Identifying Deep Tissue Pressure Injury in the Presence of Technology Protection Status
Blog Category: 
support surface technology and pressure injury prevention

by Aletha Tippett MD

The idea that pressure injuries (ulcers) can be prevented through equipment or device technology is one we must challenge as clinicians. A manufacturer of support surfaces, for example, may try to tell us that their beds, technologically superior, will prevent pressure injuries from forming.

I was doing a recent legal case and the patient was on a specialty powered support surface in an ICU. When I read the information on this bed, I was very impressed—it had continuous lateral rotation, weight-based pressure redistribution in any bed position, and advanced microclimate management technology. Wow. Do you even need a nurse? Of course, there were nurses who turned the patient every few hours, that is, propped the patient on one hip or the other with pillows. But this patient had a deep tissue pressure injury (DTPI) that had not surfaced yet.

Deep Tissue Pressure Injury and Risk Factors

The patient in this case had been in the ER and had surgery on his back for hours, so would have a deep tissue injury to his bottom that was not visible for weeks until a purple bruise appeared on his buttock. That was the first sign of DTPI. Of course, that would grow until it got to the bone, then could be healed. It didn’t matter what great technology was at hand to help protect his skin; the DTPI had already happened. But he was on a really good bed with proper pressure support, so for this hospital, they did everything they could to prevent a pressure ulcer, but DTPI is not always preventable.

It is important to know the risks for DTPI and be cognizant of this form of pressure injury when they appear. Risk factors for DTPI include immobility and prolonged pressure. Remember: it only takes 20 minutes for a pressure ulcer to develop, so a person that is immobile on their back for hours will likely have a deep tissue injury that may not be apparent for as long as six weeks.

Use of technologically advanced products in pressure ulcer management and prevention is valuable and can help in many ways, but the people caring for the patient—the nurses and doctors—still need to be aware of deep tissue pressure injury, how it occurs and what it looks like.

About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.


Love this article as it shows that we must be more active and concentrate on what really causes pressure injury = unrelieved pressure. The patient should have been placed on a good alternating pressure air mattress as soon as they were admitted to the hospital or facility. We cannot leave our patients for hours with no interventions. Also most facilities are so busy they do not get time to turn the patients even in a 2 hour period. When patients are very sick they can tissue damage in a matter of minutes.
Thank you. Eileen

I agree Eileen. Too much time filling out the risk assessment tool rather than relieving the pressure.
It is simple- If the person can not relieve there own pressure than you need to do it for them.
A combination of an alternating pressure air mattress , heel protectors and regular repositioning.
Not to mention cushions and early ambulation.
What do you think of prophylactic dressings for preventing pressure injuries? I am not sold on this.
I can not understand why facilities do not wish to spend on prevention when it costs so much for treatment .
The patient suffers so much.

Can you share your reference materials to the claims you make that DTPI can take weeks to become visible?

This is a much disputed topic. Very important to our ability to support community acquired vs facility acquired. We have literature that states 48-72 hours and up to a week.


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