From the Guidelines
The recommended frequency for repositioning a patient with a lumbar fracture to prevent pressure sores is every 2-4 hours. This guideline is based on the French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury, as outlined in the 2020 study published in Anaesthesia 1. When repositioning, it is crucial to use proper techniques to maintain spinal alignment and prevent further injury, especially in patients with lumbar fractures.
Key Considerations for Repositioning
- Repositioning should be done carefully using proper log-rolling technique to maintain spinal alignment.
- The skin should be inspected for early signs of pressure damage, particularly over bony prominences, during each repositioning.
- Specialized pressure-redistributing surfaces like air mattresses or foam overlays may complement the repositioning schedule but do not replace the need for regular position changes.
- Maintaining good skin hygiene, ensuring adequate nutrition and hydration, and managing moisture are also essential components of pressure sore prevention that should accompany the repositioning schedule. The 2-4 hour interval for repositioning is considered optimal because pressure ulcers can begin to form when tissue is compressed for longer periods, as compression reduces blood flow to the skin and underlying tissues, as recommended by the study 1.
From the Research
Recommended Frequency for Repositioning
- The optimal frequency for repositioning a patient with a lumbar fracture to prevent pressure sores is not clearly established, as evidenced by studies 2, 3, 4, 5, 6.
- A study published in 2008 found that repositioning every 4 hours, when combined with an appropriate pressure redistribution surface, is just as effective for the prevention of facility-acquired pressure ulcers as a more frequent (every 2 hour) regimen 2.
- Another study published in 2014 found that repositioning every 2 hours did not reduce the incidence of pressure ulcers compared to repositioning every 4 hours in patients on mechanical ventilation with alternating pressure air mattresses 5.
- A systematic review and meta-analysis published in 2020 found that more frequent repositioning (every 2-3 hours) was associated with a 25% reduction in the odds of pressure ulcer development compared to less frequent repositioning (every 4-6 hours) 6.
Considerations for Repositioning
- The frequency of repositioning should be individualized based on the patient's health status and risk factors for pressure ulcer development 4.
- The use of a repositioning system or turning team may also be effective in reducing pressure ulcer incidence, although the evidence is limited 6.
- The certainty of the evidence for repositioning frequency and pressure ulcer prevention is generally considered low, and further research is needed to establish clear guidelines 3, 6.