Pressure Ulcer Prevention

Abstract

The purpose of this collective review is to outline the predisposing factors in the development of pressure ulcers and to identify a pressure ulcer prevention program. The most frequent sites for pressure ulcers are areas of skin overlying bony prominences. There are four critical factors contributing to the development of pressure ulcers: pressure, shearing forces, friction, and moisture. Pressure is now viewed as the single most important etiologic factor in pressure ulcer formation. Prolonged immobilization, sensory deficit, circulatory disturbances, and poor nutrition have been identified as important risk factors in the development of pressure ulcer formation. Among the clinical assessment scales available, only two, the Braden Scale and Norton Scale, have been tested extensively for reliability and/or validity. The most commonly used risk assessment tools for pressure ulcer formation are computerized pressure monitoring and measurement of laser Doppler skin blood flow. Pressure ulcers can predispose the patient to a variety of complications that include bacteremia, osteomyelitis, squamous cell carcinoma, and sinus tracts. The three components of pressure ulcer prevention that must be considered in any patient include management of incontinence, nutritional support, and pressure relief. The pressure relief program must be individualized for non-weight-bearing individuals as well as those that can bear weight. For those that can not bear weight and passively stand, the RENAISSANCE Mattress Replacement System is recommended for the immobile patient who lies supine on the bed, the stretcher, or operating room table. This alternating pressure system is unique because it has three separate cells that are not interconnected. It is specifically designed so that deflation of each individual cell will reach a ZERO PRESSURE during each alternating pressure cycle. The superiority of this system has been documented by comprehensive clinical studies in which this system has been compared to the standard hospital bed as well as to two other commercially available pressure relief mattresses. The most recent advance in pressure ulcer prevention is the development of the ALTERN8* seating system. This seating system provides regular periods of pressure relief and stimulation of blood flow to skin areas while users are seated. By offering the combination of pressure relief therapy and an increase in blood flow, the ALTERN8* reportedly creates an optimum pressure ulcer healing environment. Foam is the most commonly used material for pressure reduction and pressure ulcer prevention and treatment for the mobile individual. For those immobilized individuals who can achieve a passive standing position, a powered wheelchair that allows the individual to achieve a passive standing position is recommended. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased blander pressure, enhanced orthost...

Pressure ulcer management and research priorities for patients with spinal cord injury: Consensus opinion from SCI QUERI Expert Panel on Pressure Ulcer Research Implementation

“…Environmental risk factors include the local skin envi ronment (e.g., moisture level secondary to sweatin g and bowel or bladder incontinence), interface press ure and sh ear force between the skin and the support surface, friction [52], residential situation, and ps ychosocial support. These factors may interact with intrinsic physical/medical risk factors to increase PU risk.…”

Análise da prevenção e tratamento das úlceras por pressão propostos por enfermeiros

“…Nursing interventions should be enforced, such as bed immobilization, multiprofessional team interacting for educational activity planning, pain management, raising the bed's upper part to 30°, creation of rehabilitation programs for clients with medullar lesion, conduction of nursing research on risk factors, prevention and new therapies for pressure ulcers, knowledge of the prevalence of pressure ulcers in general hospitals and use of new technologies for prevention and treatment (6)(7)(8)(9)(10)(11)(12)(13).…”

Effect of system tilt and seat-to-backrest angles on load sustained by shoulder during wheelchair propulsion

“…By tilting the seat backward, clinicians and users could modify pressure distribution at the seat interface by shifting the weight toward the back and thereby reducing pressure under the buttocks [22]. Reduction of pressure under the buttocks by modification of the seating angle could, along with other means (i.e., pressure relief cushions), help prevent pressure ulcers [23][24]. Pressure ulcers are frequent among wheelchair users, especially among the elderly population [25].…”