From the Guidelines
Pressure injuries should be managed with a comprehensive approach that includes regular repositioning, use of pressure-redistributing surfaces, nutritional support, and appropriate wound dressings, as these interventions have been shown to reduce wound size and promote healing 1.
Key Interventions
- Regular repositioning every 2 hours to reduce pressure on bony prominences
- Use of pressure-redistributing surfaces such as specialized mattresses or cushions
- Nutritional support with adequate protein (1.25-1.5 g/kg/day) and calories to promote wound healing
- Appropriate wound dressings, such as hydrocolloid or foam dressings, to reduce wound size and promote healing
- Wound cleansing with normal saline and debridement of necrotic tissue as necessary
Adjunctive Therapies
- Electrical stimulation as an adjunctive therapy to accelerate wound healing, although it may not be suitable for frail elderly patients due to increased risk of adverse events 1
- Other adjunctive therapies, such as electromagnetic therapy, negative-pressure wound therapy, therapeutic ultrasound, and laser therapy, may be considered, although evidence for their effectiveness is limited 1
Considerations
- Daily skin inspection is crucial, especially for those with limited mobility
- Pain management may include topical lidocaine or systemic analgesics as needed
- Pressure injuries can have a significant impact on health status, quality of life, and healthcare costs, making prompt and effective treatment essential 1
From the Research
Definition and Prevention of Pressure Injury
- Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear 2
- Prevention of pressure injuries in critical care patients requires risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions 2
Role of Nutrition in Pressure Injury Prevention and Healing
- Nutrition plays an important role in the prevention and treatment of pressure injuries 3
- Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues 3
- Interventions for improving nutrition status and promoting pressure injury healing can be identified 3
Support Surfaces for Treating Pressure Injury
- There is no statistically significant effect on pressure injury size with low air loss devices compared with foam alternatives 4
- The current evidence base requires improvement by undertaking robust trials to ascertain which support surfaces are most effective for the treatment of pressure injuries 4
- An evidence- and consensus-based support-surface algorithm can help clinicians choose the most appropriate support surface for preventing or treating pressure injuries based on patient, nurse, and institutional considerations 5