What are the management options for pressure ulcers?

Management Options for Pressure Ulcers

The management of pressure ulcers requires a comprehensive approach including risk assessment, support surface selection, repositioning, wound care, nutritional support, and adjunctive therapies, with advanced static mattresses or overlays being the recommended support surface for patients at risk of developing pressure ulcers. 1, 2

Risk Assessment and Prevention

• Perform risk assessment to identify patients at risk of developing pressure ulcers using validated tools such as:

  • Braden Scale
  • Norton Scale
  • Waterlow Scale
  • Cubbin and Jackson Scale 1

• Risk factors to assess:

  • Older age
  • Black race or Hispanic ethnicity
  • Lower body weight
  • Cognitive impairment
  • Physical impairments
  • Comorbidities affecting tissue integrity (incontinence, diabetes, edema, poor circulation)
  • Hypoalbuminemia and malnutrition 1

Support Surface Selection

• Use advanced static mattresses or overlays for patients at increased risk (strong recommendation, moderate-quality evidence) 1

  • More effective than standard hospital mattresses
  • Cost-effective compared to alternating-air systems
  • No specific brand has been shown to be superior

• Avoid alternating-air mattresses or overlays (weak recommendation, moderate-quality evidence) 1

  • No clear benefit over static mattresses
  • Significantly higher costs
  • Lower-cost support surfaces should be preferred

• For seated patients, use advanced static cushions with high specifications and viscoelastic properties to redistribute pressure 2

Repositioning Protocol

• Implement regular repositioning every 2-4 hours 2, 3
• Use 30-degree tilted positions to relieve pressure on vulnerable areas 2
• Consider 4-hour turning intervals when using viscoelastic foam mattresses, which has shown significant reduction in pressure ulcer development compared to more frequent turning on standard mattresses 3

Wound Care and Dressing Selection

• Select dressings based on wound characteristics:

  • Hydrocolloid dressings: For wounds with minimal to moderate exudate 2
  • Foam dressings: For wounds with moderate exudate 2
  • Alginates/hydrofiber dressings: For wounds with heavy exudate 2

• Ensure dressing covers are breathable and moisture-wicking to prevent skin maceration 2

• Perform daily wound inspection and documentation of wound characteristics 2

• Monitor for signs of infection (spreading cellulitis, systemic signs) 2

Nutritional Support

• Provide adequate protein intake (1.2-1.5 g/kg/day) to enhance tissue integrity and healing 2
• Consider protein-containing supplements to improve wound healing 2
• Ensure adequate hydration 2

Adjunctive Therapies

• Consider electrical stimulation as an adjunctive therapy for stage 2 pressure ulcers (moderate-quality evidence) 2
• Negative pressure wound therapy may be beneficial for deeper wounds 2
• Systemic hyperbaric oxygen therapy may be considered for poorly healing wounds 2

Multicomponent Approach

• Implement multicomponent interventions which have been shown to improve outcomes 1
• Key components of successful interventions:
  • Standardization of pressure ulcer-specific interventions and documentation
  • Multidisciplinary team involvement
  • Designated skin champions for staff education
  • Ongoing staff education
  • Sustained audit and feedback 1

Common Pitfalls and Caveats

• Failure to address underlying causes will result in poor healing outcomes 4
• Relying solely on dressings without addressing pressure relief is ineffective 4, 5
• Neglecting nutritional status can impair healing potential 6
• Inadequate staff training on proper repositioning techniques can lead to shearing injuries 5
• Overuse of expensive support systems without evidence of benefit increases healthcare costs unnecessarily 1
• Prevention is more effective and less costly than treatment - 95% of pressure ulcers are considered preventable 4