I. Pressure Relief

Pressure sores form when there is constant pressure on certain parts of the body. Long periods of unrelieved pressure cause or worsen pressure sores and slow healing once a sore has formed. Taking pressure off the sore is the first step toward healing.

Pressure sores usually form on parts of the body over bony prominences (such as hips and heels) that bear weight when you sit or lie down for a long time.

You can relieve or reduce pressure by:

• Using special surfaces to support your body.
• Putting your body in certain positions.
• Changing positions often.

Support surfaces

Support surfaces are special beds, mattresses, mattress overlays, or seat cushions that support your body in bed or in a chair. These surfaces reduce or relieve pressure. By relieving pressure, you can help pressure sores heal and prevent new ones from forming.

You can get different kinds of support surfaces. The best kind depends on your general health, if you are able to change positions, your body build, and the condition of your sore. You and your doctor or nurse can choose the surface best for you.

One way to see if a support surface reduces pressure enough is for the caregiver to do a "hand check" under the person. The caregiver places his or her hand under the support surface, beneath the pressure point, with the palm up and fingers flat. If there is less than 1 inch of support surface between the pressure point of the body and the caregiver's hand, the surface does not give enough support. If you need more support, your doctor or nurse will recommend a different support surface.

Caregivers should know that pressure sores are often painful, and a hand check may increase pain. Caregivers should ask if it will be okay to do a hand check, which should be done as gently as possible. top link

Good body positions

Your position is important to relieving pressure on the sore and preventing new ones. You need to switch positions whether you are in a bed or a chair.

In bed. Follow these guidelines:

• Do not lie on the pressure sore. Use foam pads or pillows to relieve pressure on the sore,.
• Change position at least every 2 hours.
• Do not rest directly on your hip bone when lying on your side. A 30-degree side-lying position is best.
• When lying on your back, keep your heels up off the bed by placing a thin foam pad or pillow under your legs from midcalf to ankle. The pad or pillow should raise the heels just enough so a piece of paper can be passed between them and the bed. Do not place the pad or pillow directly under the knee when on your back, because this could reduce blood flow to your lower leg.
• Do not use donut-shaped (ring) cushions-they reduce blood flow to tissue.
• Use pillows or small foam pads to keep knees and ankles from touching each other.
• Raise the head of the bed as little as possible. Raise it no more than 30 degrees from horizontal. If you have other health problems (such as respiratory ailments) that are improved by sitting up, ask your doctor or nurse which positions are best.
• Use the upright position during meals to prevent choking. The head of the bed can be moved back to a lying or semi-reclining position 1 hour after eating.

In a chair or wheelchair. When sitting, you should have good posture and be able to keep upright in the chair or wheelchair. A good position will allow you to move more easily and help prevent new sores.

For your specific needs, use cushions designed to relieve pressure on sitting surfaces. Even if pressure can be relieved with cushions, your position should be changed every hour. Remember to:

• Avoid sitting directly on the pressure sore.
• Keep the top of your thighs horizontal and your ankles in a comfortable, "neutral" position on the floor or footrest. Rest your elbows, forearms, and wrists on arm supports.
• If you cannot move yourself, have someone help you change your position at least every hour. If you can move yourself, shifting your weight every 15 minutes is even better.
• If your position in a chair cannot be changed, have someone help you back to bed so you can change position.
• Do not use donut-shaped or ring cushions, because they reduce blood flow to tissue.

Changing positions

Change your body position often-at least every hour while seated in a chair and at least every 2 hours while lying in bed. A written turning schedule or a turn clock (with positions written next to times) may help you and your caregiver remember turning times and positions. You may want to set a kitchen timer.

Be sure your plan works for you. It should consider your skin's condition, personal needs and preferences, and your comfort level.top link

II. Pressure Sore Care

The second principle of healing is proper care of the sore. The three aspects of care are:

• Cleaning.
• Removing dead tissue and debris (debridement).
• Dressing (bandaging) the pressure sore.

You should know about sore care even if only your caregiver is caring for the sore. Knowing about your care will help you make informed decisions about it.

1. Cleaning

Pressure sores heal best when they are clean. They should be free of dead tissue (which may look like a scab), excess fluid draining from the sore, and other debris. If not, healing can be slowed, and infection can result.

A health care professional will show you and your caregiver how to clean and/or rinse the pressure sore. Clean the sore each time dressings are changed.

Cleaning usually involves rinsing or "irrigating" the sore. Loose material may also be gently wiped away with a gauze pad. It is important to use the right equipment and methods for cleaning the sore. Tissue that is healing can be hurt if too much force is used when rinsing. Cleaning may be ineffective if too little force is used.

