Device-Related Pressure Ulcers From A Biomechanical Perspective

Pressure ulcers (PUs) in the pediatric population are different from those in adults, in their risk factors and aetiology, with more than 50% of the cases related to contact with medical equipment. The aims of this study were to (i) Determine the mechanical loads in the scalp of a newborn lying supine, near a wedged EEG electrode or wire, which is deforming the scalp at the occiput. (ii) Evaluate the effect of a doughnut-shaped headrest on the mechanical state of tissues at the occiput. We used finite element computational modeling to simulate a realistic three-dimensional head of a newborn interacting with the above devices. We examined effective and shear stresses and strain energy density (SED) in the fat and skin tissues at the occipital region. The contact of the skin with the above devices resulted in concentrated stresses and elevated SEDs in the affected soft tissues, compared to a flat foam mattress. Our simulations suggest that misplaced medical devices, and using a doughnut-shaped headrest, impose an actual risk for developing device-related PUs. We conclude that pediatric clinical care should recommend routine inspections of the medical setting to prevent unnecessary contact of misplaced devices with the body of the patient.