Chronic Tissue Injury

[Patrick Williams]

I’m wondering if any experts out there can help me. I have a patient in home care that has a deep purple blanchable area to the bilateral buttocks with scattered areas of abrasion and scattered areas of ridges. Over the past few weeks it has neither improved or deteriorated. 
 

I just recently read an article on a new type of injury/wound called Chronic Tissue Injury but I can find a treatment for it. Currently I’m just using a sacral foam dressing to provide pressure relief and instructing the patient to get up frequently throughout the day. But is there anything else I can do. 
 

https://nursing.ceconnection.com/ovidfiles/00152192-201905000-00003.pdf

if anyone is interested in the article. 
 

thank you

[vampiregirl, BSN, RN]

Based on the description, sounds like you've already identified pressure and shearing as concerns that need addressed... So skin care, protection and pressure offloading are all appropriate strategies even if the exact type of tissue injury isn't able to be defined. 

Other ideas would be to look at nutrition/ hydration status, education on getting up without causing further shearing (would PT be appropriate for this patient?) and are pressure relieving surfaces in place (cushions, mattress etc)? Is the patient aware to reposition frequently when in a chair? 

Interesting article. The article notes that no evidence of confirmation for this condition was noted during a literature review but also acknowledges that since this is a newly identified phenomenon that cases would be characterized under other recognized wound types. It will be interesting to see if this gets officially recognized/ defined in the future.

https://www.internationalguideline.com/guideline

 

[Patrick Williams]

Thank you. Yes we’ve discussed nutrition and to shift position while sitting. The patient is ESRD on HD so healing is always difficult. I was just hoping I was missing something else we could do. 

[Kittypower]

Would they be allowed to take a Roho cushion to sit on during dialysis? It would also help outside of dialysis, but I know that the ability to move around is limited during dialysis.