Derm

Decubitus Ulcer Prevention

search

Decubitus Ulcer Prevention, Pressure Sore Prevention, Pressure Sore Positioning

  • Indications
  1. See Decubitus Ulcer for Risk Factors
  • Prevention
  • General Measures
  1. Frequent patient repositioning (every 2 hours)
    1. Pressure Ulcers may develop within 2-4 hours
  2. Daily skin care (apply topical moisture barriers)
  3. Reduce excessive moisture exposure
  4. Correct Malnutrition
    1. Avoid Feeding Tubes (decrease mobility further, as well as other complications)
  • Prevention
  • Tissue loads while supine
  1. Positioning in bed
    1. Avoid positioning patient on ulcer
    2. Use positioning device to keep ulcer off surface
    3. Avoid donut-type devices (may cause ulcers)
    4. Written repositioning schedules every 2 hours
      1. Often more frequent than 2 hour turning is required
  2. Prevention for patients at risk
    1. Avoid positioning immobile patients on trochanters
    2. Use pillows and foam wedges
      1. Relieve heel pressure
      2. Relieve bony prominence pressure (knee and ankle)
      3. Sheepskin does not relieve pressure
    3. Maintain head of bed at lowest appropriate level
      1. Limit time head of bed is elevated
      2. Higher head of bed causes patient to slide down
        1. Sliding leads to shear forces
        2. Sacral ulcers may result
  • Prevention
  • Tissue loads while sitting
  1. Avoid pressure on ulcer while sitting
  2. Properly position
    1. Consider patient weight
    2. Consider balance
    3. Consider patient stability
  3. Reposition so pressure points shifted once per hour
    1. Return to bed if this schedule can not be met
    2. Attempt to teach patient to shift weight every 15 min
  4. Appropriate seat cushion (avoid donut-types)
  5. Wheelchair related Pressure Ulcers
    1. Consider wheelchair mapping (computerized pressure readings) at wheelchair clinic
  • Prevention
  • Bed Types
  1. Static Surfaces
    1. Surface types
      1. Mattress
      2. Foam
      3. Static floatation
    2. Indications
      1. Patient in many positions without loading ulcer
      2. No bottoming out of patient
      3. Fully compresses surface to <1" at injury site
  2. Dynamic Surfaces
    1. Surface types
      1. Air-fluid (costs $100 per day)
      2. Low-air (costs $65 per day)
      3. Alternate air
    2. Indications for all dynamic surfaces
      1. Stage 3 or 4 Decubitus Ulcers
      2. Conditions not met for static surface bed
      3. Pressure Ulcer not healing by 2 to 4 weeks
    3. Additional indications for air-fluid or low-air bed
      1. Large Stage 3 to 4 Ulcers
      2. Ulcers on multiple turning surfaces
      3. Ulcer fails to heal on dynamic overlay
  • References
  1. Habif (1996) Clinical Derm, Mosby, p. 810-13
  2. Krasner (1995) Prevention Management Pressure Ulcers
  3. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
  4. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
  5. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
  6. Way (1991) Current Surgical, Lange, p.95-108
  7. Bello (2000) JAMA 283(6): 716-8 [PubMed]
  8. Degreef (1998) Dermatol Clin 16(2): 365-75 [PubMed]
  9. Findlay (1996) Am Fam Physician 54(5): 1519-28 [PubMed]
  10. Knapp (1999) Pediatr Clin North Am 46(6):1201-13 [PubMed]
  11. Raetz (2015) Am Fam Physician 92(10): 888-94 [PubMed]
  12. (1995) Am Fam Physician 51(5):1207-22 [PubMed]