How to Take Care of a Pressure Injury

In an ideal world, anyone at risk of developing a pressure injury (ulcer) would be using a dynamic support surface or other appropriate prevention tools.

However, the speed with which pressure injury can form often catch unsuspecting patients and/or caregivers unawares.

Do not feel guilty or incompetent should your loved one develop a pressure injury as this can happen in spite of your best efforts. Other complicating factors contribute that are often well beyond any caregivers control such as advanced age, incontinence, poor nutritional status including dehydration and certain medical conditions such as neuromuscular disorders, diabetes and cardiovascular disease.

Pressure injury can be healed but it is a challenging process that may require a team of individuals working together including patients, caregivers and medical staff.

Useful information about the patients’ general health should always be provided to your doctor or nurse, including conditions that could slow healing (such as diabetes); a list of current prescription and over-the-counter medicines; and who is available to help carry out the treatment plan if residing at home.

Treatment of pressure injury focuses on many of the same activities done to prevent them; for example, reducing or eliminating pressure from the injury/wound, and eating a nutritious diet that includes adequate calories, protein, vitamins and minerals in order to promote healing. Specific care for the ulcer includes cleaning the injury/wound and removing dead tissue, and applying a dressing or bandage to protect the area while it heals. Your health care provider should be consulted for specific instructions on diet, relieving pressure and changing positions safely, and for cleaning and dressing the injury.

Tips for caregivers

Keep in mind that pressure injury can be deadly serious, depending on how much skin and tissues have been damaged. You should always contact your doctor if you suspect a pressure injury is forming, to ensure the severity of the condition is assessed and appropriate treatment prescribed. Ideally, this will include the use of a pressure-reducing support surface such as an alternating mattress.

The tips below are not meant to replace medical advice, merely offer some guidance to caregivers when dealing with pressure injury outside of an institutional environment.

• While waiting for clinical assessment and/or an appropriate pressure reducing support surface, initiate an aggressive turning and pressure relief schedule doing everything possible to relieve the pressure that caused the injury, avoiding further trauma or friction. Powdering the sheets lightly can help decrease friction in bed.
• Prevent build-up of skin moisture where pressure exists in an attempt to prevent further skin breakdown of early Stage I injury.
• Institute all possible measures to improve nutrition, hydration and other conditions to help the injury heal.
• In general, do not use strong antiseptic agents for cleaning wounds, such as a Betadine, Dakins Solution, Hydrogen Peroxide, Acetic Acid and others. Older patients may heal slowly and these agents slow the healing process even further.
• Use skin barriers and other barrier ointments/lotions around the injury to help maintain it intact and prevent further breakdown as well as a barrier to irritating adhesive created by some dressing applications.
• Clean the injury/wound and keep free of dead tissue by rinsing the area with a salt-water solution or a special prescribed solution with every dressing change. The solution removes extra fluid and loose material. Your doctor or nurse will show you how to properly clean the pressure injury/wound.
• Sometimes doctors will suggest a method to remove dead tissue such as applying wet gauze bandages on the injury/wound and allowing them to dry with frequent changes. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. Other times he may order special dressings that are left in place for days to assist with debridement or surgical debridement may be necessary.
• Maintaining a moist environment is critical at Stage II and more advanced stages. After cleansing, if moderate to heavy draining injury/wound an alginate, hydrocolloid, foams or hydrofibers may be prescribed with waterproof dressing cover or cover with gauze.
• If the injury/wound is dry, hydrating the injury/wound bed with a hydrogel may be ordered with a secondary dressing to cover and keep the gel in wound bed. Frequency of dressing changes will depend on type of dressing prescribed and amount of drainage.
• Deep injury can go down into the muscle or even to the bone and if not treated properly can become infected. An infection in a pressure injury can be serious and spread to the rest of the body requiring immediate medical attention. Medical consultation for the appropriate treatment is required.
• Treatment for an infected injury/wound depends on how extensive the infection is. If only the injury/wound is infected, an antibiotic ointment may be prescribed to apply to the sore. When bone or deeper tissue is infected, IV antibiotics are often required.
• Controlling infection is crucial. Report any of the followings signs related to the injury:
  – thick yellow or green pus
  – foul smell from the injury/wound
  – redness and swelling around the injury/wound
  – tenderness and warmth around the injury/wound
• Since removing dead tissue and cleaning the injury/wound can be painful, ask your doctor to suggest a pain reliever to be taken 30 to 60 minutes before dressing changes.
• Report signs that the infection may have spread (systemic infection) including:
  – fever or chills
  – mental confusion
  – rapid heartbeat – weakness

As a pressure injury heals, it slowly gets smaller and has less drainage. New, healthy tissue starts growing initially at the bottom or base of the injury/wound. This new tissue is light red or pink and looks lumpy and shiny.

Remember persistence pays off when it comes to healing pressure injury/wound. It may take two to four weeks or more of treatment or longer before you see these signs of healing. Do not get discouraged and take one day at a time.