APEX Medical
Alternating Pressure Mattress
Domus 4 Alternating Pressure Redistribution System Clinical Practice Guideline June 2021
Clinical Practice Guideline
18 Pages
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Page 1
Domus 4 Alternating Pressure Redistribution System Clinical Practice Guideline
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Apex Medical Corp.
Index Risk Factors and Development of Pressure Injuries
Support Surface Solution • Pressure Mapping • Product Therapy Modes and Performance • Design of Mattress
Support Surface Solution
FAQ
Domus 4 Clinical Practice Guideline
Risk Factors and Development of Pressure Injuries Pressure Injuries commonly occur as a result of tissue being exposed to prolonged pressure or pressure associated with friction & shear, or the weaker tissue caused by moisture. 1
Friction & Shear
Causes of Pressure Injuries Moisture & Heat
Prolonged pressure
Common Risk Factors of Pressure Injuries Pressure injuries are categorized into 6 stages2: Stage I with a non-blanchable erythema of intact skin; Stage II with a partial-thickness skin loss with exposed dermis; Stage III with a full-thickness skin loss; Stage IV with a full-thickness skin and tissue loss; Unstageable pressure injury is defined as obscured fullthickness skin and tissue loss; And last, Deep tissue pressure injury is the persistent non-blanchable deep red, maroon or purple discoloration of the skin.
Images used with permission from https://npiap.com/page/PressureInjuryStages
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Apex Medical Corp.
They may be superficial injuries affecting the epidermis and dermis or they can extend into the subcutaneous tissues and involve muscle, tendon and bone. Pressure injuries typically occur over bony prominences with the lower trunk (sacrum, coccyx, trochanter and ischial tuberosity) and heels being the two most common anatomical locations.3,4
Ear
Occiput Great Trochanter Shoulder Spinous Process
Toe
knee Elbow
Ankle
Sacrum
37.3%
Hips
7.8% Heel
29.5%
Locations in Risk of Pressure Injuries Localized areas of tissues that have prolonged pressure cause the occlusion of blood flow, preventing the supply of nutrients and oxygen to the tissue, resulting in ischaemia and re-perfusion injury, leading to cell obliteration and eventually tissue death.5 From the information of the mechanism of pressure injuries above, additional risk factors that have been correlated with are age of 70 years and older, current smoking history, dry skin, low body mass index, impaired mobility, altered mental status (i.e., confusion), diabetes mellitus, peripheral vascular disease, urinary and fecal incontinence, malnutrition, physical restraints, malignancy, history of pressure injuries, and human race. Pressure injuries can develop within 2 to 6 hours. Therefore, the key to preventing pressure injuries is to accurately identify at-risk individuals quickly, so that preventive measures may be implemented.6 A major method of redistributing pressure is the use of support surfaces. Many researches had been conducted on the effectiveness of the use of support surfaces in reducing the incidence of pressure injuries. The concept of pressure redistribution has been embraced by the NPIAP.
Domus 4 Clinical Practice Guideline
“Support surfaces are: “Specialized devices for pressure redistribution” “ 7
“Support surfaces are specialized devices for pressure redistribution designed for management of tissue loads, microclimate, and/or other therapeutic functions (i.e., any mattress, integrated bed system, mattress replacement, overlay, or seat cushion, or seat cushion overlay)“.7 In this context, pressure refers to the distribution of force on the individual’s body surface that is in contact with the device.
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Apex Medical Corp.
Support Surface Solution Domus 4 is equipped with the following features to tackle the most common risk factors
Prolonged Pressure (1) Prolonged pressure:
Continuous Low Pressure (CLP)
Alternating Mode
Seat Inflation & Cell-on Cell Design
Heel Relief Function
Friction & Shear (2) Shear & Friction
4-way Stretch Top Cover with Low Friction & High MVTR
(3) Moisture Moisture & Heat
Micro Low Air Loss
Domus 4 Clinical Practice Guideline
Pressure Mapping
By investigating the pressure mapping of Domus 4, we can use the software to analyze the Pressure Area Index (PAI) and Pressure Redistribution Index (PRI) of different modes to see the performance of product, when threshold of interface pressure gets stricter, you can find out that Domus 4 can still offer good performance for prevention of pressure injuries.
