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Table of Contents    
LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 3  |  Page : 873-875

A novel cost-effective pillow for prevention of an occipital pressure sore


Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication15-May-2018

Correspondence Address:
Dr. Jayesh Sardhara
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.232303

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How to cite this article:
Sardhara J, Mishra R. A novel cost-effective pillow for prevention of an occipital pressure sore. Neurol India 2018;66:873-5

How to cite this URL:
Sardhara J, Mishra R. A novel cost-effective pillow for prevention of an occipital pressure sore. Neurol India [serial online] 2018 [cited 2018 May 20];66:873-5. Available from: http://www.neurologyindia.com/text.asp?2018/66/3/873/232303




Sir,

Pressure sores are localized areas of tissue necrosis that tend to occur when the soft tissue is compressed between a bony prominence and an external surface for a prolonged period.[1] In the neurosurgical setting, a pressure sore more commonly occurs in patients who require a prolonged hospital stay, i.e., those in a post-traumatic coma, or altered sensorium due to a poor grade subarachnoid hemorrhage, those on a traction, or those with quadriplegia/pentaplegia after spine trauma or following surgery for atlantoaxial dislocation. Prolonged weight-bearing and mechanical shear forces act on the areas of soft tissue overlying bony prominences. When this pressure exceeds the normal capillary perfusion pressure (32 mm Hg), it further leads to occlusion and tearing of small blood vessels. This subsequently leads to reduced tissue perfusion to the extent that ischemic necrosis develops. This sequence is followed by the development of a pressure sore.[1],[2] A pressure sore commonly occurs in the skin overlying bone prominences such as the sacrum, occiput, greater trochanter, ischial tuberosity, malleolus, heel and the fibular head.

Apart from a frequent change in posture, a water-bed, air-bed or a silicon pillow that is recommended for back of the head, are commercially available in the market but are unaffordable by many poor patients. We believe that in the developing countries, there is an extreme need for some cost-effective device to prevent the development of a bed sore. The device should be capable of being prepared at home in a very simple manner to aid in domiciliary care of those patients who are likely to undergo a period of prolonged recumbence. We have routinely used 6 water-filled latex gloves intermingled with each other. [Figure 1]a. All these hand gloves are tied by a single knot in the centre and the finger of gloves remain at the periphery. All the fingers are tied with each other in such a way that these 6 water-filled gloves form the shape of a circle and are placed beneath the occiput of the patient [Figure 1]b and [Figure 1]c. The central knot is covered by the seventh glove to prevent the feeling of hardness in the centre. [Figure 1]d. In one of the trials, we also tried filling air instead of water in seven balloons, but the size of the pillow become too large and because of its very light weight, it become difficult to stabilize the head especially in patients with spinal ailments. Water permitted the expansion of the glove to the optimum extent and was ideal for our purpose.
Figure 1: Method to prepare the occipital pillow: Six routine water-filled gloves, intermingled with each other (a). All six gloves are tied by single knot in the centre and the finger of the gloves should remain at the periphery. All the fingers of the 6 gloves are tied with each other in such a way that a bunch of water-filled six gloves, shaped like a circular balloon occupies the region under the occiput (b and c). The central knot is covered by the seventh water-filled glove to prevent the patient from feeling of hardness of the knot in the centre (d)

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We are routinely using this pillow in poor-grade patients with incipient risk factors for the development of a bed sore, as well as in ventilator-dependant patients in the neurosurgical intensive care unit (ICU) to prevent the development of an occipital pressure sore. [Figure 2]. Seven unsterile, and reused hand gloves in the ICU do not cost any money since they are anyway going to be thrown away; and, at home, the cost of purchasing 7 rubber gloves is less than Rs. 300. The average life-span of this pillow is approximately 15 days. According to our experience, if one of the seven water-filled gloves ruptures by the second week, another pillow may be prepared reusing same hand gloves by just replacing the single glove. The method is very cost-effective. In the last six months, using this device in our ICU and at home, a significant impact has been seen in decreasing the incidence of occipital bed sore in our postoperative patients who have either been operated for the presence of atlanto-axial dislocation and any other conditions in which there is a high risk factor for the development of a bed sore.
Figure 2: The usage of the occipital pillow in our Neurosurgery ICU in quadriplegic patients after atlantoaxial dislocation surgery (a and b). A small pillow to prevent bedsore at the heel can also be made by using two water-filled gloves (c)

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Acknowledgment

We are grateful to the Neurosurgery ICU nursing staff as well as faculty members and residents of the Department of Neurosurgery, SGPGIMS, Lucknow for using this device for patient care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
NPUAP pressure injury stages. National Pressure Ulcer Advisory Panel. Available from: http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages. April 2016. [Last accessed on 2017 Mar 14].  Back to cited text no. 1
    
2.
Woolsey RM, McGarry JD. The cause, prevention, and treatment of pressure sores. Neurol Clin 1991:9;797-808.  Back to cited text no. 2
    


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