A Guide to Pressure Management and Care

A Guide to Pressure
Management and Care
Sitting or lying for long periods of time without changing your
position can cause pressure injuries.
What causes pressure areas?
Sitting or lying for long periods of time without
changing your position can reduce blood
supply, oxygen and nutrients to some areas of
your body. This can damage the skin and
underlying muscle, leading to a pressure injury
(PI) or ulcers.
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Poor hygiene
Excessively moist or dry skin
Long term illness
Being overweight or underweight
Diabetes
Medications such as sedatives
Dementia.
PI’s are most common over the heels, bottom,
elbows, shoulders, ears, and lower back. They
are serious and can sometimes cause
complications that may require hospitalisation.
What are the signs?
• Areas of redness on the skin
• Broken skin
• Skin numbness, tingling, discomfort or pain.
Who is at risk?
The elderly are particularly at risk, but PI’s can
occur at any age. You or the person you care
for may be at risk of developing a PI due to:
• Reduced independent mobility or paralysis
– unable to independently change sitting or
lying position
• People who are bed or chair bound
• Reduced activity
• Poor circulation
• Poor sensation
• Incontinence
• Poor nutrition and inadequate fluid intake
Check, check, check!
PI’s can begin to develop within hours. People
at risk should check their skin daily. People at
high risk should have their skin checked
several times each day. Report any changes
to a health professional immediately so
appropriate treatment can start as soon as
possible.
Prevention is always better than cure.
Guide to Pressure Management and Care
The Independent Living Centre provides a free and impartial
information and advisory service to help you choose the right
product for you
Almost all pressure injuries are preventable.
In addition to regular skin checks:
• Repositioning should be undertaken to
reduce time and amount of pressure over
vulnerable areas
• Ensure skin is clean, dry and well
moisturized. Use non-perfumed, non drying
pH balanced products and avoid massaging
or rubbing susceptible areas
• Manage incontinence problems – contact a
Continence Advisor for support
• Ensure clothing, sheets and cushion covers
are clean and wrinkle free
• Empty pockets in clothing
• Check that you are not lying or sitting on
other objects
• Be careful when getting into and out of bed
or transferring on and off other surfaces as
skin can be easily damaged
• Please refer to a health professional or the
National Pressure Ulcer Advisory Panel
www.npuap.org for further information
With advice from an Occupational
Therapist use appropriate equipment to:
Change position
Using, for example, a slide sheet, hoist, bed
rail, electric bed, and electric recliner lift chair
or electric wheelchair.
Reduce or relieve pressure
Using mattresses, overlays or cushions made
of special foam, air, gel or a combination of
these.
Protect the area
Use ear, elbow or heel protectors.
Only use the mattress or cushion cover
provided with the equipment as they are also
specialised for pressure care.
Pressure Redistributing Mattresses and
Cushions
Foam
Can conform to the body when sat or laid on,
however it insulates heat and does deteriorate
over time. Viscoelastic or memory foams
rebound more slowly when weight is removed
and conform better to the user than standard
elastic foams. Some mattresses and cushions
are laser cut to allow the foam to conform even
more and also increase airflow.
Gel/Fluid
Is a semi-solid substance that conforms well to
the body, it also features shear reduction
properties. It draws heat away from the user,
however can be quite cold when first sat or laid
on. Usually viscous fluids are combined with
other materials e.g. foam to ensure that the
fluid is contained and so that it is not able to
“bottom out” as easily.
Air
Is generally the most conforming medium and
tends to be light in weight. Air products do
require regular maintenance and correct set
up. Adequate immersion is vital to achieve low
pressure (over inflation increases pressure).
They can also be more unstable surfaces
which should be considered for transfers and
posture.
Guide to Pressure Management and Care
Dynamic Air Devices
Consist of air filled cells connected to an
electrically powered pump which will inflate
and deflate alternate cells over a period of
time.
Factors to Consider
Comfort, Stability and Transfers…
• Always perform all transfers while trialling a
device to ensure that it does not reduce
independence.
These are available in:
• Overlays which sit onto an existing
mattress.
• Mattress replacement systems have a
larger cell depth and more complex cycle
patterns than an overlay.
• Rotation systems rotate the user from lying
on one side to the other, useful if the person
is immobile and has limited care.
• Low air loss systems that release air
through microscopic holes in order to
reduce heat and moisture on the skin.
• Self adjusting systems that automatically
adjust the pressure of the cells according to
the user’s weight and position. This is useful
if the user sits up in bed, as the cells under
the bottom will not “bottom out”.
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Monitor skin after use and comfort felt by
user during use.
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Consider whether the user will be able to
manage the maintenance of the device.
Consider which cover will best protect the
cushion, but also manage moisture, heat,
shear and friction.
Other Materials
Honeycomb-shaped polymer material has
some conforming properties, however due to
its construction it has holes in the material
which allow airflow and take heat and moisture
away from the body.
Other areas of the body that may require
protection include heels, elbows, and ears.
There is a range of products available
specifically for these areas of the body to
assist with preventing and managing pressure
sores.
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Choosing a Pressure Redistribution Device
is only one way of managing pressure,
however when use of a device is combined
with other strategies the user can
significantly reduce their risk.
Mattresses, cushions and other pressure
management equipment can be trialled or
hired through the Independent Living Centre.