Pressure Ulcers: repositioning and staging

I believe most healthcare workers know that unrelieved pressure over any part of the body for a period of time can result in pressure ulcers. But do pressure ulcers always start on the surface of the skin and work through fat and muscle to the bone? Or is it possible that pressure damage starts at the bone and works outwards to the skin…meaning that you can’t actually see the damage until it is too late. Is a Stage I pressure ulcer actually an ulcer or is it just a sign that the patient is at risk? Is it possible for pressure ulcers to start anywhere between skin and bone, the mattress, fat and muscle. We can’t be sure because we cannot ’see’ inside the tissues — we can only imagine.

And how do you prevent pressure ulcers? Are you still repositioning patients every two hours (or three or four?) Perhaps some of your patients don’t get repositioned at all on a busy shift.

You may be fortunate to have alternating pressure air mattresses (APAM) and chair cushions that will relieve pressure to all parts of the body, every few minutes, for all your patients. That really does help!

There is so much to read on this fascinating subject but I bet you, like me, just don’t have time to search all the literature for the right information. And how do you know what is right? Well you can reduce your reading time from hours to minutes each week and still learn lots about pressure ulcers…real common sense information! Because all it takes to prevent pressure ulcers is common sense. It really is a very simple concept described in a paper that will open a window into this intriguing topic.

WHAT’S THE PAPER?

‘A discourse on pressure ulcer physiology: the implications of repositioning and staging’
by Sharp & McLaws October 2005
WHERE DO I FIND THIS?

Just go to the World Wide Wounds site and you can download the paper for free: www.worldwidewounds.com

Or Click on this link to go directly to the paper

A discourse on pressure ulcer physiology: the implications of repositioning and staging by CA Sharp, M-L McLaws

I trust it will give you answers but what I hope it will do more than anything is provoke great debate in your wound care groups and with your colleagues.

Hydrocolloid Dressings & Caterpillar Spikes

I just love Sydney in the summertime! I bet you find summer glorious too, no matter which hemisphere you live in right now. It is a perfect time to go bare-foot everywhere. But often times hidden in the grass, basking in the sun, are furry, stinging caterpillars which, when stood on, detonate hundreds of tiny spikes into the sole of your foot. This stops you dead in your tracks because it is not only excruciatingly painful but the spikes make it impossible to walk.

You can pick the spikes out one at a time with tweezers but this can take forever and the pain is still searing!

One really easy way to reduce the pain and remove all those stinging furry spikes at the same time is to stick a hydrocolloid dressing over the sole of the foot. Make sure you cover the spiked area, with a good margin around – say 3-4 cms., and lay back and relax for a while, allowing your body heat (and/or sun) to soften the hydrocolloid dressing. The dressing will adhere firmly to the spikes and the soles of your feet. For best results leave on as long as practical… overnight is good; two to four days is better.

When you peel off the hydrocolloid, which may well have turned into a gluggy, sticky, jelly and custard-looking substance all the spikes should be embedded in the hydrocolloid!! Wash your feet – you can repeat the process if spikes still remain in the skin – and remember to wear thongs or sandals.

Why not pass this on to your colleagues working in emergency departments. You can use this process for other areas of the body that get spiked too.

Gravel rash and hydrocolloids ‘step-by-step.’

Gravel rash…adults and kids get it — falling off a bike or skateboard- sustaining nasty grazes. OUCH!!! What looks like such a superficial wound can be absolute agony for days.

Critical to pain reduction in the management of these wounds is knowing what wound dressing will give the best results, as well as being the most cost-effective, BUT how often does some well-meaning person ‘paint’ the bleeding graze with a coloured antiseptic solution and cover it with dry gauze – and how painful it is to remove!! The gauze hardens and it can take many hours of soaking and gentle pulling –amidst tears, squeals and fresh bleeding, to remove it.

Here’s how you can make it easier for yourself and your patients with a cost effective, secure, dressing that is like a second skin’ and will not stick to the wound surface?

Step by Step

1. wash the grazed area –under the shower is fine if your water is clean – picking out as much gravel and dirt as you can.
2. pat the grazed area dry, especially the surrounding skin.
3. apply a hydrocolloid dressing over the graze with a large margin around the edges of the wound.
4. if the graze is over a joint, i.e. the knee, you can use two or more pieces, overlapped and/or make sure the joint is slightly bent.
5. press gently all around the margins of the hydrocolloid for a few minutes – the warmth of your hands will aid the adhesive process.
6. you will notice that there is immediate pain relief. This is because you have just covered all the nerve endings in the dermis.

When should the hydrocolloid dressing be changed?

‘A week or a leak’ is good to remember. The hydrocolloid dressing can stay in place for a week but you will often find that the exudate (leakage that looks like pus & may have an odour) starts to leak out before this time. Don’t be alarmed. It is unlikely to be pus. This exudate is quite normal. You will see bits of gravel in the jelly like exudate. Repeat steps 1-6 again until the exudate has ceased and there is new pink epithelial tissue. Most grazes will heal within 3 weeks or so. If there is increasing pain, fever, offensive smelling pus consult your doctor.