Pressure Injuries

WoundSource Editors's picture

By the WoundSource Editors

Moist wound healing is the current cost-effective, evidence-based modality to achieve faster wound healing rates and decreased pain and infection. As part of the wound healing process, acute wounds produce reparative exudates consisting of growth factors to support extracellular matrix production; in contrast, chronic wounds contain inflammatory-producing exudates studded with cytokines and proteases that may help maintain the inflammatory phase but can exert destructive effects on the fragile wound bed and may extend to the periwound surface.

Heidi Cross's picture

By Heidi Cross, MSN, RN, FNP-BC, CWON

As detailed in my last few blogs, nutrition plays a huge role in risk for skin breakdown as well as healing of wounds. Just about ALL wound litigation involves nutrition in one way or another, be it diabetes control (or lack thereof) or weight loss, which occurs often in patients with dementia and toward end of life, or general malnutrition.

WoundSource Practice Accelerator's picture

Erythema: A result of injury or irritation that causes dilation of blood capillaries and manifests as patchy reddening of the skin. Occurs after a patient/resident is exposed to unrelieved pressure for 2 hours. It can be identified as a deep, localized redness; can also be blue or purple.

Hyperemia: The condition of having excess blood in vessels that supply an organ or area of the body. Occurs after patient/resident is exposed to 30 minutes of unrelieved pressure. It can be identified as a localized, non-blanchable redness.

Perfusion: The passage of blood through arteries and capillaries into tissues or organs. When insufficient, there is an increased chance that the patient may have complications.

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WoundSource Practice Accelerator's picture

Here’s a question for you: How long does it take for a pressure injury (PI) to form? Do you think it happens in 30 minutes? 2 hours? 8 hours? The answer is actually all of the above. The time it takes for a PI to develop depends on a number of different factors, which we will discuss here.

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WoundSource Practice Accelerator's picture

Do you remember that cartoon from the 1960s (and later reproduced in the 1980s), The Jetsons? It was about a futuristic family that had all kinds of amazing robot helpers and automatic appliances. Rosie the Robot was the wonderbot that would whisk about the house, frantically preforming housekeeping duties, monitoring the security of the home, and generally making sure that everything was online and functioning. Do you ever feel like this as a clinician?

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WoundSource Practice Accelerator's picture

In the last 2 years, hospitals and skilled nursing facilities have seen unprecedented surges in admissions attributed to the COVID-19 pandemic sweeping across the world. Just in the United States, we saw a high of 116,243 weekly hospital admissions in mid-January of 2021. This dropped to a low of 13, 424 in mid-June of 2021 and then bumped up again to 86,871 in August of 2021.1 With this fluctuation of numbers, along with staffing shortages and burnout, wound care professionals have seen significant overcrowding in many hospitals and facilities.

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WoundSource Practice Accelerator's picture

A nurse recently shared some of her experiences as a charge nurse in a skilled facility during the COVID-19 pandemic. She worked evenings (3-11:30 pm) at a local facility and was overwhelmed by the high number of patients she was responsible for. She typically worked on a 26-bed floor with just one nurse assistant for the shift. She later transferred to the night shift, where she was the only person on a 16-bed unit for the 8 hours. When asked how she was able to reposition patients as frequently as was recommended, the nurse said that she did “the best I could.” She is, unfortunately, not alone.

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Dianne Rudolph's picture

By Dianne Rudolph, DNP, GNP-bc, CWOCN

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

Charles Buscemi's picture

By Charles P. Buscemi, PhD, APRN, CWCN and Arturo Gonzalez, DNP, APRN, ANP-BC, CWCN-AP

Urinary catheters serve several purposes, including monitoring urine output, relieving urinary retention, and facilitating diagnosis of disease in the lower urinary tract. These catheters can be inserted easily and are universally available, which usually results in their continued and indiscriminate usage. Urinary catheters can be indwelling or external-condom types. The indwelling catheter can be either a suprapubic or a urethral catheter. The external catheter provides a safe alternative to an indwelling catheter for patients having urinary incontinence (UI). It comprises a sheath surrounding the penis with a tube situated at the tip linked to a collection bag. Conversely, the condom catheter seems an attractive option for patients with UI. About 40% of condom catheter users have urinary tract infections. Moreover, 15% of condom catheter users have necrosis, ulceration, inflammation, and constriction of the penile skin. There is also an additional risk of urine leakage and condom detachment. Furthermore, the use of the external catheter requires significant nursing time. Overall, the condom catheter cannot be satisfactorily used for managing UI; nevertheless, it is useful for the non-invasive measurement of bladder pressure.