Pressure Relief with Mattresses, Cushions and Repositioning
Wounds which are located over bony parts of the body are usually caused by pressure to the area. Common locations for this to occur are hips, buttocks, lower back, between the knees, heels, ankles, shoulders and elbows. This pressure is often complicated by the patient’s inability to sense the discomfort of this pressure due to paralysis or their inability to change position due to weakness.
Pressure may exist in various forms. Pressure applied while a body part rests against the mattress, while it presses against a chair, or while it touches another body part is enough to create a wound. Once the wound has formed, it is critical to remove this pressure in order for the healing process to occur.
The best way to have the wound to heal is to completely remove all pressure from the wound. However, this is not always possible. Instead, it is often necessary to compromise with the reduction of pressure, and the more reduction we can achieve, the better results we will have. It is quite safe to say that continuing to sit or lie on a wound which is located over a bony prominence will almost guarantee its failure to heal!
Pressure reduction may be achieved through the use of pressure relief equipment. Special beds, mattresses and wheelchair cushions are available, with a doctor’s prescription, to help reduce pressure at the bony areas. Foam block boots, splints and bed cradles may also be used to remove or reduce pressure from an area of the body, which has a wound or is at high risk for developing a wound.
In addition to using pressure relief equipment, it is also essential to change position frequently to limit pressure. Repositioning while sitting should occur approximately every 20 –30 minutes, and while lying approximately every 1 – 2 hours. While attempting to heal a wound, minimal time should be spent in a position, which bears weight over the wound.
Pressure relief equipment is never intended to replace the need for regular repositioning.
Ultimately, prevention is the best cure for pressure wounds. It is important to recognize that anyone who spends long periods of time in a wheelchair or bed, with minimal movement, is at high risk for developing a pressure wound. Inspecting skin several times each day for redness or open wounds, especially in bony areas is essential. Keep skin well maintained - dry skin should be moisturized, and wet skin should be kept dry with regular changing of absorbent pads and moisture barrier creams. Reduce friction by lifting, rather than dragging, when changing position. Also raise the head of the bed as little as possible, and only for short periods of time. Use pillows or foam wedges to keep knees and ankles from touching, and heels suspended off the bed.