According to the National Pressure Ulcer Advisory Panel meeting of 2016, “a pressure injury occurs when there is localized skin and soft tissue damage, usually over a bony prominence or from another device such as a shoe or bed.” The injury can present as intact skin or an open ulcer and may or may not be painful. The injury occurs as the result of continued pressure or shear forces, or a combination of the two. The tolerance of the tissue to shear and pressure may also be affected by nutrition, perfusion, co-morbidities and the condition of the tissue itself.
Tips to prevent ulceration and skin injury include:
- Inspect skin daily for changes and signs of redness, swelling, pain that may indicate infection or breakdown.
- Avoid pressure points on the body of the heels, ankles, buttocks, elbows and bony areas.
- Change position in bed at least 3 times per hour.
- Keep the skin clean, dry and healthy.
- Use cream or lotion to protect dry skin under the direction of a healthcare provider.
- Eat a balanced healthy diet and drink adequate fluids.
- Do not massage warm or red tender areas.
- Notify your healthcare provider without delay if you notice red, tender areas, open wounds, ulcerations or skin changes.
- Use pressure off-loading devices for heels.
- Use pressure redistribution devices for chairs and beds to prevent ulcerations.
FAQ
Pressure ulcerations can vary greatly in appearance depending on their stage. In the early stages they can appear like a thick callus or dried blood and when more advanced can go all the way through the skin down to deeper layers and become more serious. In the more serious stages, they may look black or brown having a leather appearance. Regardless of appearance, immediate medical attention is recommended to avoid serious complications.
Pressure ulcerations can be caused by not moving but also anytime the force on the skin creates a constant pressure that exceeds the limit of the skin.
The skin may look bruised, thin, red, or thickened. Immediate medical attention should be sought regardless of appearance to prevent it from worsening. Pressure ulceration in the foot or ankle can lead to amputation of the leg and is a serious event.
A vital key to preventing pressure ulcers is the concept of moving and changing position. Alternating sides as well as changing position from laying down supine or being seated. Additionally, modifying the way in which we sit and finding variations of the seated position or laying position to change pressure points. Evaluate the environment for surfaces such as air fluid mattresses and foam surfaces to remove pressure points. Offloading with devices such as heel protectors and pillows is a good idea too.
