From the Guidelines
Before turning a patient with a stage 3 sacral pressure injury (PI), the nurse should first ensure the patient is positioned off the affected area using tools for discharge, such as cushions, foam, or pillows, to avoid interosseous contact and utilize high-level prevention supports like air-loss or dynamic mattresses to prevent further pressure ulcer development, as recommended by recent guidelines 1. The nurse should assess the wound thoroughly, documenting its size, depth, appearance, drainage, and surrounding tissue condition, and gather all necessary supplies including clean gloves, wound dressing materials, and positioning aids.
- Key considerations include:
- Administering pain medication 30 minutes prior to the procedure if ordered, as manipulation of the area will likely cause discomfort
- Ensuring adequate staff assistance is available for safe patient handling
- Maintaining proper hand hygiene and sterile technique throughout the procedure to prevent infection
- Preparing to clean the wound with normal saline or prescribed wound cleanser and apply the appropriate dressing according to the wound care plan after repositioning This comprehensive preparation helps prevent further tissue damage, reduces pain, and promotes optimal conditions for wound healing, in line with strategies for preventing pressure ulcers in patients with spinal cord injuries 1. The use of early mobilisation, visual and tactile checks of all areas at risk, and repositioning every 2-4 hours with pressure zone checks, as outlined in the French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury 1, should also be prioritized to prevent the development of pressure ulcers.
From the Research
Pre-Breeding Care for Patient with SCI and Stage 3 Sacral Pressure Injury
- The nurse should prioritize preventing further pressure injury and promoting a clean environment for the patient's sacral area before breeding.
- According to 2, the use of a multi-layer foam dressing or a gel mattress can be considered to reduce the risk of sacral pressure ulcers in patients with spinal cord injuries.
- However, the study 2 found that the occurrence of sacral pressure ulcers was similar between patients receiving the dressing and those using the gel mattress.
- It is essential to note that patients with complete tetraplegia receiving the preventive dressing had a higher incidence of sacral ulcers (82%) compared to those using the gel mattress (36%) 2.
- The nurse should also consider the patient's overall positioning and mobility to minimize the risk of pressure injuries, as discussed in 3.
- Additionally, the nurse may consider using prophylactic dressings, such as silicone foam border dressings, to reduce the incidence of pressure injuries, as proposed in 4 and 5.
- The nurse should follow the hospital's protocol for wound care and pressure injury prevention, and consult with the healthcare team to determine the best course of action for the patient's specific needs.