Dealing with pressure sores (sore skin)
This page is about pressure sores. There is information about
Pressure sores are wounds that develop when constant pressure or friction on one area of the body damages the skin. Constant pressure on an area of skin stops blood flowing normally, so the cells die and the skin breaks down. Other names for pressure sores are bedsores, pressure ulcers and decubitus ulcers.
Pressure sores happen if you can’t move around and so stay in one position for a long time. We normally move about constantly, even in our sleep. This stops pressure sores developing.
People who are unable to move around tend to put pressure on the same areas of the body for a long time. If you are ill, bedridden or in a wheelchair, you are at risk of getting pressure sores.
A number of things can increase your risk of pressure sores, including
- Being unable to move around easily due to old age or illness
- Weight loss - you may have less padding over bony areas
- Sliding down in a bed or chair - pressure on the skin cuts off blood supply because the skin is being pulled in different directions (called shearing)
- Friction or rubbing of the skin, for example against sheets
- Medicines such as chemotherapy, biological therapies, steroids or non steroidal anti inflammatory drugs (NSAIDS)
- A poor diet
- Lack of fluid (dehydration)
- Moist skin - for example, due to sweating or incontinence
- Other medical conditions, such as diabetes
It is much better to prevent pressure sores than to treat them once they have happened. The National Institute for Health and Care Excellence (NICE), Healthcare Improvement Scotland and the European Pressure Ulcer Advisory Panel (EPUAP) have guidelines on pressure sores. They all recommend that a member of the health care team looking after you should assess your risk of developing pressure sores and create a plan to prevent them.
The areas of skin most at risk of getting sore depends on whether you are lying down or sitting. The following diagrams show the areas most at risk.
The first sign of a pressure sore is the skin going red or darkening. It may look a bit like a bruise and starts going a purple colour in fair skinned people. In dark skinned people the area looks darker than the surrounding skin. The damaged area may feel sore when touched. It sometimes feels warmer or cooler than the surrounding skin and may also feel harder or softer. If you don’t treat it, the skin gradually wears away and can break open. Tell your nurse or doctor if you notice any of these skin changes as assessing any changes as early as possible will help to prevent pressure sores.
Relieving pressure on the skin is the best way of preventing pressure sores. Changing position and keeping moving as much as possible will help. If possible stand up to relieve the pressure. If you can’t move yourself, your carer can be shown how to help you change position. You should change position at least every 2 hours. When moving, make sure your skin is lifted clear of the bed or chair so you don't rub the skin.
It is important to keep the skin clean and dry. If you are in bed, the bedsheets must be smooth and not wrinkled.
Some equipment can also help relieve pressure. These include mattresses and cushions. A Cochrane review in 2011 found that people who lay on special mattresses were less likely to develop pressure sores when compared to ordinary hospital mattresses. Some special mattresses work by moulding around your body. NICE guidelines recommend that if you have reddening or a bruised area you need to have one of these special mattresses.
Cushions are also available to make it more comfortable to sit for a long time in a chair. Avoid ring shaped cushions, as they put more pressure on your lower back and bottom, stop the flow of blood to the area and can make sores worse. Also avoid synthetic sheepskin pads and water filled gloves as they can make pressure sores worse. The Cochrane review found that natural sheepskin overlays can help prevent pressure sores.
Special beds, mattresses and cushions should be available if you are in hospital. At home, your GP, district nurse or specialist nurse can assess your needs and help you to get any equipment you need.
In some people, the skin breaks down and creates a wound. There is then a risk that the wound can get infected. This can be a serious problem. It is very important to treat infections quickly.
If you develop a pressure sore, it is important that a nurse or doctor examines you. District nurses can visit and advise you how to look after your skin if you are at home. In hospitals, specialist nurses known as tissue viability nurses have training in treating pressure sores. They can advise on the best treatment for you.
It can take a long time for pressure sores to heal.
If you develop a pressure sore, it is vital to relieve pressure on the area at least every 2 hours. The best way to do this is by not lying or sitting on that area of skin at all. A few studies have looked at a special bed to relieve pressure. The bed contains a mixture of air and fluid. Researchers found that pressure sores became smaller after 2 weeks using this type of bed.
Other types of specialist mattress are available but there is less research to say how helpful they are. These include waterbeds, inflatable mattresses and ripple mattresses. NICE guidelines on treating pressure ulcers recommend that you should have a more sophisticated mattress if your skin has broken down. For example, a continuous low pressure system or an alternating pressure system. Your district nurse can assess your skin and order you a special mattress if you are at home.
If your skin has broken down you may need to have a dressing on it. The dressing protects the area, keeps it clean and moist and helps it to heal.
There are different types of dressings. The one you need depends on your wound. They include
- Alginate dressings, made from seaweed
- Clear film dressings, like medical cling film
- Hydrocolloids - gels put on to the wound that soak up fluid
- Hydrogel - a gel that keeps wounds moist and helps to clean them
- Foam dressings that absorb fluid from the wound
- Honey dressings
- Silver dressings
Your nurse will assess your pressure sore to decide which dressing is best for you, change it as needed and monitor how well it is working.
If there is some dead tissue around the sore, it can slow healing. You may have to have any dead cells removed to help it heal. Nurses call this debridement. It can be done in different ways.
Your nurse may be able to remove the dead tissue when cleaning your wound and changing the dressing. Some of the dressings may help to remove it but sometimes a specialist tissue viability nurse needs to cut dead areas away. Usually you can have this done at home or at your GP surgery. More rarely, when the sore is deeper you may need to have an operation in hospital to remove the dead cells and clean the wound.
Other treatments may help but we need more research about them. They include
- Diet changes and supplements
- Suction treatment to remove excess fluid from the wound
- Electrical therapy - a small amount of electricity stimulates the cells and helps healing
- Laser treatment, which uses light to help repair the wound
- Sterile maggots (larvae) are very good at removing dead cells and cleaning the wound
A number of things can help you to reduce your risk of pressure sores, or to help them heal if you have one. Signs to look for include
- Purplish or bluish patches on dark skinned people
- Red or white patches on fair skinned people
- Shiny areas
- Dry patches
- Cracks and wrinkles
Contact your nurse or doctor if you notice any of these.
You can help to prevent pressure sores by
- Keeping your skin clean and dry
- Avoid scented soaps as they can be more drying
- Moisturising your skin thoroughly after washing
- Changing your position every 2 hours, at least
- Not dragging your heels or elbows when moving in your bed or chair
- Asking your doctor or nurse for specialist equipment such as a pressure relieving mattress
- Using pressure relieving aids such as pillows, natural sheepskins and foam pads
- Eat a well balanced diet
- Have at least 2 litres of fluid a day in food or drink
- Try to make sure there are no wrinkles or crumbs on your sheets or chair
- Not rubbing areas likely to get sore
- Checking your skin regularly - your nurse will do this as well
- Keeping your skin well moisturised
- Avoid using talcum powder as this dries the skins natural oils
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