Equipment Used: The XSENSOR X3 Display Medical Mattress System Software Used: Xsensor X3 medical V6 Method: Each test is conducted over a 30-minute period during which the average, peak and minimum pressures are recorded.
Pressure Area Index (PAI): Pressure Area Index (PAI) is a method used to measure the interface pressure of the surface. The PAI is calculated as the proportion of sensors that register interface pressure values.8 Pressure Redistribution Index (PRI): Pressure Redistribution Index (PRI) is a method to assess the ability of a dynamic support surface to sustain interface pressures below a chosen set of thresholds. The PRI is calculated as the ratio of the time during which the dynamic support surface interface pressure trace spends below the threshold and the total time of one inflation/deflation cycle.9
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Apex Medical Corp.
Product Therapy Modes and Performance Continuous Low Pressure (CLP)
“Consider using a reactive air mattress or overlay for individuals at risk for developing pressure injuries “ 10
Reactive air mattresses redistribute pressure by deforming in response to an individual’s weight on the surface.11 Domus 4 offers a Continuous Low Pressure mode, which provides a stable surface with a pressure lower than the corresponding level when in the alternating mode. Also, this therapy mode is for the patients who are not fond of vibrations or alternating sensations.
Supine Position: PAI 82.42% < 32 mmHg
PAI & pressure mapping test of Domus 4 in the supine position for 30 minutes User Height: 175 cm User Weight: 110 Kg
PAI
BMI: 35.9 77.82%
Average Pressure
Interface Pressure (mmHg)
Domus 4 (when used in Continuous Low Pressure mode) reaches a maximum of 26.8 mmHg and a minimum of 24.9 mmHg, and the 100% of interface pressures during its 30-minute cycle are all below 32 mmHg.
< 32 mmHg
32
Pressure
30
Redistribution
28
Index
26
< 32 mmHg
24
PAI
22 20
0
5
10
100% 15
20
< 32 mmHg
25
30
Time (minutes)
89.32%
Average Pressure mmHg)
8
32 30
PAI
Pressure Redistribution
PAI Domus 4 Clinical Practice Guideline
82.42%
< 32 mmHg
Sitting Position: PAI
Interface Pressure (mmHg)
Average Pressure 77.82%
32 30
Pressure
< 32 mmHg
Redistribution
28
Index
26
PAI & pressure mapping test of Domus 4 in the sitting position for 30 minutes 24
< 32 mmHg
User Height: 175 cm
100%
User Weight: 110 Kg
22 20
0
5
10
PAI
15
20
BMI: 35.9
30
89.32%
< 32 mmHg
Interface Pressure (mmHg)
Average Pressure
32
Pressure
30
Redistribution
28
Index
26
PAI
24
< 32 mmHg 100%
22 20
0
5
10
15
20
25
30
Time (minutes)
< 32 mmHg
85.71%
Interface Pressure (mmHg)
Average Pressure 32 30
Pressure
28
Index
Redistribution
26
< 32 mmHg
24
100%
22 20
0
5
10
15
20
25
30
Time (minutes)
Average Pressure Interface Pressure (mmHg)
Domus 4 (when used in Continuous Low Pressure mode) reaches a maximum of 26.6 mmHg and a minimum of 25.2 mmHg, and the 100% of interface pressures during its 30-minute cycle are all below 32 mmHg.
25
Time (minutes)
32
Pressure
30
Redistribution
28
Index
26
< 32 mmHg
24
100%
22 20
0
5
10
15
20
25
30
Time (minutes)
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Apex Medical Corp.
