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Background: Positioning during pediatric cardiac catheterizations and EP studies has been a high priority since 2000 when the clinical area began a quality assurance (QA) project for patient complaints of pain and when problems with skin integrity were noted after these procedures. A literature search suggested that the use of air filled cushions or air fluidized cushions might decrease skin breakdown,but studies have not been done in the pediatric population.
Sample/Method: A prospective, randomized, comparative study was initiated to determine the interface pressure distribution using an air-filled cushion versus air fluidized cushion on skin integrity and complaints of pain in pediatric cardiac catheterization/EP patients. The study was approved by the institutional review board. A sample of 89 subjects, undergoing procedures in the Pediatric Cardiac Catheterization Laboratory was recruited. Subjects lie on a pressure mapping system. Patients were asked to report the presence of any pain before and after the procedure, at discharge, and a week following discharge. The sacral area and heels were visualized for skin breakdown, by a team member. Groups were compared with Fisher’s exact test.
Results: We found distribution of pressure over a larger area had less erythema and complaints of pain than the smaller, boney prominence areas. There was a statistically significant difference for skin integrity (erythema) immediately post procedure at the heel/ankle site (p=0.0228).
Implications for practice: The air filled cushion resulted in significantly more erythema for the heels/ankles, while the air fluidized cushion prevented contact with the mattress. The results of this research suggest that the heels should be suspended off the mattress to maintain skin integrity for procedures in the Pediatric Catheterization Laboratory.