Management of Stage 1 Pressure Ulcer to the Coccyx
For a stage 1 pressure ulcer over the coccyx, immediately implement complete pressure offloading using an advanced static mattress or overlay, reposition the patient every 2 hours using a 30-degree tilt position, and provide protein supplementation if nutritional deficiencies are identified. 1
Immediate Pressure Redistribution
Use advanced static mattresses or advanced static overlays as first-line pressure redistribution surfaces, as they provide adequate pressure relief at lower cost compared to alternating-air systems and are specifically recommended for stage 1 pressure injuries 1
Reposition the patient at least every 2 hours with special attention to offloading the coccyx completely 1
Apply a 30-degree tilt position rather than 90-degree lateral rotation to reduce pressure on bony prominences like the coccyx 1, 2
Avoid expensive alternating-air beds and low-air-loss mattresses at this stage, as evidence for their effectiveness is limited and they add unnecessary costs 1, 3
Skin Assessment and Monitoring
Perform risk assessment using the Braden Scale to identify factors that may cause progression 1
Assess the skin every shift and after each repositioning, being particularly attentive to the coccygeal area for signs of progression (increased redness, non-blanching erythema, or blister formation) 1
Keep the skin clean and dry at all times, manage any incontinence promptly, and avoid excessive friction or pressure when moving the patient 1
Nutritional Support
Assess nutritional status immediately, including body weight, body mass index, caloric counts, and serum protein levels 1
Provide protein or amino acid supplementation if nutritional deficiencies are identified, as this can reduce the risk of progression to higher stages 4, 1
High protein oral nutritional supplements (30 energy percent) can reduce the risk of developing new pressure ulcers (OR 0.75; 95% CI 0.62–0.89) 1
Prevention of Progression
Complete pressure offloading from the coccyx is essential to prevent advancement to stage 2 or higher 1
Address any conditions that may exacerbate pressure injury development, such as urinary tract infections, fecal incontinence, or other acute illnesses 1
Educate the patient and family members regarding proper skin care and repositioning techniques 1
Common Pitfalls to Avoid
Do not delay nutritional assessment, as 50% of severe stroke survivors are malnourished at 2-3 weeks, increasing the risk of pressure ulcer progression 1
Avoid using advanced support surfaces like low-air-loss beds without clear indication, as evidence for their effectiveness at stage 1 is limited 1
Do not apply topical dressings or agents at stage 1, as the skin is intact and these interventions are reserved for stage 2 or higher ulcers 3, 5
Monitoring for Progression
If the area does not improve or progresses despite optimal management within 2 weeks, reassess all risk factors and interventions 1
Risk factors that increase vulnerability to progression include older age, immobility, cognitive impairment, diabetes, incontinence, and malnutrition 1
Watch specifically for development of blistering, skin breakdown, or non-blanching erythema, which would indicate progression to stage 2 5