Transcript
Pressure ulcersMussa MensaCT2 The Welsh Centre for Burns and Plastic Surgery
Introduction•Localised skin and underlying tissues
damaged due to prolonged pressure sufficient to impair blood supply
•Typically occur in a person confined to bed or a chair by an illness
•Develop quickly•All patients are potentially at risk
Introduction•Cost the NHS an estimated £1.8-2.6
billion a year1
•2-4% of health expenditure 1,2
•Pressure ulcers are (potentially) preventable
5 Key PointsEarly recognition of people who are
at risk of developing
pressure ulcers is an essential part
of prevention
Risks are most often assessed using specific
tools
Ulcers/Sores should be
assessed, graded and recorded/ documented
Adequate pressure redistribution,
appropriate wound management and good nutrition are
key to management
The majority of pressure ulcers
can be prevented
Risk factors
pressure on bony prominence
reduced/occluded blood flowmovement
tissue hypoxia pain
tissue necrosis/ ulceration
reduces
Risk factorsPatient factors
•Serious illness•Neurological condition•Impaired mobility•Impaired nutrition•Poor posture/deformity
• Alzheimer’s• Cardiovascular disease• Diabetes mellitus• COPD• Hip fracture/ hip surgery• Heart failure• DVT• Limb paralysis • Lower limb oedema• Malignancy• Parkinson’s disease• Rheumatoid arthritis • Urinary tract infections
Environmental factors•Seating & beds that do not provide pressure relief
Risk assessment•Identify individuals at risk – initial + ongoing•Most common assessment tools:
•*No evidence to suggest use of risk assessment tools reduces incidence
Risk assessment tool SpecialtyWaterlow (Waterlow 2005) Orthopaedic/ GenericBraden (Bergstrom et al, 1987) GenericNorton (Norton 1975) Older people/GenericMortenson/Gelis (Mortenson et al 2008, Gelis et al, 2009)
Spinal cord injury
Glamorgan (Willock et al, 2009) Paediatric
Risk assessment
•Most common assessment tools:Risk assessment tool SpecialtyWaterlow (Waterlow 2005) Orthopaedic/ GenericBraden (Bergstrom et al, 1987) Generic
Norton (Norton 1975) Older people/Generic
Mortenson/Gelis (Mortenson et al 2008, Gelis et al, 2009)
Spinal cord injury
Glamorgan (Willock et al, 2009) Paediatric
Risk assessment
•Most common assessment tools:Risk assessment tool SpecialtyWaterlow (Waterlow 2005) Orthopaedic/ Generic
Braden (Bergstrom et al, 1987) GenericNorton (Norton 1975) Older people/GenericMortenson/Gelis (Mortenson et al 2008, Gelis et al, 2009)
Spinal cord injury
Glamorgan (Willock et al, 2009) Paediatric
Risk assessment
•Most common assessment tools:Risk assessment tool SpecialtyWaterlow (Waterlow 2005) Orthopaedic/
GenericBraden (Bergstrom et al, 1987) GenericNorton (Norton 1975) Older people/GenericMortenson/Gelis (Mortenson et al 2008, Gelis et al, 2009)
Spinal cord injury
Glamorgan (Willock et al, 2009) Paediatric
Ulcer assessment•Should be supported by photography (calibrated with a ruler) and tracings •Include:
•Reassessment of the ulcer should be performed at least weekly
• Cause of ulcer• Site/ Location• Dimensions• Stage/Grade• Wound appearance
• Surrounding skin• Local signs of infection• Pain• Exudate amount + type• Odour
Ulcer grading/classification •European Pressure Ulcer Advisory Panel
grading system4
Ulcer grading/classification •European Pressure Ulcer Advisory Panel
grading system•Grade 1:
▫non-blanchable erythema of intact skin▫discolouration of the skin, warmth,
oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin - in whom it may appear blue or purple
Ulcer grading/classification •European Pressure Ulcer Advisory Panel
grading system•Grade 2:
▫partial-thickness skin loss involving epidermis, dermis, or both
▫the ulcer is superficial and presents clinically as an abrasion or blister
▫surrounding skin may be red or purple
Ulcer grading/classification •European Pressure Ulcer Advisory Panel
grading system•Grade 3:
▫full-thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia
Ulcer grading/classification •European Pressure Ulcer Advisory Panel
grading system•Grade 4:
▫extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures, with or without full-thickness skin loss
▫extremely difficult to heal and predispose to fatal infection
Management•Goals - achieve a healthy wound bed and
promote healing
Key factors in ulcer healing:1.Adequate pressure redistribution2.Good nutrition3.Appropriate wound management
ManagementPrinciples:•Repositioning•Pressure relieving support•Local wound management – dressings/VAC•Treatment of concurrent conditions delaying wound healing•Pain relief•Infection control•Dietary supplementation
Management•Debridement:
▫Autolytic – occlusive dressings
▫Mechanical – during dressing changes
▫Surgical – for deep ulcers not responding to standard care
Prevention•The majority of pressure ulcers can be
prevented:▫Education and training
▫Reduce skin injury through correct positioning, transferring and repositioning
▫Reduce underlying risk factors e.g. nutrition
▫Pressure redistributing equipment should be used
Prevention▫Emollients for dry skin
▫Barrier preparations to prevent skin damage in those at high risk of developing a moisture lesion or incontinence-associated dermatitis
▫Polyurethane foam dressing can be applied to bony prominences
Thank you for listening!
References1. Mahalingam S, Gao L, Nageshwaran S, et al;
Improving pressure ulcer risk assessment and management using the Waterlow scale at a London teaching hospital. J Wound Care. 2014 Dec;23(12):613-22. doi: 10.12968/jowc.2014.23.12.613.
2. Posnett J, Franks P (2007) The costs of skin breakdown and ulceration in the UK. In: Pownall M (ed) Skin Breakdown: the Silent Epidemic. London: Smith & Nephew
3. Pressure ulcers; NICE Quality Standard, June 2015 4. Treatment of Pressure Ulcers: Quick Reference
Guide; National Pressure Ulcer Advisory Panel, 2014
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