Pressure Injury

Pressure injury, sometimes called a bedsore, is an injury to the skin and underlying tissue caused by pressure. Pressure on blood vessels causes decreased blood flow to the skin, which can eventually cause the skin tissue to die and break down into a wound.

Pressure injuries usually occur:

• Over bony parts of the body such as the tailbone, shoulders, elbows, hips, and heels.
• Under medical devices such as respiratory equipment, stockings, tubes, and splints.

Pressure injuries start as reddened areas on the skin and can lead to pain, muscle damage, and infection. Pressure injuries can vary in severity.

What are the causes?

Pressure injuries are caused by a lack of blood supply to an area of skin. They can occur from intense pressure over a short period of time or from less intense pressure over a long period of time.

What increases the risk?

This condition is more likely to develop in people who:

• Are in the hospital or an extended care facility.
• Are bedridden or in a wheelchair.
• Have an injury or disease that keeps them from:
  • Moving normally.
  • Feeling pain or pressure.
• Have a condition that:
  • Makes them sleepy or less alert.
  • Causes poor blood flow.
• Need to wear a medical device.
• Have poor control of their bladder or bowel functions (incontinence).
• Have poor nutrition (malnutrition).
• Are of certain ethnicities. People of African American and Latino or Hispanic descent are at higher risk compared to other ethnic groups.

If you are at risk for pressure ulcers, your health care provider may recommend certain types of bedding to help prevent them. These may include foam or gel mattresses covered with one of the following:

• A sheepskin blanket.
• A pad that is filled with gel, air, water, or foam.

What are the signs or symptoms?

The main symptom is a blister or change in skin color that opens into a wound. Other symptoms include:

• Red or dark areas of skin that do not turn white or pale when pressed with a finger.
• Pain, warmth, or change of skin texture.

How is this diagnosed?

This condition is diagnosed with a medical history and physical exam. You may also have tests, including:

• Blood tests to check for infection or signs of poor nutrition.
• Imaging studies to check for damage to the deep tissues under your skin.
• Blood flow studies.

Your pressure injury will be staged to determine its severity. Staging is an assessment of:

• The depth of the pressure injury.
• Which tissues are exposed because of the pressure injury.
• The causes of the pressure injury.

How is this treated?

The main focus of treatment is to help your injury heal. This may be done by:

• Relieving or redistributing pressure on your skin. This includes:
  • Frequently changing your position.
  • Eliminating or minimizing positions that caused the wound or that can make the wound worse.
  • Using specific bed mattresses and chair cushions.
  • Refitting, resizing, or replacing any medical devices, or padding the skin under them.
  • Using creams or powders to prevent rubbing (friction) on the skin.
• Keeping your skin clean and dry. This may include using a skin cleanser or skin protectant as told by your health care provider. This may be a lotion, ointment, or spray.
• Cleaning your injury and removing any dead tissue from the wound (debridement).
• Placing a bandage (dressing) over your injury.
• Preventing or treating infection. This may include antibiotic, antimicrobial, or antiseptic medicines.

Treatment may also include medicine for pain.

Sometimes surgery is needed to close the wound with a flap of healthy skin or a piece of skin from another area of your body (graft). You may need surgery if other treatments are not working or if your injury is very deep.

Follow these instructions at home:

Wound care

• Follow instructions from your health care provider about:
  • How to take care of your wound.
  • When and how you should change your dressing.
  • When you should remove your dressing. If your dressing is dry and stuck when you try to remove it, moisten or wet the dressing with saline or water so that it can be removed without harming your skin or wound tissue.
• Check your wound every day for signs of infection. Have a caregiver do this for you if you are not able. Watch for:
  • More redness, swelling, or pain.
  • More fluid, blood, or pus.
  • A bad smell.

Skin Care

• Keep your skin clean and dry. Gently pat your skin dry.
• Do not rub or massage your skin.
• Use a skin protectant only as told by your health care provider.
• Check your skin every day for any changes in color or any new blisters or sores (ulcers). Have a caregiver do this for you if you are not able.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it or apply it as told by your health care provider. Do not stop taking or using the antibiotic even if your condition improves.

Reducing and Redistributing Pressure

• Do not lie or sit in one position for a long time. Move or change position every two hours or as told by your health care provider.
• Use pillows or cushions to reduce pressure. Ask your health care provider to recommend cushions or pads for you.
• Use medical devices that do not rub your skin. Tell your health care provider if one of your medical devices is causing a pressure injury to develop.

General instructions

• Eat a healthy diet that includes lots of protein. Ask your health care provider for diet advice.
• Drink enough fluid to keep your urine clear or pale yellow.
• Be as active as you can every day. Ask your health care provider to suggest safe exercises or activities.
• Do not abuse drugs or alcohol.
• Keep all follow-up visits as told by your health care provider. This is important.
• Do not smoke.

Contact a health care provider if:

• You have chills or fever.
• Your pain medicine is not helping.
• You have any changes in skin color.
• You have new blisters or sores.
• You develop warmth, redness, or swelling near a pressure injury.
• You have a bad odor or pus coming from your pressure injury.
• You lose control of your bowels or bladder.
• You develop new symptoms.
• Your wound does not improve after 1–2 weeks of treatment.
• You develop a new medical condition, such as diabetes, peripheral vascular disease, or conditions that affect your defense (immune) system.