From the Guidelines
To treat a stage 2 pressure injury to the coccyx area, first clean the wound gently with saline or wound cleanser and pat the surrounding skin dry, then apply an appropriate dressing such as hydrocolloid or foam dressing, and relieve pressure on the coccyx by repositioning every 2 hours. The treatment of stage 2 pressure injuries, particularly in sensitive areas like the coccyx, requires careful consideration of the best evidence available to minimize morbidity, mortality, and improve quality of life. According to the American College of Physicians guideline on the treatment of pressure ulcers 1, the use of hydrocolloid or foam dressings is recommended to reduce wound size, as these have been shown to be effective in promoting healing and are cost-effective compared to other dressings like those containing platelet-derived growth factor (PDGF). Some key points to consider in the treatment include:
- Cleaning the wound gently with saline or wound cleanser and patting the surrounding skin dry.
- Applying an appropriate dressing such as hydrocolloid, foam, or transparent film dressing, changing it according to the manufacturer's recommendations or when soiled.
- Relieving pressure on the coccyx by repositioning every 2 hours, using pressure-redistributing surfaces like specialized mattresses or cushions, and avoiding direct pressure on the wound.
- Maintaining good nutrition with adequate protein, calories, and hydration to support wound healing, as nutritional supplementation with protein or amino acids has been shown to reduce pressure ulcer wound size 1.
- Monitoring the wound regularly for signs of infection, such as increased pain, redness, warmth, swelling, odor, or drainage, and consulting a healthcare provider if these occur.
- Keeping the area clean and dry, especially after toileting, to prevent contamination. These measures work by removing dead tissue, maintaining a moist healing environment, reducing pressure that impairs blood flow, and providing nutrients necessary for tissue repair. Complete healing typically takes 2-3 weeks with proper care, but can vary based on the individual's overall health status. It's also important to note that while electrical stimulation has been shown to accelerate wound healing compared to control, the evidence for its superiority in achieving complete wound healing is insufficient 1. Therefore, a comprehensive approach that includes wound care, pressure relief, nutritional support, and regular monitoring is crucial for the effective treatment of stage 2 pressure injuries to the coccyx area.
From the Research
Treatment Options for Stage 2 Pressure Injuries to the Coccyx Area
- The treatment of stage 2 pressure injuries to the coccyx area can be managed with various types of dressings, including foam dressings, hydrocolloid dressings, and sterile gauze dressings 2, 3, 4, 5, 6.
- A systematic review and network meta-analysis found that moist dressings, such as hydrocolloid and foam dressings, were more advantageous than traditional dressings, with hydrocolloid dressings showing a higher cure rate than sterile gauze dressings and foam dressings 2.
- Another study found that foam dressings were associated with the least healing time and required fewer dressing changes compared to other types of dressings 2.
- A Cochrane review found that the certainty of evidence for the effectiveness of foam dressings in treating pressure injuries was low to very low, making it difficult to draw comparisons between foam and other dressings 3, 6.
- A study comparing hydrocolloid and saline gauze dressings found that hydrocolloid dressings performed better in terms of adherence to the wound bed, exudate handling ability, overall comfort, and pain during dressing removal 5.
Dressing Comparison
- Hydrocolloid dressings have been shown to have a higher cure rate than sterile gauze dressings and foam dressings 2.
- Foam dressings have been associated with the least healing time and require fewer dressing changes compared to other types of dressings 2.
- Sterile gauze dressings have been found to have a lower cure rate compared to polymeric membrane dressings and biological wound dressings 2.
Considerations for Treatment
- The choice of dressing should be based on the individual patient's needs and the specific characteristics of the pressure injury 2, 3, 4, 5, 6.
- Clinicians should carefully consider the lack of robust evidence in relation to the clinical and cost-effectiveness of foam dressings for treating pressure injuries when making treatment decisions 3, 6.