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Pressure Injuries

 

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A pressure injury is a wound caused by unrelieved pressure of tissue compressed between a bony prominence and an external surface which is classified according to the extent of tissue damage.
† Synonymous terms include pressure sores, bedsores, and decubitus ulcers.

As a result of unrelieved pressure, the network of vascular and lymph vessels supplying oxygen and nutrients to the tissues can be occluded. Several factors are involved in determining if a pressure injury will develop and include:

  • duration of pressure.
  • intensity of pressure.
  • ability of tissue to tolerate pressure (tissue tolerance)

However, there is no universal agreement as to the length of time and the intensity of pressure before tissue damage occurs. Other major factors include:

  • shear
  • friction forces
  • moisture

Pressure injuries affect people who are largely immobile. They are most common amongst the elderly, but can effect anyone who is confined to a bed or wheel chair. On average 10% of hospitalised patients can develop a pressure injury during their stay. Recent prevalence studies undertaken in several major Australian teaching hospitals identified the prevalence rate of pressure ulcers as being between 5.4% and 15.6%.

 

The most common positions for pressure injuries are:

  • Sacrum/tail bone
  • Heel
  • Ischia/buttocks
  • Greater trochanters/hip

 

Pressure Injury Classification

Pressure injuries are classified according to the level of tissue damage that has been sustained and a staging system is used:

 

Stage

Description

 

 

Stage 1         

 

Intact skin with observable changes including areas of persistent redness.

 stage 1

 

Stage 2

 

Partial thickness skin loss involving epidermis and/or dermis.

 stage 2

 

 

Stage 3

 

Full thickness involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.

 stage 3

 

 

Stage 4

 

Full thickness skin loss with extensive tissue destruction to muscle, bone, or supporting structures i.e. tendon, joint capsule. May have undermining or sinus formation.

 stage 4

 

 

Treatment

 

The primary objectives for management of pressure injuries are:

  • Reduction of pressure and shear forces
  • Management of exudate
  • Prevention of contamination leading to infection
  • Creation of a moist wound environment
  • To minimise the frequency of dressing changes (less frequent dressing changes are generally more cost effective, provide more rapid healing and less disruption to the patient)
   

Product Selection

Allevyn* Adhesive is particularly useful for pressure injuries as it can assist in the fulfillment of the above mentioned treatment objectives. Over 50% of all pressure injuries occur on the heel or sacral areas - Allevyn Heel and Allevyn Sacrum are specifically designed to manage these challenging anatomical positions to minimise complications. Deep or undermined injuries can be especially difficult, as these must be gently packed without causing unnecessary pressure within the wound. Allevyn Cavity is a specifically designed to address this, though alginate ropes such as Algisite* M are also used, especially for narrow wounds or sinuses.

 

For low grade pressure injuries, where the skin is at risk of breakdown or where the wound is very shallow and has low exudate, OpSite* Flexigrid* can provide a barrier to contamination and reduce shear forces.

 

Necrotic Tissue
Necrotic tissue is a particular issue with pressure sores, with both yellow slough and black necrotic tissue often present. Effective debridement of this dead tissue is normally a desired component of best practice protocols, to deliver optimal management outcomes. The moisture donating properties of IntraSite* Gel can be routinely used in combination with these other products to facilitate autolytic debridement, especially where surgical debridement is not appropriate.

 

Incontinence
Incontinence is a major risk factor, as it has been shown to accelerate skin breakdown and increase infection risk if not adequately managed. Advanced skin care products such as Secura* can help reduce this risk by protecting the skin while Iodosorb* can be used to manage risks of contamination by micro-organisms.

 

Related Links

An information booklet for patients on preventing pressure injuries can be downloaded from 
http://www.health.vic.gov.au/pressureulcers/downloads/ppu/english.pdf


 

†Based on the Australian Wound Management Association National Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers.