Pressure Sores 101

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Pressure sores are a very serious threat for people with spinal cord injuries and other medical conditions where body movement is limited. Sores can develop quickly and can takes months to years to heal, and some sores require surgery to repair.

Jay Erwin is the administrator and creator of the Facebook page Spinal Cord Peer Support USA, and has shared the following important information about pressure sores:

How can I avoid getting a pressure sore?

  • Do regular pressure reliefs (also called weight shifting, pressure redistribution and pressure reduction).
  • Pressure relief is moving or lifting yourself to take the pressure off areas that have been under pressure, usually from sitting or lying in one position, so blood can circulate.
  • When sitting in your wheelchair you should do pressure reliefs every 15 to 30 minutes for a duration of at least 30 to 90 seconds. Continue to perform pressure reliefs when sitting in a car or on other surfaces (such as on sports equipment).
  • If you are unable to perform a pressure relief independently, instruct the person who helps you with your daily care (family, attendant) to consistently, routinely move you and reduce pressure over areas at risk for pressure sores.
  • Your therapist or nurse will teach you how to do pressure reliefs before you leave the hospital. The methods and timing of pressure reliefs will vary somewhat according to your injury and skin tolerance.
  • Each person’s skin tolerance is different. Some people may need to relieve pressure very often, others may not need to do it very often, but they still need to do it! Building skin tolerance is a gradual process.

Tips for skin inspection

  • Check your skin, or have your attendant or caregiver check your skin, a minimum of twice a day (morning and bedtime).
  • Look for changes in skin color (redness or darkening), blisters, bruises, or cracked, scraped or dry skin.
  • Feel for hardness, swelling or warmth that may signal skin breakdown.
  • Inspect areas of skin that are in contact with casts or braces twice daily.
  • * Use a mirror to inspect skin in hard-to-see areas. Train the person who helps you to carefully and regularly check your skin.
  • * Pay attention to fingernails and toenails: an ingrown toenail or cut along your nail bed may lead to a sore which can easily be infected.
  • * As soon as you notice a discolored area, stay off the area until it returns to normal skin color.
  • Closely inspect areas that are at especially high risk for pressure sores because in some areas of the body the bones are close to the surface of the skin; the skin that is directly over bone is at highest risk.

Highest risk areas: 

  • sacrum (lower back)
  • coccyx (tailbone)
  • heel of the foot
  • ischium (the base of the buttocks, “seat bones”)
  • trochanter (hip, from lying on side, something rubbing, or tight clothes)
  • elbow (from leaning on it)
  • knee (from spasms or side-lying with one knee on top of other)
  • ankle ( from lying on side)
  • toes and bony areas of foot (from tight-fitting shoes)
  • back of the head

Padding, positioning and turning in bed:

  • Use a regular schedule of turning at night. Depending on weight and skin tolerance, your turning schedule may vary from every 2 to every 6 hours. Ask your health care provider for advice about a turning schedule. When turning and moving in bed, lift rather than slide across sheets.
  • Use pillows and foam pads (not folded towels or blankets) to protect bony areas. No two skin surfaces should rest against each other!
  • Unless your doctor tells you to do it, avoid elevating the head of your bed, which can put too much pressure on your buttocks and lower back areas.
  • For individuals at the highest risk for pressure sores, your health care provider may prescribe a special mattress, mattress overlay or bed for long-term use.

Keep skin clean and dry:

  • Bathe daily with mild soap and warm water and rinse and dry thoroughly. Pay particular attention to keeping the genital area and skin folds clean and dry.
  • Immediately wash and dry skin and change clothing after any leakage of stool or urine.
  • Avoid harsh soaps, skin agents with alcohol, and antibacterial or antimicrobial soaps. Do not use powders. Use a moisturizer that has been approved by your health care provider.

Get a proper seating evaluation every two years (or more if your health or skin condition changes):

  • Make sure you have the proper cushion for your wheelchair and your seating tolerance.
  • Make sure you have the appropriate wheelchair, one that has been measured specifically for you and is compatible with your level of mobility, activities, work and associated equipment.
  • The therapist doing the seating evaluation should place a pressure map above your cushion and under your buttocks to see where your pressure-sensitive areas are. If at-risk areas on the pressure map are found, then the therapist may try a different cushion; alter the wheelchair seat, back or foot rest; or show you how to relieve pressure on the vulnerable areas by repositioning your bod
  • Pressure mapping is an excellent way to visually demonstrate the effectiveness of weight shifts.
  • If pressure mapping is unavailable, work with a seating professional and try several different cushions to see what works best for you.

What is your experience with a pressure sore? Share your story with us to help others who might be facing the same thing.

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