As part of a total pressure ulcer prevention and treatment program, Invacare® microAIR® mattresses help to provide the vital pressure relief needed for patients who are at risk of developing a pressure ulcer. The clinical algorithms within this guide are suggestions to better assist in choosing the correct support surface to help promote comfort and improve outcomes for patients with pressure ulcers.

I n vac a r e ®

T h e r a p e u T I c S u p p o r T S u r fac e S

c l I n I c a l g u I d e l I n e S f o r p r e S S u r e u l c e r S

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Identifying Characteristics of Pressure Ulcer Stages1:

Skin Assessment & Monitoring of Healing - Assess and monitor wound progress at least weekly- Assess and manage pain related to a pressure ulcer or its treatment- Manage patient continence

Debridement - Non-viable tissue should be removed with appropriate wound care treatment, including sharp and other forms of debridement

Infection Control - Use infection control techniques as indicated to ensure an optimal wound healing environment

Support Surfaces & Pressure Redistribution - Provide a support surface that is properly matched to the individual’s needs for pressure redistribution, shear reduction and microclimate control- Choose positioning devices and incontinence pads that are compatible with the support surface- Limit the amount of linen and pads placed on the bed- Do not position an individual directly on a pressure ulcer- Continue to turn and reposition the individual

Patient Healing - Review patient’s overall wound healing capability. For example, is the patient’s nutritional status, diabetes control, vascular status and renal function reasonably compatible with wound healing?- Consult with multidisciplinary treatment team to include nutritional and pharmacy care plans- Assess exudate levels and NPWT treatment option

Suspected Deep Tissue Injury. Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Stage I. Intact skin with non-blanchable redness of localized area usually over a bony prominence. Redness or discoloration of the skin may also be present.

Stage II. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as a blister.

Stage III. Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Some slough may be present.

Stage IV. Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often include undermining and tunneling.

Unstageable/Unclassified. Full thickness skin or tissue loss with unknown depth, obscured by slough and/or eschar.

Pressure ulcers are a significant, common and costly medical problem associated with the care of patients in the home, hospice or long-term care environments. Patients with pressure ulcers have decreased quality of life and increased morbidity and mortality rates2. Clinicians who utilize comprehensive pressure ulcer prevention protocols have demonstrated a decrease in the incidence of pressure ulcers3-8. In addition, suggested guidelines may reduce hospital readmissions, reduce costs associated with treating pressure ulcers and decrease the risk of litigation while improving the quality of life.

A Pressure Ulcer Protocol may include the following assessment and therapy Recommendations1

This information is not intended to be, nor should it be considered, medical, billing or legal advice. The physician and other medical care providers are responsible for determining proper product selection and the appropriate billing codes when submitting claims to the Medicare program, and should consult an attorney or other advisor to discuss specific situations in further detail.

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Powered Surface Algorithm Suggestions*

Guide for selecting Invacare® Therapeutic Support Surfaces

Therapeutic Support Surfaces are part of a total program for pressure ulcer prevention and treatment. When pressure ulcers deteriorate or fail to heal, the health care professional should consider replacing the existing support surface with one that will improve pressure redistribution, shear and microclimate (heat and moisture control) for the individual.1

Most Invacare powered mattresses feature microprocessor control to continually monitor the air pressure in the mattress to maintain optimal therapeutic pressure and to prevent capillary occlusion to promote healing and comfort. The systems have additional safety features such as a lock out to prevent tampering or accidental adjustments, audio/visual alarms, fire barrier and a 2" safety foam mat.

*This decision tree is merely a recommendation guideline for products. Information is subject to change without notice. Decision tree is not a guarantee or warranty of product performance, product selection or outcomes. Guidelines are distributor recommendations regarding products to assist the physician or caregiver in product selection. Please consult physician or caregiver regarding patient condition, individual treatment protocols and institution protocols.