PAI 82.42% < 32 mmHg
Alternating Mode
“Assess the relative benefits of using an alternating pressure air mattress or Average Pressure overlay for individuals at risk of pressure injuries “ PAI Interface Pressure (mmHg)
12
32
Pressure
30
Redistribution
28
Index
77.82%
Domus 4 offers an alternating mode,26 which continuously and sequentially inflate and deflate air < 32 mmHg 32 mmHg 24 cells (1-in-2 alternating) to avoid long term pressurization of<tissue. 100% 22
Supine Position:
20
0
5
10
15
20
25
30
Time (minutes)
PAI
Interface Pressure (mmHg)
Average Pressure 32 30
Pressure
89.32%
< 32 mmHg
Redistribution
28
Index
26
< 32 mmHg
PAI & pressure mapping test of Domus 4 in the supine position for 30 minutes 24 User Height: 175 cm User Weight: 110 Kg
100%
22 20
0
5
10
PAI
15
20
25
30
Time (minutes)
BMI: 35.9
85.71%
< 32 mmHg
Average Pressure Interface Pressure (mmHg)
Domus 4 (when used in alternating mode) reaches a maximum of 25.4 mmHg and a minimum of 21.4 mmHg, and the 100% of interface pressures during its 30-minute cycle are all below 32 mmHg.
32 30
Pressure
28
Index
Redistribution
26
< 32 mmHg
24
100%
22 20
0
5
10
15
20
25
30
Time (minutes)
From the pressure mapping images you can easily observe the alternating situation in the supine position: Average Pressure Interface Pressure (mmHg)
10
32
Pressure
30
Redistribution
28
Index
26
< 32 mmHg
24
100%
22 20
0
5
10
15
20
25
30
Time (minutes)
Interface Pressure (mmHg)
Average Pressure 32
Domus 4 Clinical Practice Guideline
PAI
30
Pressure Redistribution
28
Index
26 24
< 32 mmHg
22 20
< 32 mmHg 89.32% 100%
0
5
10
15
20
25
30
Time (minutes)
Sitting Position: PAI
Interface Pressure (mmHg)
Average Pressure 32 30
Pressure
85.71% Redistribution
< 32 mmHg
28
Index
26
< 32 mmHg
24 PAI & pressure mapping test of Domus 4 in the sitting position for 30 minutes
User Height: 175 cm User Weight: 110 Kg
100%
22 20
0
5
10
15
20
BMI: 35.9
30
Average Pressure Interface Pressure (mmHg)
Domus 4 (when used in alternating mode) reaches a maximum of 26.4 mmHg and a minimum of 23.7 mmHg, and the 100% of interface pressures during its 30-minute cycle are all below 32 mmHg.
25
Time (minutes)
32
Pressure
30
Redistribution
28
Index
26
< 32 mmHg
24
100%
22 20
0
5
From the pressure mapping images you can easily observe the alternating situation in the sitting position:
10
15
20
25
30
Time (minutes)
11
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Apex Medical Corp.
Design of Mattress Seat Inflation & Cell-on-Cell Design
“For individuals with a pressure injury, consider changing to a specialty support surface when the individual: ‘Bottoms out’ on the current support surface 13
“
To avoid the situation of bottoming out, Domus 4 offers an extra support in sacral area during sitting position. It will increase pressure of the whole mattress when patient is in a fowler’s position for steady support.It can be used with continuous low pressure (CLP) or alternating mode. The cell-on cell design also prevents the patient from bottoming out in case of power failure.
Heel Relief Function
“The heel is one of the two most common anatomical sites for pressure injuries. In a European survey on pressure injury prevalence, almost 80% of all Category/Stage IV pressure injuries were found at the sacrum and heels14
“
APEX Heel Relief Function is a simple and easy way to prevent and assist in treating heel pressure injuries by eliminating interface pressure from heels as if they are suspended in air. The heel is typically reported as the second most common sites for pressure injury development.14 With the Heel-Relief quick connectors on the last five cells from the foot end, regardless of patients’ height, the caregivers can always deflate the cell directly underneath the heel to achieve zero pressure.
Domus 4 Clinical Practice Guideline
Microclimate Management
“An increasing body of evidence suggests that the microclimate between skin and the supporting surface plays a role in the development of pressure injuries. “ 16
As for the microclimate control, Domus 4 offers micro low air loss function; it provides good ventilation and reduces the accumulation of heat and moisture.
