How to safely transfer a Spinal Cord Injury (SCI) patient with a pressure ulcer (decubitus ulcer) without exacerbating the wound?

From the Guidelines

To safely transfer a spinal cord injury (SCI) patient with a decubitus ulcer, use proper positioning and equipment to avoid pressure on the wound, as recommended by the American College of Physicians guideline 1. When transferring a patient with a decubitus ulcer, it is crucial to prioritize techniques that minimize pressure and shear forces on the wound.

Key Considerations

• Identify the exact location of the ulcer and ensure it remains completely offloaded during transfers.
• Use a sliding board placed away from the wound site, and consider a transfer sling or mechanical lift for patients with larger or sacral wounds.
• Maintain proper body mechanics with a wide base of support and bend at the knees rather than the waist.
• Provide adequate padding with specialized cushions like ROHO or Jay cushions on all surfaces the patient will contact.
• For bed transfers, use a draw sheet to slide rather than drag the patient, and consider using a low-friction transfer sheet. Some of the key evidence-based recommendations for preventing pressure ulcers include:
• Using advanced static mattresses or advanced static overlays in patients who are at an increased risk of developing pressure ulcers, as they are associated with a lower risk for pressure ulcers compared with standard hospital mattresses 1.
• Avoiding the use of alternating-air mattresses or alternating-air overlays in patients who are at an increased risk of developing pressure ulcers, as the current evidence does not show a clear benefit for pressure ulcer prevention using these devices compared with static mattresses and overlays 1.

Implementation

Establish a turning schedule (typically every 2 hours) to relieve pressure when the patient is in bed or seated. Keep the patient's skin clean and dry, checking the wound site after each transfer for any signs of deterioration. These approaches work by eliminating shear forces and pressure that would otherwise damage fragile healing tissue and potentially enlarge the wound or introduce infection. Proper transfer techniques not only protect the wound but also maintain the patient's dignity and independence during the healing process. By following these evidence-based guidelines, healthcare providers can minimize the risk of exacerbating the wound and promote optimal healing outcomes for SCI patients with decubitus ulcers.

From the Research

Safe Transfer of SCI Patients with Pressure Ulcers

To safely transfer a Spinal Cord Injury (SCI) patient with a pressure ulcer, it is essential to consider the following factors:

• Avoiding further pressure on the affected area to prevent exacerbating the wound 2, 3
• Using proper positioning and repositioning techniques to reduce pressure on the skin 3
• Implementing pressure relief maneuvers to minimize the risk of skin breakdown 3

Pressure Ulcer Prevention and Management

Prevention of pressure ulcers is crucial, and this can be achieved through:

• Regular skin checks to identify areas at risk 4
• Frequent change of position to reduce pressure on bony prominences 2
• Education on pressure ulcer prevention and management for both patients and caregivers 3

Surgical Intervention

In some cases, surgical intervention may be necessary to treat decubitus ulcers in SCI patients:

• Surgical treatment can help eliminate existing decubitus ulcers and improve the quality of life for patients with spinal cord injury 5
• Early necrotomy is important for the adequate treatment of decubitus ulcers 4

Transfer Techniques

When transferring an SCI patient with a pressure ulcer, consider the following:

• Avoid the 90° lateral position due to high pressures and PU risk over the trochanters 3
• Use recline and tilt to redistribute pressure during sitting, but be aware of the increased risk of shear forces on the skin 3