Multiple Stage II or Large III or IV, Unable to Position, Had Pressure Ulcers or Flap, Graft Surgery

Diagnosis

Therapy Options

Prevention and Stages I, II &/or Smaller Frames

Prevention and Stages

I- IV &/or Large Frames

Stages I-IV Moisture

Management

Stages I-IV Pulmonary, Pneumonia

Turn Required

Alternating Pressure,With On

Demand Low Air Loss

True Low Air Loss

True Low Air Loss

With Alternating Pressure

30° Turn, Moisture Management,

Alternating Pressure

45° Turn, True Low Air Loss, Moisture

Management,Alternating Pressure

Model Suggestions

CG9900MA50MA51

MA55 MA65

MA80

MA85

MA90Z

MA95Z

Alternating Pressure

Alternating Pressure,With On

Demand Low Air Loss

This information is not intended to be, nor should it be considered, medical, billing or legal advice. The physician and other medical care providers are responsible for determining proper product selection and the appropriate billing codes when submitting claims to the Medicare program, and should consult an attorney or other advisor to discuss specific situations in further detail.

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Invacare Corporation www.invacare.com

USAOne Invacare WayElyria, Ohio44035-4190(800) 333-6900

Canada570 Matheson Blvd. E.,Unit 8Mississauga, Ontario L4Z 4G4 Canada(800) 668-5324

©2013 Invacare Corporation. All rights reserved. Trademarks are identified by the symbols ™ and ®. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Specifications are subject to change without notification. Form No. 13-157 130272

References

1. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009.

2. Berlowitz DR, Brandeis GH, Anderson J et al. Effect of pressure ulcers on the survival of long-term care residents. J Gerontol A Biol Sci Med Sci 1997;52A: 106-110.

3. Cuddigan J, Ayello EA, Sussman C, eds. Pressure Ulcers in America. Prevalence, Incidence, and Implications for the Future. Reston, VA: National Pressure Ulcer Advisory Panel, 2001.

4. Bodnar B, Myron P. Portrait of practice: Reducing the prevalence of pressure ulcers. Decubitus 1992;5: 49-52.

5. Regan M, Byers PH, Mayrovitz HN. Efficacy of a comprehensive pressure ulcer prevention program in an extended care facility. Adv Wound Care 1995;8: 49-55.

6. Kartes SK. A team approach for risk assessment, prevention, and treatment of pressure ulcers in nursing home patients. J Nurs Care Qual 1996;10: 34-45.

7. Boettger JE. Effects of a pressure-reduction mattress and staff education on the incidence of nosocomial pressure ulcers. J Wound Ostomy Continence Nurs 1997;24: 19-25.

8. Xakellis GC, Frantz RA, Lewis A et al. Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care. Adv Wound Care 1998;11: 22-29.

9. Hu T, Stotts NA, Fogarty TE et al. Cost analysis for guideline implementation in prevention and early treatment of pressure ulcers. Decubitus 1993;6: 42-46.

10. Xakellis GC, Frantz RA. The cost-effectiveness of interventions for preventing pressure ulcers. J Am Board Fam Pract 1996;9: 79-85.

*Information is subject to change without notice. The Guideline is not a guarantee or warranty of product performance, product selection or outcomes. Guidelines are distributor recommendations regarding products to assist the physician or caregiver in product selection. Please consult physician or caregiver regarding patient condition, individual treatment protocols and institution protocols.

Key Benefits of Invacare Therapeutic Support Surfaces

Benefit MA55 MA65 MA85

Alternating pressurereduces interface pressure to aid in the prevention and treatment of pressure ulcers

Four minute cycles of alternating therapy available 5, 10, 15 and 20 minutes

Four minute cycles of alternating therapy available 5, 10, 15 and 20 minutes

Four minute cycles of alternating therapy available 5, 10, 15 and 20 minutes

Low air lossKeeps the mattress environment cool and assists with moisture management

On-Demand – air is pushed in between the bladders

On-Demand – air is pushed in between the bladders

True Low Air Loss – air is pushed up through the bladders for a dryer environment

Liters Per Minute (LPM) Impacts air output, setup and therapy cycles

10 LPM compressor 50 LPM compressor 1275 LPM blower

Inflation time Fast setup

35 minute 10 minute Immediate

Fowler automatically adds 25% more air to prevent bottoming out when bed is articulated

Manual Automatic Automatic

Mattress depth increases patient immersion to maximize pressure redistribution

8" mattress 10" mattress 10" mattress

This information is not intended to be, nor should it be considered, medical, billing or legal advice. The physician and other medical care providers are responsible for determining proper product selection and the appropriate billing codes when submitting claims to the Medicare program, and should consult an attorney or other advisor to discuss specific situations in further detail.

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