Stop the Pressure – November 15th 2018

If you’ve ever noticed that sitting in the same position gets uncomfortable over time, you’ll have changed position with hardly a conscious thought, moved your limbs, stood up, straightened your clothes, scratched an itch, rubbed a muscle, wiggled your toes and settled down again.

Now, imagine if you couldn’t do these things.

Imagine if the ability to make these simple and subtle adjustments was taken away.
If you’re unable to move or adjust your position then it’s highly likely that you will be at risk of a pressure injury.
Without the luxury of postural or positional adjustment, constant pressure is applied to your skin modifying the flow of blood to the cells. And without adequate blood flow, your skin and the tissue beneath can die; the resulting wound is a pressure injury.

Pressure ulcers cause patients long term pain and distress. If you're a healthcare professional, please take a look at this two minute animation, which might be full of surprises and practical help for you and your colleagues.

Causes:

Pressure injuries are caused by pressure against the skin that limits blood flow to the skin. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.

Some contributing factors for pressure injuries are:

• Pressure

Constant pressure on any part of your body can lessen the blood flow to tissues. Blood flow is essential to delivering oxygen and other nutrients to tissues. Without these essential nutrients, skin and nearby tissues are damaged and might eventually die.

For people with limited mobility, this kind of pressure tends to happen in areas that aren't well-padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.

• Friction

Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.

• Shear

Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the coccyx moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.

• Moisture

Failure to effectively wash and dry skin can be another cause of pressure sores, and so it is important to ensure you find an appropriate soap that is gentle on your skin. When washing, pay special attention to the folds of the skin where moisture can collect. Drying is just as important, because if the skin is left wet, as mentioned above, it can become sore, infected, and quickly broken down.

Risk Factors

If you have difficulty in mobility and find it difficult to change your position whilst sitting or lying then you are at risk of these injuries. Other factors include;

• Immobility. This might be due to poor health, spinal cord injury and other causes.
• Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
• Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
• Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.

Other complications

Common sites of pressure sores

The areas at most risk will change depending on whether you are sitting or lying

For people who use a wheelchair, pressure sores often occur on skin over the following sites:

• Coccyx or buttocks
• Shoulder blades and spine
• Backs of arms and legs where they rest against the chair

For people who are confined to a bed, common sites include the following:

• Back or sides of the head
• Shoulder blades
• Hip, lower back or coccyx
• Heels, ankles and skin behind the knees

Symptoms

Some warning signs of pressure ulcers are:

• Unusual changes in skin colour or texture
• Swelling
• Pus-like draining
• An area of skin that feels cooler or warmer to the touch than other areas
• Tender areas

Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from red, unbroken skin to a deep injury involving muscle and bone.

Stage 1

Stage 2

Stage 3

Stage 4

Thanks to:

http://www.npuap.org/

https://www.spinalcord.com/pressure-sores-after-sci

https://www.sci-info-pages.com/pressure-sores.html

https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893

https://www.nhs.uk/conditions/pressure-sores/

https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/pressure-ulcers