A study from the Cleveland Clinic Journal of Medicine indicates that when it comes to treating pressure sore wounds, an “occlusive dressing” might be a patient’s best option. Occlusive dressings are air- and water-tight covers that retain some of the wound’s original moisture. Unlike traditional gauze dressings, which tend to cause pain when removed, occlusive dressings rarely cause secondary trauma.

“In both acute and chronic wounds, the principal function of a wound dressing is to provide a moist healing environment,” the study says. “Removal of [wound dressings] by aggressive scrubbing or drying has been shown to be detrimental.”

The study recommends that doctors not change occlusive dressings until they leak, a period typically lasting several days to three weeks. The study also indicates that saline-soaked gauze may be an acceptable alternative to occlusive dressings, as long as the gauze is not allowed to dry.

Among the key points of the study:

- 95 percent of pressure ulcers occur in the lower part of the body.

- The incidence of pressure ulcers is actually higher in acute care hospitals than in nursing homes.

- A great majority – 70 percent – of all pressure ulcers occur in people 70 years of age or older

- The use of catheters in incontinent patients greatly increases the risk of bed sores

- Healing occurs most rapidly when open bed sores are closed surgically

The study recommended that care staff turn patients every 1 1/2 hours, versus the usually standard two hour interval. Researchers also found that doctors should take great care in selecting preventative devices, which range pressure-relieving mattresses to manual movement from nurses and doctors. Proper preventative devices should ward off all bed sores, which vary in severity from stage 1 to stage 4.

PLAINSTONE.COM

In most cases, pressure sores are a preventable problem.  Pressure ulcers are a very painful and embarrassing condition, and all efforts should be taken to reduce the potential for developing sores.

These areas depend on whether you are bed-bound or use a wheelchair.  If you use a wheelchair, these areas include the buttocks, should blades, and backs of arms/legs.

If you are bed-bound these areas include your buttocks, back of your head, back of your ears, shoulders, backs of knees, ankles, and heels.  Any areas where there is a thin layer of tissue covering bone are more susceptible to bed sores.  Any time prolonged pressure prevented adequate blood flow to the tissue, a patient is at risk.

There are many factors that lead to the development of bed sores.  Some easy steps that can help prevent decubitus ulcers include:

• Ensuring adequate hydration and nutrition
• Keeping residents dry and clean (this is especially important for patients without bladder/bowel control)
• Turning / repositioning patients
• Performing skin checks (especially for patients with decreased sensation or mental awareness)
• Using pressure relieving devices

Pressure relieving devices include pressure relieving mattresses (air alternating mattresses, cushions), joint protectors heel pads, and wheelchair cushions.  These devices help redistribute pressure from places that are more susceptible to developing pressure sores.  Mattresses can inflate/deflated to reduce pressure on different areas of the body.  It is important that long-term care providers are adequately trained in using these devices, so they can take advantage of their full benefits.

Attention should be given to distribution of weight, posture, alignment, stability, and relief.  Pressure relieving devices are a helpful tool for long-term care providers, especially for residents who would otherwise require frequent turning, but they are not a substitute for quality care.

If you do develop a pressure sore, it is important to continue using pressure relieving devices, maintain a healthy diet, keep the wound clean to prevent infection, properly dress the wound, remove damaged tissue if the pressure ulcer is severe, and take antibiotics if the wound is infected.  If the pressure sore is severe enough, it might even require surgery.

Early detection is the most important step in treating pressure ulcers.  It is important to remember that each and every resident requires an individualized care plan that can determine what prevention treatment, if any, should be used.  The hope is that with adequate care, pressure sores can be prevented.

Sources:

MayoClinic: Bedsores

The Journals of Gerontology – Issues and Dilemmas in the Prevention and Treatment of Pressure Ulcers: A Review

Medline Plus: Pressure Sores

AHRQ: Pressure Ulcers in the Long-Term Care Setting

Nursing Homes Abuse Blog: Bed Sores – Not Just a Pain in the Butt, More Like an Uncontrollable Killer

Bed Sore FAQ: Are bed sores on the heels common?

A physician generally determines how frequently a bed sore should be measured and re-assesed on a formal basis.  Nonetheless, staff should note any rapid deterioration or unusual changes and bring the changes to the attention of a treating physician if warranted.

The healing time for a bed sore depends on the size and severity of the wound(s).  For example, a stage 1 bed sore may heal within a few days while a stage 4 bed sore may take several months or more. Patients suffering from severe bed sores may require years of medical treatment.  Unfortunately, some bed sores may never heal– especially when the person has other illnesses or is elderly.  There are no specific guidelines that can be used to predict whether an ulcer will be “non-healing.”

