Recommended Sitting Time for Individuals with Pressure Ulcers
Individuals with pressure ulcers should be repositioned every 2-4 hours when sitting, with regular pressure zone checks, even when using specialized cushions. 1
Risk Assessment and Monitoring
- Patients with pressure ulcers require visual and tactile checks of all areas at risk at least once a day 1
- Common pressure ulcer locations include the sacrum (39%), heels (13%), ischium (8%), and occiput (6%) 1
- Risk factors include older age, black race or Hispanic ethnicity, lower body weight, cognitive impairment, physical impairments, and comorbidities that affect tissue healing 1
- Regular skin assessment should be performed every time patients have been repositioned or after sitting 1
Sitting Time Guidelines
- Repositioning every 2-4 hours with pressure zone checks is necessary to prevent worsening of existing pressure ulcers 1, 2
- Sitting creates higher interface pressures than lying due to the smaller surface area supporting body weight 3
- Poor sitting posture can lead to development of pressure ulcers on buttocks, sacrum, greater trochanter, and heels 3
- Prolonged sitting without repositioning significantly increases pressure ulcer risk, especially in immobile patients 4, 5
Support Surfaces and Equipment
- Advanced static cushions should be used for individuals at risk of developing pressure ulcers 1, 2
- Additional tools for pressure discharge (cushions, foam, pillows) should be used to avoid interosseous contact between bony prominences 1, 2
- Wheelchair cushions should be selected based on individual assessment of the location and severity of existing pressure injuries 2
- The American College of Physicians recommends advanced static support surfaces over alternating-air mattresses due to better evidence for effectiveness 1
Additional Preventive Measures
- Early mobilization should be implemented as soon as medically stable 1
- Skin should always be kept clean and dry, with special attention to the affected side 1
- Multicomponent interventions that include standardized pressure ulcer prevention protocols are recommended 1
- Special care should be taken when moving patients to avoid excessive friction or pressure 1
Practical Implementation
- Sitting time should be gradually increased as tolerance develops, starting with shorter periods 5
- Weight shifting or repositioning should be performed at least every 30 minutes when sitting for extended periods 4, 6
- Proper positioning in chairs is essential to distribute pressure evenly and avoid shear forces 3, 5
- Patient and caregiver education regarding proper skin care and repositioning techniques is crucial for prevention 1, 5
Common Pitfalls and Caveats
- Even with specialized cushions, regular repositioning is still necessary - cushions alone are insufficient 2, 3
- Failure to check skin condition after sitting periods can lead to undetected pressure damage 1
- Assuming that advanced support surfaces eliminate the need for repositioning is a dangerous misconception 1, 5
- Neglecting to assess the appropriateness of seating equipment for individual patients can increase pressure ulcer risk 3, 4