Pressure Injury Prevention

Holly Hovan's picture

By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Pressure injuries (PIs) typically are the result of unrelieved pressure, shear, or force. In an inpatient or hospital setting, interventions are put into place to prevent pressure injuries based on evidence and patient risk. However, PIs still develop in some patients despite interventions. Experts agree that most PIs are in fact avoidable; however, some patients may experience unavoidable skin breakdown at end of life (EoL).¹ Kennedy terminal ulcers (KTUs), skin changes at life’s end (SCALE), and Trombley-Brennan terminal tissue injuries (TB-TTIs) are some of the common terms used to describe unavoidable skin changes at EoL.¹

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By WoundSource Editors

Pressure injuries are common among patients who experience extended exposure to pressure on a bony prominence or shear to areas of poor turgor, two factors that lead to constriction of a patient’s blood supply to the exposed area. A patient who is bedridden or has certain chronic conditions, such as diabetes, is more likely to develop a pressure injury. When mechanical force is imposed on the skin, it can result in poor blood flow and damage to the bone-muscle interface, thus making tissue sensitive and painful. For patients with limited mobility, this can be especially frustrating because they may not be able to adjust positions or medical equipment. If pressure injuries are left untreated or unnoticed, they can also become infected and even enter muscle and bone. Risk assessment tools are available to assess pressure injury risk and can work in tandem with practice standardization, thereby leading to effective treatment plans for practitioners and patients.

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Ivy Razmus's picture

by Ivy Razmus, RN, PhD, CWOCN

Neonatal patients have unique skin properties compared with older patient populations. However, there is little evidence reported for neonates who receive pressure injury (PI) prevention interventions and the related occurrence of PIs compared with adults. The use of a pressure redistribution surface is intended to decrease pressure and thereby reduce PIs. The Institute for Healthcare Improvement guidelines recommend a support surface that meets the patient’s need for pressure redistribution based on the level of immobility and inactivity to reduce shear and change microclimate; additional factors for type of surface include size and weight of the patient and whether there are existing PIs. Consequently, knowledge about selection and use of pressure redistribution surfaces for neonatal patients is needed.

Ivy Razmus's picture

Neonates are widely known as a vulnerable patient population—especially critically ill and premature infants.1 This vulnerability has limited clinicians’ knowledge of moisture management products in the neonatal population that prevent pressure injuries. Recently, a survey of neonatal nurses from across the United States was conducted to find out what is being used for moisture management.2

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Pressure injuries impact quality of life. Tissue destruction in pressure injuries occurs when capillaries supplying the skin structure are compressed for a prolonged time, usually occurring between a bony prominence and a surface. Education and prevention are essential in reducing the prevalence of pressure injuries.

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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.

Dianne Rudolph's picture

By Dianne Rudolph, APRN, GNP-BC, CWOCN, UTHSCSA

Pressure injuries (PIs) are defined by the National Pressure Injury Advisory Panel as “localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device.” Pressure injuries may present as intact skin or as an open ulcer. These wound may be painful. Pressure injuries occur after exposure to prolonged pressure or as a result of pressure in combination with shear. Other factors may affect soft tissue tolerance, such as nutrition, perfusion, microclimate, the presence of comorbidities, and the condition of the soft tissue.

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Fairground

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

My approach to wound care education with patients, providers, and nursing staff the last 20+ years has always been to make learning fun while emphasizing that wounds are a serious topic. My strong passion drives me to motivate anyone and everyone who wants to learn. If they don’t want to learn, then I’ll figure out the best way to motivate them! Everyone learns differently; however, hands-on training with added fun usually wins. Education should be ongoing and engaging, and it should create fun ways to experience more of those “aha” moments. We want to impact that long-term memory storage! Every care setting has variances, but my blog will provide you with some ideas that you can alter to fit your needs.

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Diane Krasner's picture
wound care documentation

By Diane L. Krasner, PhD, RN, FAAN

Scope of Practice and Standards of Practice guide nurses and other members of the interprofessional wound care team in caring for patients with wounds. Documentation in the medical record is a key aspect of the standard of practice and serves to record the care delivered to the patient or resident. Your documentation should follow your facility guideline for documentation. Accurate documentation helps to improve patient safety, outcomes, and quality of care.

This WoundSource Trending Topic blog considers general wound documentation dos and don'ts and presents 10 tips for success. Good, better, and best documentation examples are included for each tip.

WoundSource Practice Accelerator's picture

The coronavirus disease 2019 (COVID-19) pandemic has forced health care professionals to take a closer look at the most effective and appropriate measures for pressure injury prevention. In 17% of all COVID-19 cases pneumonia secondary to acute respiratory distress syndrome is the most common complication; therefore, prone positioning is used as an adjuvant therapy. The prone position allows for dorsal lung region recruitment, end-expiratory lung volume increase, and alveolar shunt decrease. To be most effective, this position should be maintained for 10 to 12 hours, thereby increasing prolonged pressure on certain areas of the body. However, prone positioning should be supervised and monitored regularly by nursing staff experienced with this positioning technique.