Phillis is a 92-year-old lady with end-stage Alzheimer’s disease. She lives in a care home and is cared for in bed. Phillis has developed grade 3 pressure ulcers in the crease of her arms and forearms due to very tight contractures.

The nurses are treating the ulcers and dressing them regularly, however, due to the pressure, heat, and moisture, the wounds are not healing. Phillis also has increased tone in her hands, causing her fingers to flex and contract into a fist. The care team is unable to open her hands out and the pressure from her fingers and nails are causing wounds on the palms of her hands.

Phillis was prescribed flat and dimensional gel, which was positioned underneath her forearms and in-between the creases of her arms. She was also prescribed custom-made gel hand rolls to put between her fingers and palm to encourage opening her hands for hygiene and to protect her skin.

Elin is a 78 Year old Lady, 5ft 4” tall, weighing 8 stone 9lb with Vascular Dementia. Elin lives with her husband and receives care four times a day.

She is hoisted between her hospital bed and specialist comfort chair using a portable hoist and universal sling to have her meals with her husband. However, after losing weight and recovering from a chest infection Elin developed redness and marking on her inner thighs caused by the sling when being transferred. She became very agitated during transfers and uncooperative with the care team.

From the Occupational Therapy and District Nurse Assessments, it was identified that the sling was causing shear, friction, and pain for Elin, and was the cause for her skin break down and her increased agitation and aggression during transfers.

Intervention

The following interventions were provided: Low profile SlingGel pads were inserted between the legs and sling to provide pressure relief and comfort for Elin when being hoisted. This eliminated the sling rims shearing on her skin and improved comfort straight away reducing her agitation. Loops of the sling were adjusted to recline Elin in the sling to reduce pressure from underneath her legs and improve her comfort. Her specialist chair was put into further tilt for transfers.

A ceiling track hoist was installed to make transfers more timely. As a result, transfers became much quicker and smoother. A new sling was prescribed, a Deluxe Leg with extra padding, which provided more support, comfort, and improved positioning for seating.

Low profile Silicone Gel Pads shown inserted into a sling The pads are made of medical grade silicone gel which emulates the characteristics of human fat tissue to protect sling users from skin damage. Review After two weeks of using the SlingGel inserts and reclining the sling, the redness and marking completely cleared. Elin was more settled and happier being hoisted.

After 3-4 weeks a new ceiling track hoist and sling were provided to further improve transfers and seating. The new sling worked well, and the sling gel continued to be used to prevent any further pressure injuries and maintain Elin’s skin integrity. Elin is back to sitting out in her specialist chair daily and enjoying her meals with her husband. Her nutrition, fluid intake, and weight has improved.