Pressure Care

Some Guidance , Advice and Tips

The most important factor with Pressure Care is to try and prevent problems from occurring in the first place. Most Health care settings now have strict guidelines aimed at preventing pressure ulcers from developing. 

If a pressure ulcer has developed special equipment (for example, an alternating pressure mattress or cushion) or wound dressing will be required. Don't forget that lying in bed spreads the load (except for heels)

Do not rub the affected area as this may cause further tissue damage. Inflatable and material ring-shaped cushions should never be used as they may further restrict the supply of oxygen to the affected area.

If the sore has become infected, further treatment by a Nurse or Doctor may be required. This will be specific to the grade, type and location of the ulcer and may be accompanied by irrigation of the wound with a salt-water wash.

Pressure Care is Important

Pressure ulcers tend to develop on bony prominences and on areas of the body that have little body fat to cover them. This includes the hips, buttocks, heels, shoulder blades and the small of the back. 

Sitting in a chair or wheelchair for long periods of time, without pressure being relieved, is even more likely to cause pressure ulcer development.

Pressure ulceration occurs when the skin and underlying tissues are compressed for a period of time, between the bone and the surface, on which the patient is sitting or lying.

Blood cannot circulate causing a lack of oxygen and nutrients to the tissue cells. Furthermore, the lymphatic system cannot function properly to remove waste products. 

If the pressure continues, the cells die and the area of dead tissue that results is called pressure damage. 

The amount of time this takes will vary, but may develop in as little as one hour in patients at greatest risk.

Aetiology of Pressure Sores

The factors causing pressure ulcers are divided into 2 Groups

INTRINSIC - Disease, medication, malnourishment, age, dehydration/fluid status, lack of mobility, incontinence, skin condition, weight.

EXTRINSIC – External influences which cause skin distortion – 
Pressure, Shearing Forces, Friction, Moisture.


Pressure

The blood pressure at the arterial end of the capillaries is approximately 32 mmHg, while at the venous end this drops to10 mmHg. 

The average mean capillary pressure equals about 17 mm Hg and any external pressures exceeding this will cause capillary obstruction. 

Tissues that are dependent on these capillaries are deprived of their blood supply. Eventually the ischaemic tissues will die. 


Shearing Forces

Shearing forces will only exist if pressure, usually caused by the persons own body weight, is also present. Shear forces occur when a part of the body tries to move but the surface of the skin remains fixed. (See Waterlow Manual for a better understanding of this phenomenon).

Friction

Friction forces occur when the shearing force increases sufficiently to overcome the bodies resistance to movement. The movement has an abrasive action.(See Waterlow Manual for a better understanding of this action).


Moisture

Skin should not be left wet as moist skin sticks to material (e.g. bathing, perspiration, incontinence (as urine and faeces are acidic), amniotic fluid) as it can become macerated making it more susceptible to shear and friction.

Certain areas of the body are more vulnerable to pressure ulcer formation than others.

Bony prominences in particular : heels, sacrum, buttocks, hips , elbows etc

Some groups of people are at greater risk from pressure ulcers than others. 

Immobility for any reason contributes to the risk of pressure sore, therefore the elderly, wheelchair users and patients who are bed-ridden are most at risk. 

People living with incontinence especially women may also develop pressure ulcers, as prolonged exposure to moisture can cause breakdown of skin tissue.

Many other conditions such as diabetes and arterial diseasecan also increase the risk of pressure ulcers as the supply of blood and oxygen to body tissue may be restricted.

In order to prevent pressure ulcers developing, it is important that those who are immobile have pressure relieved frequently either by manual turning or sophisticated bed systems. However even if a patient is lying on a bed system risk areas still require regular inspection.

This may need to be more frequent if sitting. A healthy balanced diet and plenty of fluids will also help the condition of the skin.
Those at higher risk of pressure ulcers, such as the elderly and those with existing medical conditions should keep as active and mobile as possible, taking some form of exercise every day. 

It is advisable to take part in exercise that uses a range of motions.


Also important is keeping the skin clean and dry, and checking that bed linen is free from wrinkles.