Alignment and Pressure-Reducing Devices
Various assistive devices can be used to maintain correct body positioning and to help prevent complications that commonly arise when a patient must be on prolonged bed rest. Alignment and pressure-reducing devices, or pressure-redistribution devices, include boots to protect the heels and help prevent skin breakdown and footdrop; abduction pillows to help prevent internal hip rotation after femoral fracture, hip fracture, or surgery; trochanter rolls to help prevent external hip rotation; and hand rolls to help prevent hand contractures. Several of these devices—cradle boots, trochanter rolls, and hand rolls—are especially useful when caring for patients who have a loss of sensation, mobility, or consciousness.
Cradle boots, made of sponge rubber with heel cutouts, cushion the ankle and foot without completely enclosing it. Other commercial boots are available, but not all help to prevent external hip rotation. Footboards with anti-rotation blocks help prevent footdrop and external hip rotation, but they don’t prevent heel pressure. High-topped sneakers may be used to help prevent footdrop, but they don’t prevent external hip rotation or heel pressure. The abduction pillow is a wedge-shaped piece of sponge rubber with lateral indentations for the patient’s thighs. Its straps wrap around the thighs to maintain correct positioning. Although a properly shaped bed pillow may temporarily substitute for the commercial abduction pillow, it’s difficult to apply and fails to maintain the correct lateral alignment. The commercial trochanter roll is made of sponge rubber, but it can also be improvised from a rolled blanket or towel. The hand roll, available in hard and soft materials, is held in place by fixed or adjustable straps. It can be improvised from a rolled washcloth secured with roller gauze and adhesive tape. (See Common preventive devices.)
Cradle boots ▪ abduction pillow ▪ trochanter rolls ▪ hand rolls.
Preparation of Equipment
If you’re using a device that’s available in different sizes, select the appropriate size for the patient.