Top Tips for Pressure Ulcer Prevention from ABC Medical!

The latest advice and helpful tip from our resident Registered Nurse.

A pressure sore is any redness or break in the skin caused by too much pressure in one area for too long a period of time. The pressure prevents blood from getting to your skin, causing the skin to die. Normally, your nerves send messages of pain or feelings of discomfort to your brain to let you know that you need to change position, but damage to your spinal cord keeps these messages from reaching your brain.

In order to prevent pressure sores, do pressure reliefs (also called weight shifting, pressure redistribution and pressure reduction) on a regular basis.

• Pressure relief is moving or lifting yourself to take the pressure off areas that have been under pressure, usually from sitting or lying in one position, so blood can circulate.
• When sitting in your wheelchair you should do pressure reliefs every 15 to 30 minutes for a duration of at least 30 to 90 seconds. Continue to perform pressure reliefs when sitting in a car or on other surfaces.
• If you are unable to perform a pressure relief independently, instruct the person who helps you with your daily care (family, attendant) to consistently move you to reduce pressure over areas at risk for pressure sores.

Check your skin, or have your attendant or caregiver check your skin, a minimum of twice a day (morning and bedtime).  Look for changes in skin color (redness or darkening), blisters, bruises, cracked, scraped or dry skin. Feel for hardness, swelling or warmth, as these may signal skin breakdown. In some areas of the body, the bones are closer to the surface of the skin, causing increased pressure and risk for sores.

Below are some areas that the skin that is directly over bone and is at highest risk; check these areas very carefully:

Lower back

Tailbone

Heel of the foot

The base of the buttocks (“seat bones”)

Hip (from lying on side, something rubbing, or tight clothes)

Elbow (from leaning on it)

Knee (from spasms or side-lying with one knee on top of other)

Ankle (from lying on side)

Toes and bony areas of foot (from tight-fitting shoes)

Back of the head

Inspect areas of skin that are in contact with casts or braces twice daily.  Use a mirror to inspect skin in hard-to-see areas. Pay attention to fingernails and toenails: an ingrown toenail or cut along your nail bed may lead to a sore which can easily be infected.  As soon as you notice a discolored area, stay off the area until it returns to normal skin color.

Make sure you clean any areas in which you notice any discoloration, and keep all pressure off this area!  Wash with mild soap and water, rinse well, and gently pat dry.  Do not rub vigorously directly over the wound, as this will further irritate the skin.

If you do notice a pressure sore and if any of the following occur, you need to seek help:

• An increase in the size or drainage of the sore
• Increased redness around the sore or black areas starting to form
• The sore starts smelling and/or the drainage becomes a greenish color
• You develop a fever

If pressure sores continuously occur, you may need to make some adjustments in your day-to-day routine.  Reevaluate your diet and increase your daily exercise.  You may also need to see a doctor or physical therapist to get your seating adjusted, as sliding in a wheelchair that does not fit properly can lead to pressure sores.