Pressure Area Care

What is Pressure Area Care?

Pressure Area Care(PAC) refers to the redistribution of pressure so that no pressure is applied to the skin. Ongoing and continued pressure to the skin, especially whilst being immobile and/or bed bound can lead to pressure sores and pressure ulcers. The redistribution of pressure is usually done by moving immobile and bed bound Patients from one position to another, but also by regularly inspecting the skin, especially skin areas that are particularly prone for pressure sores such as the lower back, sacrum, buttocks, back of the head, back of the shoulders, but any other skin area that sustains pressure for too long is at risk to develop a pressure sore or a pressure ulcer.

  • What is a pressure area?
  • What is done?

These pictures of different types of special ‘pressure relieving’ mattresses or beds were found on the Web using a Google search.

What is a pressure area?

Pressure areas are localized injuries to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Most commonly this will be the sacrum, heels or the hips, but other sites such as the elbows, knees, ankles or the back of the head can be affected. The cause of pressure areas/ulcers is pressure applied to soft tissue so that blood flow to the soft tissue is completely or partially obstructed. Shear and friction are also causes; shear and friction pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in persons who are not moving about or are confined to the bed or to wheelchairs. Intensive Care Patients therefore are particularly at risk when it comes to developing a pressure sore.

Although often prevented and treatable if found early, pressure sores/ulcers can be very difficult to prevent in critically ill Patients, frail elders, wheelchair users (especially where spinal injury is involved) and terminally ill Patients. Primary prevention is to redistribute pressure by turning the Patient regularly. In addition to turning and re-positioning the patient in bed or wheelchair, eating a balanced diet with adequate protein and keeping the skin free from exposure to urine and stool is very important.

Risk factors for Pressure Ulcer development include

  • Poor physical condition
  • Poor mental condition
  • Immobility and paralysis(prolonged surgery)
  • Being restricted to either sitting or lying down
  • Urinary and fecal incontinence
  • Malnutrition and obesity
  • Age
  • Smoking
  • high level nursing care
  • Slipping down the bed and trying to sit back up again
  • hypotension(Low blood pressure)
  • Hypoxaemia(low oxygen levels)
  • Some drug treatments, especially inotropes such Adrenaline and Noradrenaline
  • Sedation in Intensive Care for induced Coma

What is done?

The most important methods to prevent pressure sores include

  • Regularly turning the immobile Patient in a different position, ideally every 2 hours, to restore circulation and oxygenation
  • Regular inspection of high risk skin areas
  • Regular skin care of high risk skin areas, i.e. washing skin, moisturising skin, rubbing skin
  • Use of Pressure Area Care devices such as a soft mattress, gel pads, heel wedges, pillows
  • Early mobilisation
  • use of special care beds that automatically rotate from one side to another in intervals

Some Patients in Intensive Care are at high risk to be moved, as they are very unstable and any movement can negatively impact on their clinical or haemodynamic stability, resulting in low blood pressure, abnormal heart rate, lack of oxygen etc… In these Patients Pressure area care has to be done quick and it also has to be weighed up on whether PAC or clinical stability is more important.

If your loved one has a spinal injury he or she may not be able to be moved and when allowed, turning or lifting requires special procedures such as a log roll(4 person roll) or spinal lift.

Any questions

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.

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