VOL: 103, ISSUE: 26, PAGE NO: 44
Joanna George, BSc, is nurse adviser, SCA Personal Care, ScotlandBody-worn disposable incontinence pads are required for people who do not respond to treatment of their continence ...
Body-worn disposable incontinence pads are required for people who do not respond to treatment of their continence problem or who are too ill or have a disability that prevents them from participating in treatment. Patients may also fail to respond to drug therapy or may have a type of incontinence that cannot be alleviated by other interventions (Newman, 2004).
DESIGN OF DISPOSABLE ABSORBENT PADS
The absorbent core takes in, distributes and holds liquid under pressure. It is made up of pulp fibres and super-absorbent polymer powder (SAP). An effective product will have a specific arrangement of pulp fibres to channel liquid away from the skin. Bending, squeezing and fluffing up a pad can disrupt the arrangement of fibres. Folding a pad lengthways is the only action needed to create a bowl shape for a better fit.
SAP is a white, granular powder that absorbs urine and holds it in a solid, rubbery state and prevents leakage (Buchholz and Peppas, 1994). SAP can absorb about 50 times its weight in urine. Pad manufacturers should provide capacities for each pad to identify how much urine products can hold.
PRODUCTS FOR LIGHT INCONTINENCE
Products for men
Anatomically shaped absorbent pads with a wider end at the front and a taped end at the back are available to manage problems such as post-micturition dribble. Adhesive strips enable the product to be worn in close-fitting underwear.
Products for women
Absorbent pads designed to fit into close-fitting underwear with an adhesive strip are suitable for the management of stress incontinence and come with different levels of absorbency.
Products for moderate/heavy incontinence
Most products in this group will have:
- An identified level of absorbency for each product;
- A system of colour coding to identify absorbency levels of different products;
- A wetness indicator that indicates when a pad has reached its maximum capacity.
Shaped pads (two-piece systems)
Shaped pads come in varying absorption levels and are adequate for day or night incontinence. Products must be worn with fixation pants. It is important to select the correct size by measuring the client's waist. If pants are too large leakage will occur and if they are too small the client will be uncomfortable and skin damage may occur.
To apply the pad and pants:
- Position the fixation pants above the knees;
- Fold the pant over on itself to create a working platform;
- Fold the pad in half lengthways;
- Slide the pad onto the working platform from the front of the user towards the back. This minimises cross-infection risk from the perineum to the groin;
- Pull up to the waist and ease the leg cuffs into the groin, like conventional briefs or Y-fronts. This ensures a close fit, better seal and more comfort and security for the user.
It is common to see fixation pants worn with the leg cuffs on the client's thighs causing skin marking that can lead to skin breakdown. The side seams of the pants should be on the outside (inside out) as seams can also cause marking.
Fixation pants can be washed up to 35 times at 70 degsC, however it is important to refer to individual manufacturer's guidelines and trust policy regarding laundering.
These can be used when laundry facilities are limited or patients have cognitive impairment and cannot manage a two-piece product.
All-in-one pads are usually elasticated around the leg to ensure a good fit in the groin. Gathers on the inside of the pad act as splashguards. These features help to reduce the risk of leakage of liquid stools.
Pants and belted products are recent developments. These are designed to look and feel like normal underwear and offer independence as they are easy to fit. Some modern products are 100% breathable, thereby allowing heat and vapour (sweat) out of the product but preventing air from getting into the product. This is beneficial for skin health.
A study by Brodersen (2002) reviewed the total economy of incontinence care when modern products are introduced. The quantitative outcomes confirmed that the use of modern products results in fewer incidents of leakage with a reduction of 34%, as opposed to using shaped and all-in-one products. A 7.6% decrease was also realised in the number of pad changes per day. A 13% decrease in the total cost of incontinence management with absorbent products was achieved, including costs related to product, time spent on leakages, changing and laundry.
Belted products. These products have a hip/waist belt that secures the absorbent product in position. They allow the hips to be exposed and are useful for people who have had hip surgery.
Pants. These are designed to look and feel like normal underwear for more independent users and as a retraining product for patients who may not cope with a two-piece system. The absorbent pad is incorporated into the product so some men with moderate to heavy incontinence find it more acceptable as a two-piece system is generally perceived to be 'feminine' (Pomfret, 1998).
Patients undergoing a course of rehabilitation after a stroke and those with behavioural difficulties who, in the past, may not have coped with shaped pads and fixation pants may benefit from this product.
Incontinence pads are designed to draw the urine away from the skin so that the skin is kept dry. SAP binds with the urine preventing air contact so that ammonia is not formed. However, if a pad has reached its maximum working capacity, is not in contact with the skin, or if the pores on the top sheet are blocked, this process of locking the urine away from the skin is disrupted.
Regular application of skin protectants for patients with incontinence is the standard of care for preventing perineal skin injury secondary to incontinence (Nix and Ermer-Seltun, 2004). Oil-based creams can be used frequently to help prevent skin damage and include petroleum ointments, zinc oxide creams and oils.
According to Hart (2002) petrolatum ointments transfer easily from the skin to the absorbent pad, thus compromising the absorbency of the pad and allowing the urine to stay in contact with the skin. The study indicated that when Calivon durable barrier cream was used 96% of the synthetic urine used in the trial was absorbed by the pad compared with 66% and 67% for Sudocrem and zinc and castor oil cream. However, Bolton (2004) found that when applied according to the manufacturer's instructions there appeared to be no significant differences in potential for different creams to clog the pores of the pad.
It is always advisable to use creams sparingly as instructed by most manufacturers and allow the creams to be absorbed before pad application. Do not use talcum powder as this also affects the performance of the top sheet.
As with every aspect of nursing practice, it is important to look closely at the evidence base, reflect on practice and act in the best interest of the patient.
Products should be stored at room temperature, in their plastic packaging. Products should not be stored in bathrooms or near direct heat, for example near radiators. Exposure to direct heat may lead to the pads drying out and becoming less effective. Exposing pads to a humid environment reduces their absorption capacity, as they absorb atmospheric moisture and retain it in the SAP granules.
It is important that health and social care professionals discuss continence issues with their clients and take positive steps to improve their symptoms and management. If disposable products are required, they should be chosen following a full product assessment.