Information of Top Cover
“Consider using textiles with low friction coefficients for individuals with or at risk of pressure injuries “ 17
Domus 4 alternating pressure redistribution system is provided with a standard cover (sanitary cover sheet) with high-performance technical material which covers them completely and is biocompatible, with low friction (μ = 0.21 (static), μ = 0.17 (dynamic)) & shear forces, water resistant and highly vapor permeable. The Moisture vapor transmission rate (MVTR) is 2315 g/24hrs/ m2 according to ASTM E96 Procedure BW.
13
14
Very easy
Easy Neutral Difficult Very difficult
Apex Medical Corp.
Clinical Study General Outline
General comfort
Stability
30 37
27 36
Very satisfied
Prospective observational study
Satisfied Neutral Study location: France (4 nursing homes and 1 geriatric long-stay center) 11 Unsatisfied 8 Very unsatisfied 0 Number of patients: 86 patients
11 12 0
Follow-up: 35 days
86%
Main objective
86%
84%
83%
Ease of Easymattress Use in terms of Use in terms of moving To determine the clinical interest in the use of Domus 4 / Auto for the prevention of pressure implementation
maintenance
repositioning patients
patient into a sitting position
31
48
82
37 46
0 0 0
0 0 0
1 1 0
1 1 1
injuries in patients at medium to high risk of55 pressure injuries Very easy 38(Braden Scale). 2 Easy Neutral Secondary objectives Difficult Very difficult (1) Patient comfort
(2) The satisfaction of the nursing staff
85%
(3) The sound level of the mattress
Sound level
(4) The safety of the mattress
Very satisfied
(5) The maceration score
Satisfied Neutral Unsatisfied Very unsatisfied
34 51 0 0 0
Results: Primary Endpoint: 0% of patients developed a pressure injury of the sacrum, spine dorsal or heel during the 35-day trial.
Day 0 Day 35 1 1 Infrequently wet Occasional humidity 14 14 Secondary Endpoints: Wet 49 49 Constantly wet Patient’s assessment of mattress comfort and stability were measured on a22 5-point22scale on the
parameters. The patients were satisfied or very satisfied in the majority of cases (Tab. 1). Very unsatisfied
Very satisfied Satisfied Neutral Unsatisfied Very unsatisfied
General comfort
Stability
30 37
27 36
11 8 0
11 12 0
Very unsatisfied
Unsatisfied 0%
Unsatisfied 0%
9.3%
Neutral 12.8%
34.9%
14.0%
Very satisfied
31.4%
Neutral 12.8%
77.9%
73.3%
43.0%
41.9% Satisfied
Satisfied
86%
86%
84%
Ease of implementation
Easy maintenance
Use in terms of repositioning patients
83% General Comfort (%)
0 0 0
1 1 Easy 0 36.0%
1 1 1
100%
Stability (%)
Use in terms of moving patient into a sitting position
55 38 2 Table 1. Patient’s assessment of mattress 37 comfort - N = 86 31 48 82 46 0 0 0
Very satisfied
100%
Difficult
Very difficult
Neutral 1.2% 1.2%
44.2%
Very easy
0%
97.7%
2.3%
Very easy
Difficult Neutral 1.2% 1.2%
Very difficult 1.2%
96.5%
43.0%
Very easy
Wet Very unsatisfied Constantly wet 85%
49 22
Unsatisfied 0%
49 22
Very unsatisfied Unsatisfied 0%
Sound level 9.3%
Neutral Very satisfied 12.8%
Satisfied Very unsatisfied Neutral Unsatisfied 0% Unsatisfied 9.3% Very unsatisfied
14.0%
Very satisfied
34.9%
14.0%
15
satisfied
73.3%
Unsatisfied 0%
Very satisfied
34.9% Satisfied
Domus 4 Clinical Very Practice Guideline 31.4%
Neutral Very 12.8% unsatisfied
0 077.9% 43.0%0
Neutral
12.8%
34 51
41.9%Very 31.4% satisfied Satisfied
