad.
Pressure Relief VISCO Foam: the top layer consists of a 1/2" layer of unique urethane Pressure Relief foam, designed to conform to the patient's anatomy; increasing surface area and distributing weight. Features temperature sensitive, energy absorption and recovery properties. This means foam will conform to the surgical patient, supporting and protecting their entire body from pressure points; and then return to its original shape when released.
Pads are available in 2", 3", or 4" inches thick and made specifically for each table. All pads are cleanable and covered with a black, 4-Way Stretch, Soft Skin Conductive Cover. This offers extra flexibility and increases pad longevity.
Below, is a diagram from a Pressure Point Test performed on our Tier 2 - 2" Pressure Relief Pads. As you can see the Pressure Relief Memory Foam is very effective in increasing the service area which then removes the pressure points.
Frame:336
Range: 10.0 to 200.0 mmHg
Ave/Peak: 23.79 / 48.64 mmHg
Area: 386.00 in^2
Test completed using Patient Mapping & Pressure Monitoring equipment from Xsensor Technology Corporation.
"Tier 2 Pressure Relief Table Pads are the industry standard in pressure point management - ideal for mid to long-term surgeries."
Tier 3 - Elite Gel & Foam Combo Table Pads:
The Elite Gel & Foam Combo Table Pads were designed for ultimate patient comfort, with complete pressure relief and patient protection forefront. The multiple layers of foam and gel form a complete pressure relief system. This pad works cohesively to provide support and weight distribution during long term procedures and with bariatric patients.
Ultra Dense Base Foam: depending on your pad thickness, this 1-1/4", 2-1/4", or 3-1/4" pad functions as the bottom layer. This foundational foam is used in all of our pads because of the protection the Ultra Dense foam provides from bottoming out and the even support it provides in both short-term and long-term surgeries.
Pressure Relief VISCO Foam: the middle layer consists of a 1/2" layer of unique urethane Pressure Relief foam, designed to conform to the patient's anatomy; increasing surface area and distributing weight. Features temperature sensitive, energy absorption and recovery properties. This means foam will conform to the surgical patient, supporting and protecting their entire body from pressure points; and then return to its original shape when released.
¼” Polymer Gel Layer: finishing off the top with a 1/4" layer of Polymer Gel is what sets this pad apart. Designed to protect against sheer and friction during long-term procedures, the gel goes one step further. While this isn’t as soft as pressure relief VISCO foam, it provides much more support when distributing weight, while maintaining support with patients that are extremely overweight. This extra layer of security is to ensure the patient does not “bottom out”.
Pads are available in 2", 3", or 4" inches thick and made specifically for each surgical table. All pads are cleanable and covered with a black, 4-Way Stretch, Soft Skin Conductive Cover. This offers extra flexibility and increases pad longevity.
Below, is a diagram from a Pressure Point Test performed on our Tier 4 – 2" Elite Gel & Foam Combo Pads. This test is very interesting. Because the gel isn’t as soft as the pressure relief memory foam used in Tier 1 and 2 pads; the overall pressure is higher on this pad. In contrast, this pad has a larger range of elasticity (or weight limit) without bottoming out. For this reason, I recommend a the 3" thick, version of this pad.
Frame:322
Range: 10.0 to 200.0 mmHg
Ave/Peak: 24.38 / 74.53 mmHg
Area: 388.00 in^2
Test completed using Patient Mapping & Pressure Monitoring equipment from Xsensor Technology Corporation
"Tier 3- Elite Gel & Foam Combo Table Pads end patient discomfort and ischemia during long term procedures."
Match the Perfect Pad with your Surgical Table.
By this point you should know what pad style fits your surgical needs. Of course, if I failed to give you this information – give me a call: 973-379-4346 or leave a comment below!
In this step you will need to know the Manufacture and Make of your surgical table. Example, Skytron 3500.
Now before we start I want to clear something up. If there is one concern I constantly hear; its whether the pad is going to fit properly. For this reason, we started Guaranteeing “A Perfect Fit” on all our Surgical Table Pads!
To find the perfect pressure-sore preventing table pad for you- check out our options here.