Pressure ulcers, also known as pressure ulcers and decubitus ulcers, are caused by long-term pressure on local tissues, resulting in tissue ulceration and necrosis due to persistent ischemia, hypoxia, and malnutrition. It is a tissue injury caused by the local pressure on the body and the duration of the pressure exceeding a certain limit.
Pressure sores are one of the common comorbidities in rehabilitation medicine. In the field of geriatric and orthopedic rehabilitation, the incidence often varies from 14% to 19%, with a higher incidence after spinal cord injury, up to 60% for complete cervical medullary injury and often 40% for incomplete injury. In China, within one month after the Tangshan earthquake, pressure sores occurred in about 80% of paraplegic casualties.
The main causes of pressure sore formation: pressure, friction and shear forces. Risk factors: exercise, nutritional status, age, and moisture.
Common sites of pressure sores.
Most of them occur at the bony bulge where there is no muscle wrapping or the muscle layer is thin, and where there is a lack of fatty tissue protection and frequent pressure.
In the supine position, they are more likely to occur at the occipital ridge, scapula, elbow, vertebral bulge, sacrococcygeal region, and heel.
2.Side lying position is more likely to be found in the ear, shoulder, elbow, ribs, hip, medial and lateral knee joints, and inner and outer ankle.
3. Prone position is more likely to occur in the ear, cheek, shoulder, female breast, male genitalia, iliac crest, knee, and toe.
In the case of pressure sores, prevention is more important than treatment, as it can be prevented by paying sufficient attention to prevention; on the contrary, once a pressure sore has formed, the human, material and financial resources spent on treatment are substantial, and the presence of pressure sores often seriously affects the treatment of major diseases.
The main method of preventing pressure sores is to regularly decompress the parts that are under severe pressure. Pressure is the cause of pressure sores, so various methods should be used to avoid the phenomenon.
I. Local management
1. Removal of local pressure
(1) Turning or changing position regularly – the most important method of prevention and treatment
In the prone position, turn every 2h. In the sitting position, decompress the sciatic tuberosity area every 15-30 min by various methods: when both upper limbs are unable to support the body by extending the elbows in order to lift the hips off the cushion, tend to one side first to make the opposite hip leave the cushion for 20-60s, and then tend to the other side at 10-20 min intervals to make the other hip leave the cushion for 20-60s; when both upper limbs are strong enough to support the body Lift off the hip directly. The above methods can be used to decompress the sciatic tuberosity area for about 15s at 15min intervals.
(2) Reduce pressure: Place a pressure-reducing pad on the area where pressure sores have occurred.
(3) The mattress should be well ventilated and free of friction and local compression.
(4) Wheelchairs whose backrests can be tilted
When the backrest is tilted, the pressure is changed from acting vertically on the sciatic tuberosity to acting tiltedly on it, which will greatly reduce the pressure. Or to do the support action when riding the wheelchair, if you can’t do the support action, you should also do the rotation to the left and right to replace the support.
2.Local insulation and massage.
3.Keep the skin clean and dry. Also constantly check the skin, early detection and early treatment.
4. Educate patients and family members on pressure sore prevention.
II. Systemic management
Pay attention to systemic nutrition, improvement of systemic blood circulation, functional training, as well as control of spasticity, etc.
In short, pressure sore prevention is multifaceted. Patients should learn to check the skin every time they leave the bed, and also check the skin at the site of pressure after each turn, and they should learn to use two mirrors to check the site of pressure behind themselves by reflection. As soon as erythema, infiltration or small breakage is found, ask medical personnel to deal with it. The nursing staff should take more responsibility for checking the skin when caring for the patient.