Pressure Injuries and Care

9 Nov, 2020

Pressure injuries – also known as bedsores and pressure ulcers – are localised injuries to the skin and underlying tissue resulting from prolonged pressure.

They develop over time as a result of shear or friction forces, or a combination of both. Pressure injuries typically develop on areas of skin that cover a bony prominence such as the tailbone, buttocks, hips, ankles or heels.

People who have reduced mobility, or spend long periods of time resting in bed or a wheelchair are at high risk of developing pressure injuries. They have several stages and can range from red, unbroken skin to a deep injury involving muscle and bone. Once developed, most pressure injuries can heal with effective treatment from a multidisciplinary team, including your doctor, occupational therapist and dietitian. 

Patient in bed

Risk Factors

  • Poor Mobility – The risk of developing a pressure injury is higher if you have difficulty moving and can’t change position easily while seated or in bed. 
  • Poor nutrition – Adequate fluid, protein and vitamins are needed to maintain healthy skin and prevent tissue breakdown.
  • Lack of sensation – Peripheral neuropathy, spinal cord injuries and other conditions can cause a decreased feeling or sensory perception, leading to an inability to feel pain and identify early warning signs.
  • Blood flow – Health conditions that affect blood flow, such as diabetes and vascular disease, can increase the risk of Pressure Injuries.
  • Incontinence – The use of continence pads can lead to skin breakdown if there is extended exposure to wetness or urine.

Act Fast!

If you begin to notice any of the following symptoms, please contact your doctor;

  1. Unusual changes in skin colour or texture
  2. Swelling
  3. Tenderness on bony areas
  4. Skin that feels warmer or cooler than the skin surrounding.

Your doctor will be able to prescribe the necessary medications to begin the healing process. 

Occupational Therapy for Pressure Injuries

While a doctor may treat the acute injury, an Occupational Therapist (OT) can help to employ long-term prevention strategies in the home to reduce the risk of wounds developing again. An OT can visit your home to discuss your concerns, conduct an environmental assessment and recommend the appropriate equipment. Here are some common equipment examples your OT may prescribe; however, there are many more!

Pressure-relieving Cushions

There are various types of pressure cushions, including foam, fluid, gel and alternating air cushions, and your OT will work to find to the best fit for you. Alternating air cushions work to minimise pressure as the person will be suspended on the air pockets and pressure is diffused across the surface evenly.

While in use, ensure nothing is covering the pressure cushion, i.e. towels, blankets, continence sheets. The cushion cover should be the outermost surface. Placing towels over the top increases shear and friction forces, increasing the risk of injury.

Pressure-relieving Mattress

Similar to cushions, pressure-relieving mattresses work by alternating air across different cells to distribute pressure evenly and minimise forces placed on bony surfaces. Your occupational therapist can arrange an equipment trial to help find the right bed to meet your individual needs.

Pressure-relieving cushion
Pressure-relieving mattress

Repositioning

Lastly, an Occupational Therapist can provide valuable education on repositioning strategies.

Change positions every 2 hours minimum. 
  • Effective repositioning can be achieved by altering the angle or tilt of an electric recliner, moving to a different seating option, i.e., wheelchair to a recliner or rolling from back to side when in bed. 
  • This allows blood to return to the skin surface, particularly on the buttocks when someone has been seated upright.
  • The best way to reposition is to stand for 3-5 minutes if you can. This should be done to break up long periods of sitting and promotes the return of blood to at-risk areas. 
  • When repositioning, please check the positioning of heels and other bony prominences. A reclining footrest should support ankles, and heels should hang off the end. When laying down, a heel wedge can be used to support the ankles and alleviate heel pressure.

Want more information on this? Please call 1300 122 884 and schedule an initial consultation with one of our experienced Occupational Therapists!


Written by Charlotte Thomson, Occupational Therapist Moreton Bay

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