Use only cleaning solutions recommended by a health care professional. Usually saline is best for rinsing the pressure sore. Saline can be bought at a drug store or made at home.

Caution: Sometimes water supplies become contaminated. If the health department warns against drinking the water, use saline from the drug store or use bottled water to make saline for cleaning sores.

Do not use antiseptics such as hydrogen peroxide or iodine. They can damage sensitive tissue and prevent healing.

Cleansing methods are usually effective in keeping sores clean. However, in some cases, other methods will be needed to remove dead tissue.

2. Removing dead tissue and debris

Dead tissue in the pressure sore can delay healing and lead to infection. Removing dead tissue is often painful. You may want to take pain-relieving medicine 30 to 60 minutes before these procedures.

Under supervision of health care professionals, dead tissue and debris can be removed in several ways:

• Rinsing (to wash away loose debris).
• Wet-to-dry dressings. In this special method, wet dressings are put on and allowed to dry. Dead tissue and debris are pulled off when the dry dressing is taken off. This method is only used to remove dead tissue; it is never used on a clean wound.
• Enzyme medications to dissolve dead tissue only.
• Special dressings left in place for several days help the body's natural enzymes dissolve dead tissue slowly. This method should not be used if the sore is infected. With infected sores, a faster method for removing dead tissue and debris should be used.

Qualified health care professionals may use surgical instruments to cut away dead tissue.

Based on the person's general health and the condition of the sore, the doctor or nurse will recommend the best method for removing dead tissue.

3. Choosing and using dressings

Choosing the right dressings is important to pressure sore care. The doctor or nurse will consider the location and condition of the pressure sore when recommending dressings.

The most common dressings are gauze (moistened with saline), film (see-through), and hydrocolloid (moisture- and oxygen-retaining) dressings. Gauze dressings must be moistened often with saline and changed at least daily. If they are not kept moist, new tissue will be pulled off when the dressing is removed.

Unless the sore is infected, film or hydrocolloid dressings can be left on for several days to keep in the sore's natural moisture.

The choice of dressing is based on:

• The type of material that will best aid healing.
• How often dressings will need to be changed.

Whether the sore is infected.

In general, the dressing should keep the sore moist and the surrounding skin dry. As the sore heals, a different type of dressing may be needed.

4. Storing and caring for dressings

Clean (rather than sterile) dressings usually can be used, if they are kept clean and dry. There is no evidence that using sterile dressings is better than using clean dressings. However, contamination between patients can occur in hospitals and nursing homes. When clean dressings are used in institutions, procedures that prevent cross-contamination should be followed carefully.

At home, clean dressings may also be used. Carefully follow the methods given below on how to store, care for, and change dressings.

To keep dressings clean and dry:

• Store dressings in their original packages (or in other protective, closed plastic packages) in a clean, dry place.
• Wash hands with soap and water before touching clean dressings.
• Take dressings from the box only when they will be used.
• Do not touch the packaged dressing once the sore has been touched.
• Discard the entire package if any dressings become wet or dirty.

5. Changing dressings

Ask your doctor or nurse to show how to remove dressings and put on new ones. If possible, he or she should watch you change the dressings at least once. Ask for written instructions if you need them. Discuss any problems or questions about changing dressings with the doctor or nurse.

Wash your hands with soap and water before and after each dressing change. Use each dressing only once. You should check to be sure the dressing stays in place when changing positions. After the used dressing is removed, it must be disposed of safely to prevent spread of germs that may be on dressings.

Using plastic bags for removal. A small plastic bag (such as a sandwich bag) can be used to lift the dressing off the pressure sore. Seal the bag before throwing it away. If you use gloves, throw them away after each use.

III. Good Nutrition

Good nutrition is the third principle of healing. Eating a balanced diet will help your pressure sore heal and prevent new sores from forming.

You and your doctor, dietitian, or nurse should review any other medical conditions you have (such as diabetes or kidney problems) before designing a special diet.

Weigh yourself weekly. If you find you cannot eat enough food to maintain your weight or if you notice a sudden increase or decrease, you may need a special diet and vitamin supplements. You may need extra calories as part of a well-balanced diet.

Tell your doctor or nurse about any weight change. An unplanned weight gain or loss of 10 pounds or more in 6 months should be looked into.

Information provided by National Library of Medicine (NLM).

Alternating pressure mattress / low air loss mattress for prevention / treatment of pressure sores.

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