Neutral 12.8%
73.3%Stability (%) General (%) Assessment of the equipment by the nursing77.9% staff on 0aComfort 5-point Day Day 35 scale on the following parameters: ease of General comfort
Stability
43.0% Infrequently wet
1
1
41.9% satisfied implementation, easyVery maintenance, ease30humidity of use in27 terms of ease of use in terms of Occasional 14 14 turning patients and Very
Very
difficult difficult Difficult Difficult Satisfied Satisfied 37 3649 Wet Satisfied 49 Very 1.2% 1.2% 2.3%easy orNeutral Neutral 1.2% 1.2% 0% very 1.2% 11 11 moving patient into aNeutral sitting position. The care team evaluated the implementation easy in the easy Constantly wet 22 22 Stability (%) General Comfort 12 (%) Unsatisfied 8 Very 0 0 Easyunsatisfied majority of cases mattress (100%), maintenance (100%), use in terms of repositioning patients (97.7%), use in
36.0%
64.0%
Unsatisfied 0%
86%
Easy
Ease of implementation
Neutral
36.0%
86%9.3%
Very easy 84%
Easy Neutral Difficult Very difficult
0
0
Easy
Satisfied Neutral Unsatisfied Very unsatisfied
36.0%
11 100% 8 64.0% 0
General comfort
Very satisfied
86%
86%
0 0 0
easy
0 0 0
Use in terms of repositioning Very patients (%) difficult Difficult
Very difficult 0%
2.3%
Very easy
0
1
53.4%
Easy
Very easy
43.0%
96.5%
95.3%
Stability (%) Day 0
0
0
1
Very
86%
86%
1
Unsatisfied 84% 9.3%
Use in terms of moving patient into a sitting position (%)
Very unsatisfied
Ease of implementation
Easy maintenance
asy
55 31
l lt ifficult
0 0 0
38 48 Very satisfied
Neutral
Use in terms of 12.8% repositioning 85% patients
2 Sound level
0 Satisfied 0 Neutral0 Unsatisfied Very unsatisfied
14.0%
Very
Use in terms of Neutral moving satisfied 12.8% patient into a sitting position
Very satisfied
31.4%
34.9%
77.9% 73.3% 37 Table 3. Patient’s assessment
41.9% 3482 43.0% of the sound46level of the 1 1 51 1Satisfied mattress - N1= 85 *Satisfied
difficult
Difficult
Neutral 1.2% 1.2%
0%
2.3%
Very easy
Sound level
60.0%
Very 40.0% satisfied
100%
Very 40.0% difficult
Very satisfied
100% Sound level (%)
Difficult Neutral 1.2% 1.2%
Satisfied
60.0%
Satisfied
0 0General Comfort (%) 1 (* 1 patient did not Stability (%) 0 answer this question) 0 Very
85% Easy
Unsatisfied 0%
83%
1.2%
Very Day 0 34 Day 35 easy 43.0% 44.2% easy Infrequently wet 1 100% 97.7% 96.5% Satisfied 51 1 100% Easy 55.8% 53.4% 64.0% Very Occasional humidity 14 Infrequently Infrequently has not Neutral 0 14 Very On day 35, the maceration score was compared to that ofEasy day 1level and easy Sound (%)the degree of maceration 95.3% Wet 49 wet satisfied wet 40.0% Unsatisfied 0 49 Constantly wet 22 22 Occasional Occasional 1.2% 1.2% Very unsatisfied 0 Very
Very satisfied 36.0%
100% changed. The maceration score was 1.9 ± 60.0% 0.7 on a score of 1humidity to 4 (Tab. 4). Easy Constantly General Comfort (%)
Very unsatisfied Unsatisfied 0% 9.3%
Neutral 12.8%
9.3%
Neutral 12.8%
34.9%
77.9% 43.0%
44.2%
64.0%
fort (%)
Very easy
Easy
wet
14.0% Very difficult Neutral Very 12.8% 2.3% Neutral 1.2% 1.2% 0% easy
100% Conclusion:
Satisfied 55.8%
16.3%
Neutral 1.2% 1.2%
1.2%
56.9%
Day 1 (%) 53.4%
25.6%
25.6%
1.2%
Occasional humidity 16.3%
96.5%
43.0%
56.9% Wet
16.3%
Day 35 (%) 56.9% Wet
56.9%
Very easy
16.3%
25.6%
Occasional humidity
RemainedWet unchanged
Day 1 (%)
Wet
41.9%
97.7%Satisfied
wet
Degree56.9% of maceration Very difficult
