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Changes in Heel Skin Temperature under Pressure in Hip Surgery Patients

Wong, Vivian K. PhD, RN; Stotts, Nancy A. EdD, RN, FAAN; Hopf, Harriet W. MD; Dowling, Glenna A. PhD, RN, FAAN; Froelicher, Erika Sivarajan PhD, RN, FAAN

Advances in Skin & Wound Care:
doi: 10.1097/01.ASW.0000408466.88880.f8
Original Investigation
Abstract

OBJECTIVE: The aim of the study was to examine the effect of external pressure of the bed surface on heel skin temperature in adults in the first 3 days after hip surgery.

DESIGN: A quasi-experimental study in a prospective, within-subjects, repeated-measures design.

SETTING: This study was performed at 2 acute-care hospitals.

PARTICIPANTS: Eighteen subjects (9 men and 9 women) with a mean age of 58.3 (±16.1) years were recruited after hip surgery at the 2 hospitals.

METHODS: Temperature sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken when the heels were (1) suspended above the bed surface for 20 minutes (preload), (2) on the bed surface for 15 minutes (loading), and (3) suspended again above the bed surface for 15 minutes (unloading).

MAIN OUTCOME MEASURES: Heel skin temperature and demographic data.

RESULTS: Heel temperature increased during loading and unloading in both legs on postoperative days 1 (P = .003) and 3 (P = .04) but not on postoperative day 2. Heel temperature in the nonoperative leg decreased in the first 3 minutes of unloading on postoperative days 2 (P = .02) and 3 (P .01).

CONCLUSION: Heel temperature increased with loading and unloading on postoperative days 1 and 3. Upon immediate unloading, hyperemic response was present only in the nonoperative leg. Keeping the heels off the bed surface at all times may avoid heel skin temperature changes and prevent tissue damage. Further research is needed to identify the mechanisms that explain the effect of external pressure on heel temperature.

In Brief

The authors examine the effect of external pressure of the bed surface on heel skin temperature in adults in the first 3 days after hip surgery.

Author Information

Vivian K. Wong, PhD, RN, is Associate Professor, School of Nursing, San Jose State University, California. Nancy A. Stotts, EdD, RN, FAAN, is Professor, Physiological Nursing, University of California, San Francisco. Harriet W. Hopf, MD, is Professor, Department of Anesthesiology, University of Utah, Salt Lake City. Glenna A. Dowling, PhD, RN, FAAN, is Professor, Physiological Nursing, University of California, San Francisco. Erika S. Froelicher, PhD, RN, FAAN, is Professor, Physiological Nursing, School of Nursing, and Department of Epidemiology, School of Medicine, University of California, San Francisco.

The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this article.

Acknowledgments: This study was funded by the Individual National Research Service Award NR008317-03, the 2004 American Nurses Foundation Grant, the UCSF General Clinical Research Center, the UCSF Graduate Student Research Award, and the Wound, Ostomy, and Continence Nursing Scholarship. The authors thank Dr Steven Paul, who provided support in data management and analysis, and Dr Deidre Wipke-Tevis, who helped educate on the art of charts and figures. Thanks is also extended to the University of California at San Francisco: Dr Jergesen and Dr Ries, the General Clinical Research Center, the orthopedic clinic, and staff on the 12 Long Unit; the El Camino Hospital: the orthopedic physicians, 5E staff, and Admission Unit staff; and all the participants at both hospitals.

Submitted June 21, 2009; accepted in revised form June 15, 2010

© 2011 Lippincott Williams & Wilkins, Inc.