Pressure ulcers are caused by sustained pressure applied to a single area of the body. They are particularly prominent around bony areas, in patients that have limited mobility. They are graded in terms of severity between grade 1 and 4. Options for treating pressure ulcers include repositioning of the patient, using pressure relieving mattresses and cushions such as those manufactured by Karomed, and sometimes surgery.
Caring for patients with pressure ulcers
Because pressure ulcers are caused and exacerbated by a number of interrelating factors, the care team may consist of a number of medical professionals. This team is often referred to as a multidisciplinary team (MDT). This team usually includes:
- a tissue viability nurse (a nurse who specialises in wound care and prevention)
- a social worker
- a physiotherapist
- an occupational therapist
- a dietitian
- medical and surgical experts with experience in pressure ulcer management
Regular repositioning of patients helps to prevent pressure ulcers from developing, as well as redistributing the pressure to give relief to existing tissue damage. A healthcare professional will first complete a risk assessment then after that will create a repositioning timetable. This is individual to each patient and can range between 15 minutes and 2-hour repositioning intervals.
Mattresses and cushions
Specialised pressure relieving cushions and mattresses are available for patients in both acute and community settings. For those at low risk, with low grade ulcers between 1 and 2, a static foam mattress such as the Karomed Transwave Supreme would be sufficient. For high risk patients, or for those with grade 3 or 4 ulcers, an active air flow mattress and pump such as the Karomed Transair mattress replacement system would be a preferable option. Karomed also now offer a hybrid system called the ‘Transfoam Active’which offers both the benefits of an alternating air system and a high / very high risk static mattress. A hybrid mattress offers more responsive patient care, which leads to better use of clinical resources and as a result, saves costs and reduces the pressure ulcer rate.
There are two types of specially designed dressings that protect pressure ulcers and speed up the healing process;
- hydrocolloid dressings – the gel within these dressings encourages new skin cell growth in the ulcer, while at the same time keeping the surrounding healthy area of skin dry.
- alginate dressings – these are made from seaweed, which contains high levels of sodium and calcium, known to speed up the healing process
Antiseptic creams and ointments can also aid the healing process and prevent further tissue damage. Antibiotics are sometimes prescribed if the pressure ulcer becomes infected.
Malnutrition can worsen the risk and lengthen the healing time for pressure injuries. Dieticians may offer supplements to speed up the healing process such as zinc, protein and vitamin C.
This is the process of removing the dead tissue from the ulcer to stimulate recovery. This is carried out by one of the following methods;
- cleansing and pressure irrigation
- maggot therapy
If a high-grade pressure ulcer does not heal, then surgery may be required to close the wound either by direct closure (bringing the edges together) or by reconstruction (using tissue from a nearby part of the body).
Although surgery comes with risks, especially for those who already suffer with tissue damage, its often necessary to prevent further life threatening complications that pressure ulcers can bring such as blood poisoning or gangrene.