Paul Harrison Interview – The Importance of Turning a patient
There is a blinkered view on the benefits of turning just down to pressure ulcers and what we need to emphasize to people is that there is a parallel need to look at the other bodies, what we call holistic care. Everybody quotes holistic care but to actually see it in practice is where we are struggling.
We need people to understand that there is multi-organ, multi-system benefits where routine turning benefits the chest, routine turning benefits the bladder, routine turning benefits the blood circulation and it is psychologically beneficial to the patient as well.
There is very few written documents and very limited research into these. We need to say that it’s not just about preventing pressure ulcers that is a strain on the NHS, it’s also about preventing urinary tract infections, respiratory infections, DVTs, PEs, because all of these are physiologically linked to stasis, but they are not actually linked into the benefits of practice interventions, like the frequency of turning.
We can’t say what the frequency is because that’s on an individual patient basis, but we can say that every patient essentially would benefit at this moment in time from a frequency in turning.
So where the frequency of turning is increased because of pressure ulcers, we need to look to see if there is also a parallel reduction in things like urinary tract infections and pneumonias. These may have also been in the past, caused by stasis.
There is a thing called sedimentation that occurs within the bladder. This is where the bladder isn’t just urine and where the kidneys process solid matter as well. There is little cellular matter that comes down and settles out in the bladder, which forms sediment. The sediment becomes a focus for any infection that gets into the bladder; so any bacteria that can get into the bladder will dive into the sediment and actually breed.
One of the ways that healthy people maintain is by having an upright posture and actually draining their bladder through the day, because they’re standing upright and that is the way the bladder is designed.
When you go to bed, if you have a patient that has got a catheter in, when you turn the patient after a period of lying on the back you can see in the catheter tube that there will actually be the sediment coming down the catheter tube and you can actually visually see all of this sediment draining out.
But up until that point when you turn the patient you will actually see that there is only clear urine coming out through the catheter tube because the way the catheter is positioned and every urologist will tell you this; the catheter cant drain this bladder efficiently to take all the sediment out, if the patient stays unturned.
So every nurse is familiar that when you turn a patient, particularly if there has been a long period of stasis, they will always observe this actual sediment coming out. Another thing that sometimes happens is when somebody is left unturned particularly like in intensive care they know that when you turn a patient there is an awful lot of mucus that comes out. They time it so that turning also helps with the suctioning and cleaning of the chest as well, causing a spontaneous shift of the fluid in the chest and that is represented by the patient wanting to cough once they are turned. They then can use that to reduce the amount of depth that they have got to go on suction, in other words meeting the chest product halfway. So the patient is stimulated to cough or the fluid is stimulated to move into a position where you can suction it. This means some of the fluid that you can’t always get to or without going to great difficulty can actually be brought up easier than before.
There is a complication called orthostatic pneumonia, which as the name suggests is a pneumonia that’s caused by the bugs breeding in static fluid.
It’s a simple physiological fact that if you leave fluid hanging around for long enough, things can breed in it because it’s not moving and it doesn’t disrupt or affect the breeding cycle.
Orthostatic pneumonia as the name says is somebody who has been left static and the fluid in his lungs is static. He can inhale an infective organism and because it’s not compromised by having to dodge and move with the fluids and the normal acidity of the lungs as well as everything that protects us from getting normal fluids.
Because the patient can’t always give a good cough or breathe without effort, then the bug actually just breeds and you suddenly get pneumonia. And the primary cause of pneumonia whilst it was a bug getting into the system is that we didn’t support the natural defense mechanism of the body.
Another stasis issue is clots. Again we know from the work of people like Ricky Autar and alike that stasis in bed increases the risk of DVT’s (Deep vein thrombosis) and pulmonary embolism. The blood is hanging around, the circulation is compromised and because it moves sluggishly, there is a great risk of it clotting.
If it gets to areas where there is constant pressure, you know particularly in the calves and the thighs, then the blood is trying to move very sluggishly through areas that are under pressure and that can traumatize and cause problems. This is on top of the normal trauma, the trauma that put the patient in the bed in the first instance.