Pressure damage usually occurs through bone protrusions, but can develop on any part of the body exposed to persistent local pressure. Anyone can have pressure ulcers, but the following things can make them more likely to form: Urinary catheters or rectal tubes may be needed to prevent bacterial infection of feces or urine. Pressure ulcers are invariably colonized by bacteria; However, cleaning wounds and debridement minimize the bacterial load. A study of topical antibiotics, such as silver sulfadiazine cream (Silvadene), should be used for up to two weeks to clean ulcers that do not heal properly after two to four weeks of optimal wound care. Quantitative cultures of bacterial tissue should be used for non-healing ulcers after an attempt to use topical antibiotics or if there are signs of infection (e.g., increased drainage, odor, surrounding erythema, pain, heat) are performed. A superficial swab sample may be used; However, needle aspiration or ulcer biopsy (preferably) is clinically more important.30 Systemic antibiotics are not recommended unless there are signs of progressive cellulitis, osteomyelitis, and bacteremia. Pain assessment should be carried out, especially when repositioning, dressing change and debridement. Patients at the highest risk of pressure ulcers may not have a full sensation or may need alternative pain assessment tools to support communication. The goal is to eliminate pain by covering the wound, adjusting pressure reduction surfaces, repositioning the patient, and performing topical or systemic analgesia. Small randomized controlled trials show that topical opioid (diamorphic rings; not available in the United States) and non-opioid (lidocaine/prilocaine [EMLA]) supplements reduce pain during dressing change and debridement.20,21 In people with reduced mobility, this type of pressure tends to occur in areas that are not well padded with muscle or fat and are above a bone. such as the spine, tailbone, shoulder blades, hips, heels and elbows.
A stitch in time saves nine; All patients at risk of pressure damage should be assessed and equipped with appropriate pressure reduction strategies. The use of support surfaces, repositioning the patient, optimizing the nutritional status and moisturizing the sacred skin are appropriate strategies to prevent bedsores. If you are recovering from an illness or surgery at home, or if you are caring for a bedridden person or wheelchair user, contact your GP if you think you or the person you are caring for may have a pressure ulcer. Ulcers are difficult to resolve. Although more than 70% of stage II ulcers heal after six months of proper treatment, only 50% of stage III ulcers and 30% of stage IV ulcers heal during this period. A surgical consultation should be requested for patients with stage III or IV clean ulcers that do not respond to optimal care or if the quality of life would be improved by a rapid closure of the wound. Surgical approaches include direct closure; Skin grafts; and the skin, musculo-cutaneous and free lobes. However, there is a lack of randomised controlled trials for surgical repair and recurrence rates are high. A more recent article on pressure ulcers is available.
Common pressure fluids are the skin above the sciatic tuberosity, sacrum, heels of the feet, above the head of the long bones of the foot, buttocks, above the shoulder and above the back of the head. [9] A 2015 Cochrane systematic review found that people lying on high-specification or high-density foam mattresses were 60% less likely to develop new bedsores than regular foam mattresses. Layerings of sheepskin on mattresses have also been found to prevent the formation of new bedsores. There are unclear studies on the effectiveness of alternating pressure mattresses. Pressure redistributive mattresses are used to reduce high pressure levels on prominent or bony areas of the body. Several important terms are used to describe how these support surfaces work. These terms have been standardized by the NPUAP`s Surface Standards Support Initiative. [37] Many support surfaces redistribute pressure by immersing and/or enveloping the body in the surface. Some support surfaces, including mattresses and anti-decubitus pillows, contain multiple inner tubes that are pumped alternately. [38] [39] Methods for standardizing products and evaluating the effectiveness of these products have only been developed in recent years as a result of S3I`s work within the NPUAP.
[40] For people with paralysis, regular pressure shifting and using a wheelchair cushion with pressure relief components can help prevent pressure sores. Pressure sores occur when pressure is applied to the soft tissues, resulting in complete or partial obstruction of blood flow to the soft tissues. Shearing is also a cause, as it can pull on the blood vessels that nourish the skin. Pressure ulcers most often develop in people who do not move, such as those who have chronic bed rest or who constantly use a wheelchair. It is generally believed that other factors can affect the skin`s tolerance to pressure and shear, thereby increasing the risk of developing pressure ulcers. These factors include protein-calorie malnutrition, microclimate (moisture in the skin due to sweating or incontinence), diseases that reduce blood flow to the skin, such as atherosclerosis, or diseases that reduce sensation in the skin, such as paralysis or neuropathy. The healing of pressure sores can be slowed down by the person`s age, medical conditions (such as atherosclerosis, diabetes or an infection), smoking, or medications such as anti-inflammatories. Learn more about treatments for pressure ulcers. Definitions of pressure ulcer levels are regularly reviewed by the National Pressure Injury Advisory Panel (NPUAP)[12] in the United States and the European Pressure Ulcer Advisory Panel (EPUAP) in Europe. [13] Different classification systems are used globally, depending on the health system, health discipline, and classification objective (e.g., health care versus prevalence studies versus funding).
14] In short, they are as follows:[15][16] There are many ways to stage ulcers of sacubitus decubitus. The most widely used classification system is the National Pressure Ulcer Advisory Panel (NPUAP) system. [3] It uses the depth of the ulcer to classify these ulcers. Pressure. Constant pressure on every part of your body can decrease blood flow to the tissues. Blood flow is essential to deliver oxygen and other nutrients to tissues. Without these essential nutrients, nearby skin and tissues are damaged and can eventually die. The most important care for a person at risk of pressure ulcers and people suffering from pressure ulcers is the redistribution of pressure, so that no pressure is exerted on the bedsores. [34] In the 1940s, Ludwig Guttmann introduced a program in which paraplegics could become paraplegic every two hours so that pressure ulcers could heal. Previously, these people had a life expectancy of two years, which usually succumbed to infections of the blood and skin. Guttmann had learned the technique through the work of Boston physician Donald Munro.
[35] Pressure reduction devices can reduce pressure or relieve pressure (i.e., reduce tissue pressure unless the capillary closure pressure of 32 mm Hg) and are classified as static (stationary) or dynamic.9 Static devices include foam, water, gel and air mattresses or mattress toppers. Dynamic devices, such as AC pressure vessels and surfaces with low air and air flow, use a power source to redistribute local pressure. Dynamic devices are usually noisy and more expensive than static devices. Pressure-reducing surfaces reduce the incidence of ulcers by 60% compared to conventional hospital mattresses, although there is no clear difference between pressure reduction devices.10,11 The advantages of dynamic surfaces over static surfaces are unclear.