Avoiding Pressure Sores
Posted on 9th January 2021 at 11:14
What is a pressure sore?
Pressure sores, also known as bed sores or pressure ulcers, are injuries to the skin and underlying tissue, usually over a bony part, as a result of pressure and other facts. The bony parts of the body include heels, elbows, hips and spine.
When you lie or sit down, you naturally shift your position from time to time, often without noticing and even when you are asleep. For those that are bed-bound or unable to move on their own, the weight of their body presses down on the skin in one place for a long time.
The other factors that contribute to pressure sores include shear, friction and moisture. Shear and friction can be caused by a patient sliding down a bed or by being pulled up in bed. Tissue damage can occur from relatively short periods of exposure to high pressure or longer periods of exposure to lower pressure. Pressure sores can take a long time to heal.
It is not completely understood how pressure causes tissue death. It is thought the main cause is ischemia, which is lack of blood and oxygen to the tissue, because of blockage of the blood vessels due to the pressure. The skin cells die and break down. There are various other causes that contribute to the death of tissue and pressure sores, such as the blockage of lymphatic flow and reperfusion injuries.
Who gets them?
They commonly affect people who are confined to bed through ill health for long periods of time or those in wheelchairs. Older people with limited mobility, or people with impaired sensation in their skin such as diabetics, are particularly at risk of pressure sores. Other people at risk include obese people, those with paralysis, having a poor diet, or those with medical conditions that make the skin more fragile.
How do I tell if I have a pressure sore or a member of my family has one?
Pressure damage ranges from small, superficial lesions (small wound) to extensive wounds causing severe disability and even death.
According to the NHS, early signs of a pressure ulcer include: -
A patch of skin changing colour. Pale-skinned people tend to develop red patches and those with darker skin will have a purple or blue patch.
The skin doesn’t “blanch”. If you press it does it turn white? Pressure ulcers do not turn white when pressed.
The patch of skin feels warm, hard or spongy.
The patch feels itchy or painful.
These are symptoms of what is known as a ‘category 1 pressure ulcer’.
Later symptoms of a pressure ulcer are: -
An open wound or a blister has developed (category 2 pressure ulcer).
A deeper wound, reaching deep through the layers of the skin (category 3 pressure ulcer).
A very deep wound that reaches muscle and may even expose bone (category 4 pressure ulcer).
Preventing Pressure Sores
A patient should have a comprehensive skin examination when they are admitted to hospital, particularly those with risk factors for pressure sores. They should then be regularly checked afterwards for early signs of pressure sores (as described above).
If in a hospital or care home, a healthcare professional will carry out a risk assessment and put in place preventative measures. If a patient is recovering from illness or from surgery at home, you can ask their GP for an assessment of the risk of developing sores.
Patients should be repositioned regularly. They should be assisted if they are unable to do this themselves.
If possible, the patient should be on a healthy, balanced diet with the right amount of protein, and lots of vitamins and minerals. It is important that a patient is kept well hydrated too – sips of water little and often are best but if a patient is unable to drink, they can be given fluids via a drip in their arm.
Smoking is also a risk factor for pressure sores. Smoking causes damage to your blood circulation and makes it more likely you will suffer a pressure sore.
Cancer Research UK has more information here, including some diagrams, to help with pressure sort prevention https://www.cancerresearchuk.org/about-cancer/coping/physically/skin-problems/pressure-sores/causes-and-prevention.
What if I or a family member already have a pressure sore?
If you notice any early skin changes or signs, you must immediately notify a healthcare professional e.g. a nurse or doctor if you are in hospital or your GP if you are at home.
Special dressings that help the healing process can be applied and will help to relieve further pressure. These include alginate dressings, hydrocolloid dressings or ones such as foam, films, gels and antimicrobial dressings.
To check how serious the pressure sore is, blood samples are usually taken to look for markers of infection and inflammation, and an MRI scan may be needed to check the depth and severity. The wound may need to be swabbed so the microbiology lab can check if there are any bacteria in the wound.
You or your family member will be repositioned more regularly to prevent the pressure sore from becoming worse.
A specially designed mattress or cushions can be used instead of a normal mattress. Some have a pump attached that can provide a constant flow of air.
Eating a healthy, balanced diet and drinking plenty of liquids.
You will be given advice on correct sitting and lying positions, how to adjust yourself (if you are able to), how best to relieve pressure on your heels with foot support, and any special equipment you may need and how to use it.
Your healthcare provider should provide effective pain relief whilst you or your family member are recovering from a pressure sore. Often simple painkillers such as paracetamol or ibuprofen are given, but you may be offered something stronger such as codeine or morphine if the pain is worsening. Pain-relieving creams can also be applied directly to the wound.
A procedure called a ‘debridement’ may be needed where damaged tissue is removed, and the wound cleaned.
Antibiotics may be needed if there is a serious infection such as blood poisoning (sepsis), an infection under the skin (cellulitis) or infection of the bone (osteomyelitis).
Surgery is reserved for the most serious cases. Damage tissue will need to be surgically removed and the wound closed. Reconstructive surgery may be needed if the wound was very large. However, surgery is not without risks. Your surgeon will discuss the risks beforehand with you, but some include the implanted skin dying, blood poisoning, infection of the bone (osteomyelitis), abscesses or a deep vein thrombosis.
My doctor or nurse says it’s not a pressure sore
Wounds or lesions are the skin are not always pressure ulcers. You should be carefully examined by a healthcare professional, and if necessary, sent for further investigative tests.
Other causes of wounds, that look like pressure sores, can be moisture-associated dermatitis, venous or arterial ulcers, diabetic neuropathy, pyoderma gangrenosum or osteomyelitis (an infection of the bone).
Will I fully recover?
If a pressure ulcer is recognised early and a patient is in relatively good health, as long they receive prompt treatment then the prognosis is good. However, the risk of a pressure sore occurring again is high and therefore these patients should be managed carefully in the future.
For patients with extensive and very deep ulcers, or that are seriously unwell or have other medical problems, then the outlook is poor. They may not be able to tolerate surgery required to close their wound. They may succumb to infection or a serious complication such as sepsis.
That is why it is so very important to identify those at risk of pressure sores and to put a careful management plan to prevent them in place.
My family member or myself have (or had) a pressure ulcer and I think my healthcare provider was negligent. Who can I speak to?
If you, or a family member, have suffered a pressure ulcer and you believe that your healthcare provider, such as the hospital or a GP, was negligent then you can talk to us in confidence.
We offer ‘no win, no fee’ meaning there is no financial risk to you. If you win you case, the other side pay your basic legal fees and if you lose, we do not charge a fee.
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