73.3%
Infrequently wet
Wet wet
Very satisfied 31.4%Difficult
Very satisfied Difficult
Degree of Infrequently maceration
humidity
Constantly wet
Constantly wet
1.2% Remained Day 1 (%) unchanged Constantly
Occasional humidity
1.2%
Remained unchanged 56.9%
16.3%
25.6%
wet
Stability 0% (%) Unsatisfied 25.6%
Very easy
maceration
Occasional humidity
1.2%
31.4%
73.3% Infrequently
0% (%) General Comfort Unsatisfied
Use in terms of moving patient 16.3% into a sittingDegree positionof (%)
Sound level (%)
Very Constantly satisfied
Table 4. Degree of Satisfied41.9% Constantly Very Very unsatisfied unsatisfied wet maceration - N = 86
Satisfied
%
Use in terms of repositioning wet patients (%) 25.6% Infrequently wet
Very unsatisfied
DayUnsatisfied 0 Day0% 35 Infrequently wet 1 1 14.0% Occasional 14 14 Very humidity satisfied Neutral 34.9% Wet 49 49 12.8% Constantly wet 22 22
77.9% 43.0%
Satisfied
Stability (%)
Day 35 (%)
Wet
Day 35 (%)
Easy To conclude, Domus95.3% 4 / Stability Auto (%) has proven to be effective in preventing pressure injury and gained great customer satisfaction based on a 35-dayVeryclinical study in France. Very
General Comfort (%)
Stability (%)
Easydifficult Difficult Very 0% 2.3% Neutral Use in 1.2% terms1.2% of repositioning easy
patients (%)
Very
difficult Difficult Very 1.2% 1.2% of moving Neutral 1.2% Use in terms patient 40.0% satisfied
into a sitting position (%)
60.0%
100%
43.0%
Very easy
Use in terms of moving patient into a sitting position (%)
1.2%
Neutral 1.2% 1.2%
97.7%
unsatisfied 1 majority 1 (Tab. 3). very0 satisfied in the of cases 0%
96.5%
nursing staff - N = 86
82 the mattress was46evaluated by the patients and the results were satisfied or The48sound level of
31
ult
Difficult
DayUse 35in terms of repositioning 30 27 patients (%) 84% 83% Infrequently wet 1 1 37 36 Occasional humidity 14 14 Use in terms of 11 11 Use in terms of moving Wet 49 49 repositioning into a sitting position 8 patients patient 12 Constantly wet 22 22 0 0 2 37
Satisfied Ease of Neutral Easy implementation maintenance Unsatisfied Very unsatisfied 55 38
Table 2. Assessment of
Easy
Stability
General Comfort (%)
53.4%
Easy
Stability (%)
34 Very 51 44.2%
11 Neutral 100% 55.8% Easy Unsatisfied Very 12 easy 0 Very unsatisfied
Easy
Easy
95.3%
1 1 1
Satisfied
Neutral 1.2% 1.2% Sound level
36 Satisfied
1.2%
43.0%
Very easy
96.5% 37 73.3% 97.7% the equipment53.4% by the Use in terms of repositioning Use in terms of moving patient Easy 46 patients (%) into a sitting position (%) 41.9%
Stability (%)
Stability 27 Very satisfied
Very difficult
95.3%
Very
Stability (%)
1 1 0
General Comfort (%)
Difficult Neutral 1.2% 1.2%
easy
83%
14.0%
85% 30 37
97.7% Very
2.3%
Use satisfied in terms of in terms of moving 31.4% satisfied NeutralUseVery easy 12.8% repositioning patients 44.2% patient into a sitting position
Satisfied 0
General comfort
0%
1.2%
34.9%
maintenance
0 0 0
Neutral
Unsatisfied 0% 1.2%
Very
Easy 12.8%
General Comfort (%)
Very satisfied
55.8%
Easy
55100% 38 77.9% 2 100% Easy 55.8% General (%) 64.0% Comfort Very 31 48 82 43.0% easy
Very easy
Very Very easydifficult
44.2%
Very Very Difficult terms of moving patient into a100% sitting position (96.5%) (Tab. 100%2). unsatisfied unsatisfied
Very
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Apex Medical Corp.
