The Vacuum Mattress
A short field report from Zitha Hospital (Luxembourg) - by Frank Heinl
The history of the vacuum mattress
The vacuum mattress is mainly known in the emergency services field where it has been used for many years as an aid to comfortably place patients for emergency transport. For example, it is used in cases where a serious back injury is suspected or in event of a fracture in the thigh or femoral neck.
The mattress consists of an air-tight casing that contains small plastic pellets. By suctioning out the air, the mattress becomes firm and can be adapted to fit the patient.
Only recently has it been suggested that this positioning system could be used in the OR. I myself found out about the vacuum mattress during a positioning workshop from a Swiss colleague and was immediately impressed by this positioning concept. I was the first one to use it in our hospital in the urology lab for renal positioning. After that it seemed useful in many other situations throughout the entire OR.
It has now become standard practice for patients to be placed on the vacuum mattress in the following positions:
- Lateral position (kidneys, thorax, etc.)
- Lithotomy position (hysterectomy, hemorrhoids, etc.)
- MIC position (MIC Sigma, MIC rectum amputations, etc.)
- Lateral position in neurosurgery (all types of trepanations)
- Supine position for long operations to prevent pressure ulcers. (Neck dissection, invertebral disc replacements)
- Lateral position for minimally invasive hip replacements
Features of the vacuum mattress
The vacuum mattress design allows for very broad support of the entire body, hence a very stable position of patient on the OR table. Also, it is easy to figure out individual body features (e.g. amputated limbs) in order to find special positions, for example, in the case of extremities.
Its use helps to prevent pressure ulcers because the contact pressure is distributed across a very broad area. Pressure peaks and hard-to-access body parts, still common with the use of side supports, are therefore a thing of the past. This also means that fewer positioning accessories like supports, cushions, pillows and rollers are needed.
There is another feature of the vacuum mattress that does not garner enough attention. Since the filling is small styrofoam pellets, the mattress also functions as a heat reservoir. This means that during longer procedures the patient's temperature drops less, if at all. In many situations, this results in a safer position for the patient that is also less time-consuming and more cost-effective.
Handling the vacuum mattress
The vacuum mattress is very easy to handle if you follow several tips.
- Before the patient is placed on the mattress, the air has to be suctioned out of it. Just enough air should be left in sothe mattress can still be easily kneaded.
- In our hospital, we have height-adjustable OR table mounts, which makes it possible to lay the patient directly on the vacuum mattress using the patient transfer board.
- We do not use a sheet between the mattress and the patient (more on that later), which means it’s necessary to lift up the patient somewhat, otherwise the patient’s body will stick to the mattress. (In this case too, the vacuum is an important part of the mattress.)
- When the patient is laid on the vacuum mattress, it immediately shapes to the body and all details are worked out.
- Afterwards, the OR aspirator, which was previously connected to the mattress, is used to remove air from the mattress.
- Though the mattress functions as a heat reservoir, the patient's body temperature still be must be monitored using a rectal probe, especially during longer surgical procedures. A patient-warming device like BairHugger or others do not usually have to be used.
As already mentioned, we use no sheet as an underlayer between the mattress and the patient. There are reasons and consequences for this:
Cotton may not be used because it gets very hard when wet and wrinkles in the cloth can cause pressure ulcers. But other types of fabric may also develop folds that can cause pressure ulcers. So, after comprehensive trial runs, we have decided not to use cloths or pads. We place the patients directly on the vacuum mattress.
This naturally has its own consequences:
- When positioning, pay close attention to the patient’s skin being pulled tight. You can eliminate such tightness by slightly lifting the patient.
- When disinfecting the skin, use absorbent cloths and not too much disinfectant. The expression "too much is never enough" does not apply here.
- A highly adhesive and water-tight OR cover has to be used, even better with an incision film, if possible.
Conclusion for the Zitha Hospital
For our OR, the vacuum mattress represents one of the most important innovations in patient positioning. By using the vacuum mattress, many positioning errors can be avoided. What were once complicated positions can now be carried out in less time. The patient is positioned comfortably and firmly in his form. Pressure ulcers are avoided and patients do not lose body temperature as quickly.
Yet caution is advised: The vacuum mattress is not suitable for every situation.
You have to carefully observe how the patient behaves during the procedure and whether or not he or she can move out of the mattress' shape, as occurs in orthopedics and traumatology. If that happens the benefits of the vacuum mattress can suddenly turn into considerable disadvantages.
About the author
Frank Heinl has been working for 10 years at Zitha Hospital in Luxembourg in the main OR department there. I specialize in urology and gynecology. He also handles all questions regarding patient positioning in the OR.
For several years Heinl has been a member of an international group of positioning specialists who conduct six to eight workshops a year on OR positioning. The workshops are sponsored by an OR table manufacturer.