(Pressure Ulcers; Bed Sores; Decubitus Ulcers)
|Pressure Sore (Skin Ulceration)|
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- Pressure—Pressure sores can result from the inability to change position or to feel discomfort caused by pressure. People with normal mobility and sensation change position automatically, without thinking.
- Friction—Even friction from pulling someone across bed sheets can damage small blood vessels that supply the skin tissue.
- Poor nutrition
- Moisture—This can come from sweating due to fever or leakage of urine or stool.
- Obesity —Extra weight increases pressure on the skin over the bones and joints.
- Immobility, such as being bed- or chair-bound
- Sensory loss
- Poor nutrition
- Low body weight
- Chronic or complex medical problems, such as:
- Bone fracture
- Swelling or water retention
- Dry skin
- Skin tissue that feels firm or boggy
- Local redness, warmth, tenderness, or swelling
- Reddish or purplish skin discoloration, often over a bony area
- Pain or itching of the skin
- Blistering, sores, skin breakdown, or drainage
- Wound culture
- Blood tests
- Avoid placing any weight or pressure on the wound.
- Change position at least every 2 hours, around the clock.
- Maintain good body alignment.
- Make sure bedclothes are clean and without wrinkles.
- If needed, use a special mattress.
- Clean the sore, remove dead tissue, and apply a dressing.
- Do not put anything else on the sore.
- Wash hands before and after performing wound care. Wear disposable gloves.
- Clean the wound every time the bandage is changed.
- You may need to take pain medication a half hour or hour before dressing changes.
Surgery and Other Procedures
Follow these tips when repositioning:
- Change position in bed at least every 2 hours or, in a wheelchair, at least hourly. If you are able to move yourself, shift position every 15 minutes.
- Maintain good body alignment.
- Talk to your doctor about whether you should elevate the head of your bed.
- Find a sitting or lying position that is 30° toward one side or the other, but not squarely on the hip.
- Place a pillow under your calves to keep the heels off the mattress.
- Place a pillow between the knees.
- Do not use donut-ring cushions, which can cut off circulation.
Talk to the doctor about using:
- A special foam mattress designed to reduce the risk of pressure sores
- A mechanical mattress or overlay that inflates and deflates to change the pressure on the body
- Sheepskin overlay
- Use a special cushion for a wheelchair.
- Wear special pads to protect skin that is resting against braces and other devices.
- Keep the skin clean and dry.
- Do not massage bony areas.
- If incontinent, use a protective cream on skin that may come in contact with urine or stool. Do not let stool or urine remain for extended periods of time.
- Check the skin at least daily for signs of pressure problems.
- Keep sheets clean and free of wrinkles.
- Maintain good nutrition.
Family Doctor—American Academy of Family Physicians http://familydoctor.org
National Pressure Ulcer Advisory Panel http://www.npuap.org
Health Canada http://www.hc-sc.gc.ca
The College of Family Physicians of Canada http://www.cfpc.ca
Pressure ulcer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2015. Accessed January 12, 2015.
Pressure ulcer category/staging illustrations. National Pressure Ulcer Advisory Panel website. Available at: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-ulcer-categorystaging-illustrations/. Accessed January 12, 2015.
5/27/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4):CD001735.
11/25/2013 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2013 Aug 18;8.
8/11/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Chen C, Hou WH, et al. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev. 2014;7:CD009224.
6/22/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qaseem A, Mir TP, et al. Clinical Guidelines of the American College of Physicians. Risk assessment and prevention of pressure ulcers; a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015 Mar 3;162(5):359-69.
- Reviewer: Peter Lucas, MD
- Review Date: 01/2015 -
- Update Date: 06/22/2015 -
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
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