FAQ (1) How long does it take for the mattress to deflate when the CPR system is triggered? It takes less than 20 seconds for the mattress to be deflated for performing CPR
(2) How long does it take to fully inflate the mattress? It takes less than 30 minutes to fully inflate the mattress.
(3) The new Domus 4 replaces “Static” mode with “CLP” mode. What are the differences? What is the reason behind the change? In Domus 4/Auto, “Static” mode & “CLP” mode are the same. Apex redefined the terms to differentiate “Static” mode for non-digital pump (Domus 3) from “CLP” mode for digital pump (Domus 4, Domus 4). “CLP” - Provides patient a stable static surface with a relatively low pressure (2/3 of the chosen alternating pressure). “Static” - Provides patient a static surface with the same pressure as the chosen alternating pressure.
(4) When is Continuous Low Pressure (CLP) mode used? What are the benefits of CLP comparing to Alternating Mode? When clinically indicated, CLP can be activated for better patient immersion, envelopment and comfort.
Domus 4 Clinical Practice Guideline
References 1. Karen Hertz. 2018. Fragility Fracture Nursing. USA: Springer 2. NPIAP Pressure Injury Stages (https://cdn.ymaws.com/npiap.com/resource/resmgr/online_store/npiap_pressure_ injury_stages.pdf) 3. Zhaoyu Li, Frances Lin, Lukman Thalib, Wendy Chaboyer. 2020. Global prevalence and incidence of pressure injuries in hospitalized adult patients: a systematic review and meta-analysis. Journal of Nursing Studies. 4. Gawlitta D, Li W, Oomens CW, Baaijens FP, Bader DL, Bouten CV. 2007 The relative contributions of compression and hypoxia to development of muscle tissue damage: an in vitro study. Annals of Biomedical Engineering. 35(2), 273-84. The references listed below by page number, refer to direct statements appearing in the full version of the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019. 5. Section 5: Skin and Tissue Assessment. Page 74 6. International review. Pressure ulcer prevention: pressure, shear, friction and microclimate in context. A consensus document. London: Wounds International, 2010. 7. Section 10: Support Surfaces. Page 155 8. Section 10: Support Surfaces. Page 166 9. Kenney L , Rithalia SVS . 1999. Mattress & bed resource file: assessment of support surfaces. J Wound Care (Suppl) ;Part 2: 1-8. 10. Twiste M & Rithalia S.. 2008. Measurement system for the evaluation of alternating pressure redistribution mattresses using pressure relief index and tissue perfusion– a preliminary study. Wound Practice and Research. Volume 16. 11. Section 10: Support Surfaces: Recommendation 7.5. Page 163 12. Malbrain M, Hendriks B, Wijnands P, Denie D, Jans A, Vanpellicom J, De Keulenaer B. 2010. A pilot randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention and treatment of pressure ulcers among medical ICU patients. J Tissue Viability. 19(1), 7-15. 13. Section 10: Support Surfaces: Recommendation 7.7. Page 165 14. Section 10: Support Surfaces: Good Practice Statement 7.9. Page 169 15. Section 9: Heel Pressure Injuries. Page 145 16. Section 2: Etiology. Page 22 17. Section 6: Preventive Skin Care: Recommendation 3.4. Page 88
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HEADQUARTERS Apex Medical Corp. No. 9, Min Sheng St., Tu-Cheng, New Taipei City, 23679, Taiwan T +886 2 2268 5568 F +886 2 2268 6525 [email protected]
PAN-ASIA
PAN-EUROPE
AMERICAS
TAIWAN Apex Medical Corp. No. 9, Min Sheng St., Tu-Cheng, New Taipei City, 23679, Taiwan T +886 2 2268 5600 /0800 054 133 F +886 2 2268 6526 [email protected]
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Domus 4 Operation Video
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