Learn about pressure injuries, and how to manage and treat them... there is more to know!
Have you ever heard of a pressure injury? Have you ever wondered how they occur? Or how you might treat one?
Pressure injuries are very complex and unique to each individual due to the many contributing factors that play a part in their development, treatment, and prevention. This blog post aims to give a basic overview of some key details to help you make informed choices to help care for yourself, your loved ones, or your clients, when it comes to pressure injuries.
A pressure injury is ‘localised damage to skin/underlying tissue as a result of pressure and/or shear’. A pressure injury develops where circulation of blood has been restricted, causing tissue death. They most commonly develop on bony prominences of the body such as on a persons bottom (ischial tuberosities – sit bones), heels, elbows, and hips.
One of the biggest risk factors for developing a pressure injury is impaired mobility. As our mobility decreases, the pressure on certain areas of our body increases as we are not moving around, encouraging blood flow, and reducing pressure.
As we age our risk of pressure injuries increases for several reasons including decreased mobility and decreased elasticity and thickness of the skin making it more susceptible to injury. Our skin also takes longer to heal as we get older.
This is not to say younger persons do not develop pressure injuries! There are many contributing factors that play a part in pressure injuries and their development. Some examples are listed below.
Extrinsic Factors (external to the person):
Microclimate: Higher temperature and humidity.
Friction: One object rubbing on another, for example, clothing rubbing against skin.
Shear: One object rubbing on another with pressure, for example, sliding down the mattress as the head end of the bed is raised.
Pressure: This could include; downward pressure from gravity, upward pressure from the seated surface, horizontal pressure from other objects such as a back rest or arm rest.
Intrinsic Factors (individual to the person):
Mobility: Reduced mobility makes it harder to adjust pressure as needed for example, changing seated position, or getting up to move regularly.
Nutrition: Poor nutrition can lead to decreased ability of the skin to heal.
Medical conditions: May include symptoms such as decreased blood flow, decreased sense of feeling and more.
Incontinence: Wearing continence aids can reduce the ability of a person to sink into the pressure relieving surface, such as a foam mattress. Incontinence increases the temperature and moisture on the skin, which can increase the risk of skin breakdown.
These complexities are why each pressure injury must be treated uniquely to ensure the needs of the individual are met, and to give the best treatment and prevention recommendations possible.
The best cure is prevention! If your client or loved one is at risk of developing a pressure injury, or has a current pressure injury, then there are changes that need to be implemented to help them!
The first step is to engage a wound care professional to assess the pressure injury, or risk of pressure injury, and create a treatment plan. Pressure injury injuries are classified in four stages depending on their severity. A wound specialist, such as a specially trained nurse, will be able to identify the stage of pressure injury and start treatment involving a broader multidisciplinary team, including Occupational Therapists.
Pressure relieving surfaces:
Pressure relieving surfaces help to redistribute pressure to allow weight to be evenly dispersed over a larger surface area (reducing pressure) or offloading weight from desired areas (removing pressure).
Common pressure relieving surfaces are cushions or mattresses. There are a multitude of options available when it comes to pressure relieving surfaces and it can become quite confusing! Remember to individualise the treatment to the person to get the best fit.
Here are some considerations when choosing a pressure relieving surface:
Foam: There are many different types of foam available to create different levels of immersion (how well you sink into the material).
Gel: May need to be manipulated before each use to ensure the gel is evenly spread as it will remain in its previous position if not moved.
Air: Air cushions and mattresses can be punctured easily, consider this if your client or loved one has a pet that likes to sit with them, or if they are a smoker.
Air mattresses cycle air from the surrounding room, therefore they can be quite cold to lie on. You cannot add a rug between the mattress and person as this will reduce their ability to sink into the mattress, thus not providing pressure relief.
Air mattresses can be static, meaning they stay at the same level of inflation; Or alternating, where after a set period different sections of the mattress deflate allowing pressure to be completely removed from that area until it re-inflates, and another section deflates.
If the pressure relieving surface has a cover on it, ensure it is made of four-way stretch fabric so that it is not reducing the person’s ability to sink into the surface and hence its pressure relieving qualities. This is also important to consider in relation to continence aids such as a kylie sheet, as this will block the mattress or cushion from providing pressure relief.
Consider all extrinsic and intrinsic risk factors to see if there are any changes possible to help reduce them. For example; do they have a medical condition or disability where they cannot feel that there is pressure on their seated area? Do they need to be taught to adjust their position regularly to help reduce pressure?
Consider all places a person might contact another surface in the area of their pressure injury throughout the day. For example, if the pressure injury is on their bottom, consider their lounge chair, bed, toilet, and car seat, if it is on the heels of their feet consider their shoes, where their feet rest in bed or when sitting in their chair.
Movement:
Ideally it is best to offload pressure from the pressure injury as this allows maximum blood flow and no pressure. This may only be achievable for some body parts such as elbows. However, pressure injuries are often in places that are in contact with another surface for long periods of time, such as the bottom, so they are not always able to be offloaded.
If the person is able, encourage them to offload the pressure for 2 minutes for every 30 minutes they have had pressure on the area. This is to allow blood flow to return. This is a general guide and may not be suitable in all cases. Time for offloading must be considered on an individual basis.
If the person is unable to completely offload the area, encourage regular movement shifts to help partially offload. For example, leaning to the side for a few minutes, or using tilt in space to shift the pressure slightly.
Pressure injuries are very complex and unique to each individual case. Engage a health care team to help you work through the different options for prevention and treatment of pressure injuries such as pressure relieving equipment, adapting daily tasks and review of risk factors.
Aidacare. (2021, November 5). 'The Science of Assistive Technology for Pressure Care' [Training Course]. Aidacare Professional Training. Adelaide, South Australia, Australia.
Aidacare. (2023, September 14). 'Exploring Mattress Solutions for Pressure Care'. [Training Course]. Aidacare Professional Training. Adelaide, SA, Australia.
Brown, L. (2022, October 5). '24 Hour Pressure Care Management' [Training Course]. Leef. Adelaide, South Australia, Australia.
Kersten, R, Roessler, C. (2021, Feburary 5). [Online Training Course] 'Occupational Therapy in Pressure Injury Assessment and Management'. Occupational Therapy Australia.
Permobil. (2023, September 14). 'Under Pressure' [Training Course]. Aidacare Professional Training. Adelaide, SA, Australia.
