Stage 1 Coccyx Pressure Injury Treatment
For a Stage 1 coccyx pressure injury, implement immediate pressure redistribution using an alternative foam mattress or Australian sheepskin, combined with repositioning every 2-4 hours, daily visual and tactile skin checks, and early mobilization as soon as medically feasible.
Pressure Redistribution Devices (Primary Intervention)
Use an alternative foam mattress as the first-line support surface, which reduces pressure ulcer incidence by 69% compared to standard hospital mattresses 1. Alternative foam mattresses provide superior pressure redistribution for the sacral/coccyx region and represent moderate-quality evidence for prevention 1.
Alternative effective options include:
- Australian sheepskin overlays reduce pressure ulcer incidence by 58%, though they may bunch up in bed and require proper cleaning to prevent infection 1
- Alternating pressure mattresses reduce grade 1-2 pressure ulcer incidence by 71%, though evidence quality is lower than for foam mattresses 1
For high-risk patients, apply preventative dressings to the sacral area in addition to support surfaces 2.
Repositioning Schedule
Reposition the patient every 2-4 hours with pressure zone checks 3, 4. The specific frequency depends on risk level:
- Low-risk patients: repositioning at least every 4 hours 2
- Moderate-risk patients: repositioning every 2 hours 2
- High-risk patients: repositioning every 2 hours 2
Use a 30° tilt position rather than 90° lateral rotation when repositioning, as this reduces pressure on bony prominences like the coccyx 5. A 4-hourly turning schedule with a viscoelastic polyurethane foam mattress may be as effective as more frequent 2-3 hourly turning with standard foam 1.
Skin Assessment and Monitoring
Perform visual and tactile checks of the coccyx area at least once daily 3, 4. Stage 1 pressure injuries present as non-blanchable erythema of intact skin, representing the earliest warning sign requiring immediate intervention 1.
Use discharge tools (cushions, foam, pillows) to avoid direct bone-to-surface contact when positioning 3, 4.
Early Mobilization
Initiate early mobilization as soon as the spine is stabilized and the patient is medically stable 3, 4. Early mobilization is a cornerstone of pressure injury prevention and should not be delayed 3.
For patients who can sit, provide a pressure-redistributing cushion to offload the coccyx area 2.
Incontinence Management (If Applicable)
If the patient has urinary or fecal incontinence:
- Use a pH-balanced cleanser rather than soap and water for perineal care, which reduces pressure ulcer incidence in incontinent patients 1
- Implement a structured skin care protocol to maintain skin integrity 1
- Use disposable incontinence pads to manage moisture 2
Common Pitfalls to Avoid
- Do not delay implementation of pressure redistribution devices—standard hospital mattresses are inadequate for patients with existing Stage 1 injuries 1
- Do not rely solely on repositioning without appropriate support surfaces, as the combination is more effective than either intervention alone 1
- Do not use 90° lateral positioning, which places excessive pressure on the sacrum and coccyx; use 30° tilt instead 5
- Do not neglect daily skin assessment, as Stage 1 injuries can rapidly progress to deeper tissue damage without intervention 3, 6