Bedsores

Introduction

Pressure injuries, previously called pressure ulcers, result from local trauma to the skin and/or underlying tissues, usually over a bony prominence, due to pressure with shear or friction or unrelieved pressure.

  • They generally affect patients with limited mobility and more common in patients aged >65-70.

They often develop gradually, but can sometimes form in as little as 4-6 hours.

Bedsores

NOTE: Skin damage in the sacral region can also be caused by incontinence-associated dermatitis, but this is not classified as a pressure injury.



Risk Factors

In high-risk populations, multiple additional risk factors appear to increase the likelihood of developing a pressure ulcer, including

  • Poor nutrition
  • Comorbid conditions, such as diabetes mellitus and peripheral arterial disease (PAD), immunodeficiency or the use of corticosteroid therapy
  • Excess skin moisture, as occurs with bowel and/or bladder incontinence
  • Smoking
  • Any prior pressure ulcer increases the risks for additional ulcers.



Staging

The most commonly used system is from the National Pressure Injury Advisory Panel (NPIAP).

Pressure Ulcer Staging System



Management

Ensure an adequate management of comorbidities such as

Providing good nutrition

  • Optimizing both protein and total caloric intake.
  • Vitamin C and zinc supplementation are commonly used to promote healing, but their efficacy has not been conclusively demonstrated

Providing pressure redistribution with proper positioning and support surfaces.

  • Turning and repositioning every 2 hours.
  • Sitting upright and straight in a wheelchair, changing position every 15 minutes.
  • Providing soft padding in wheelchairs and beds to reduce pressure.
  • Features of a support surface that may assist in prevention include
    • Air fluidized - Provides pressure redistribution through a fluid-like medium created by forcing air through beads
    • Alternating pressure - Provides pressure redistribution via cyclic changes in loading and unloading
    • Lateral rotation - Provides rotation about a longitudinal axis
    • Low air loss - Provides a flow of air to assist in managing the heat and humidity of the skin
    • Multizoned - Different segments of the support surface have different pressure redistribution characteristics
  • Do not use doughnut cushions, as they can focus pressure on surrounding tissue.

Provide appropriate local wound care

  • Clean the wound with water or normal and consider topical antiseptics if wound is not improving.
  • Debride the ulcer if there is any necrotic tissue.
  • Consider pain management for symptoms and during dressing changes (e.g. oral analgesics or topical local anaesthetics).

Consider surgical repair if

  • the patient has a stage 3 or 4 pressure injury
  • the pressure injury is not improving with all other managements
  • more rapid closure is required

As prevention, remember to inspect the skin for areas of redness every day with particular attention to bony areas and to keep the skin clean and dry.



Summary

Pressure injuries are a frequent problem for patients in hospital and residential aged-care facilities.

  • The main management strategy involves off-loading, dressings, improving nutrition if necessary, and the use of pressure-reducing surfaces on beds and chairs.



External Links

Comments

Post a Comment