Despite the apparent benefits of using Clinitron beds, some facilities are slow to acquire this technology because these beds cost more than traditional models.

Clinitron is a trademark of Hill-Rom.  Below is a picture of a Clinitron bed from the companies website.

Amputation is the surgical removal of a limb or body part (arms, legs, feet, fingers, toes), usually to remove diseased tissue or relieve pain.  The amputation procedure is performed by an orthopedic surgeon in a hospital operating room under regional or general anesthesia.

The procedure varies depending on which limb is removed; however, all surgical amputations involve removing diseased tissue and constructing a stump, which will fit a prosthesis.  The procedure for an above-the-knee amputation includes: first cutting the skin and muscle layers, then clamping the major blood vessels and cutting them, then cutting the bone with a bone saw, and finally, the muscles are stitched together over the bone and the skin is closed over the wound.

The decision of how much of the limb to remove depends on how much tissue needs to be removed for proper healing, while saving as much of the healthy skin, blood vessels, and nerve tissue as possible for rehabilitative purposes.  One test that the surgeon performs to determine the health of the limb is the amount of blood flow to the affected region (measurement of blood pressure in the limb).

As with other major surgeries, amputation carries with it the same risks including complications with anesthesia, blood loss, and blood clots; however, infection is the main complication following surgery.  Amputation is a painful procedure, requiring treatment with pain medication and antibiotics post-surgery, and a hospital stay ranging from five to fourteen days, absent further complications.  Following surgery, the newly formed stump must be moved often to encourage circulation, with physical therapy commencing as soon as possible.  The rehabilitative process is a long process, especially for above the knee amputees.  The physical rehabilitation is often accompanied by grief counseling to help the patient cope with the sense of loss that comes with losing a limb.  Patients also often have phantom limb pain, which is very difficult to treat.  Amputation is a last resort for both physicians and patients, but in some cases, as with severe pressure sores (which are likely preventable), it becomes necessary.

Sources:
MayoClinic.com – Pressure Sores
Merck – Pressure Sores
Encyclopedia of Surgery – Amputation
Vascular Web – Amputation

Related:

A Graphic Example Of Nursing Home Negligence: Amputation Of A Leg Due To Untreated Bed Sores

DuoDerm dressings are impermeable to water vapor, oxygen and bacteria.  One of the reasons DuoDerm dressings are so popular is because they will not stick to the wound bed itself and can be removed without tearing the granulation tissue underneath. They are best applied to wounds that produce light to medium exudate or transudate (extravascular fluid with low protein content, a low specific gravity and low nucleated cell counts).  Depending on physician orders, DuoDerm dressings can be used on stage 1, 2, 3 and 4 bed sores.

The length of time a DuoDerm patch may be left on a wound is determined by the amount of moisture in the wound.  Under normal conditions, DuoDerm can be left on the wound for 3-4 days.  One of the advantages to using DuoDerm is that, unlike other dressings, it can be placed on wet wounds and wet surrounding skin and will remain in place due to the product’s ‘wet tact’.

Because DuoDerm essentially creates a moisture barrier, they should not be used on people with infected bed sores.  Under normal circumstances, wounds covered with DuoDerm are likely to develop a strong odor after several days.  The odor is consider to be a normal part of of the product.

The process uses a pressurized chamber filled with 100% oxygen where a person will sit or lay for a specified period.  The pressurized oxygen helps the body in its own natural healing process.  Hyperbaric oxygen therapy has been shown to help individuals with not only serious bed sores, but also complications such as gangrene, infection and osteomyelitis.

Despite the fact that flap reconstruction surgery provides an opportunity to help heal open wounds, there is a high risk of complications related to infection and the bodies rejection of the ‘flap’ skin and muscle.  In order to promote maximum healing, air mattresses and regular ‘turning’ should provided by caregivers during the post-operative period.

It should also be noted that the reconstructive flap does not generally allow sensation.

A colostomy is a major surgical procedure that involves cutting the colon into a shorter piece and bringing it through the wall of the abdomen.  A colostomy bag is attached to the end of the colon exiting the abdomen where fecal material is collected.  The end of the colon that leads to the rectum is closed off and becomes dormant.  Many colostomy procedures can be reversed, if and when they are no longer needed.

While the thought of a colostomy may be disheartening, for many people suffering from severe bed sores it is likely an essential part of the overall healing process.  Without a colostomy, many bed sore patients suffer from a systemic infection know as septicemia or sepsis.