Wound care

JBMmom, MSN, NP · Dec 11, 2020

Every hospital is going to have their own protocols and lines of treatment options for wound care. It's important to pay attention to positioning and turns with the stage 1-2 to keep them from progressing but they certainly don't require much in the way of treatments.

I would probably leave a stage 1 open to air depending on whether it gets a lot of pressure than can't be alleviated and a stage 2 might get a mepilex. Off loading, measuring and documenting are the important part.

"nursy", RN · Dec 14, 2020

The most important thing I have found is offloading. When I had my first ICU job, we were meticulous about turning patients, and I mean turning them, and making sure they were ON THEIR SIDE. Never saw pressure ulcers, unless the patient came in from someplace else. Fast forward to my last ICU postion, the "turning" method was sticking a pillow under the patient's side, but the patient still ended up flat on their backs, just tilted a little because of the pillow. Somehow it was a big mystery to everyone why the patient's kept getting pressure ulcers.

mmc51264, BSN, MSN, RN · Dec 14, 2020

we have a hospital policy/protocol. I agree with the idea of offloading. I work in ortho and heels are one of the forgotten places. We have several items that help other than elevation with floated heels (waffle boots and gel pads).

MunoRN, RN · Dec 15, 2020

Quote

The most important thing I have found is offloading. When I had my first ICU job, we were meticulous about turning patients, and I mean turning them, and making sure they were ON THEIR SIDE. Never saw pressure ulcers, unless the patient came in from someplace else. Fast forward to my last ICU postion, the "turning" method was sticking a pillow under the patient's side, but the patient still ended up flat on their backs, just tilted a little because of the pillow. Somehow it was a big mystery to everyone why the patient's kept getting pressure ulcers.

The lateral side lying position actually poses the greatest risk of pressure ulcers since it produces the most concentrated pressure due to the iliac crest.

The position with best pressure distribution is a 30 degree lateral position (more flat than side lying), this distributes the weight more evenly over a larger area with more padding between the dermis and the bony prominences.

Obviously a 1 inch thick pillow isn't going to cut it, but 4-6 inches the amount of lift to achieve this optimal positioning for avoiding pressure ulcers.

**CalicoKitty, BSN, MSN, RN** · Dec 15, 2020

Stage 1 and 2 pressure injuries can reverse pretty quickly. A lot depends on moisture and repositioning. Zinc skin barriers/creams can be good if they are wet. If they are bony, adding a foam dressing can help (not if they are always wet and the dressing gets soaked).

And always repositioning and offloading. Make sure when you turn them, you're not sticking the pillow under their butt since that's keeping the pressure there.. Put wedges/pillows under thighs and lower back to give their bottom some 'breathing room'.

Change their position. get them out of bed for meals (if possible). Toilet the and get them back into bed! 2 meals a day, that can keep them dry and reposition pretty well. People eat more when sitting up, so an extra ounce of preventative nutrition!

"nursy", RN · Dec 15, 2020

15 hours ago, MunoRN said:

The lateral side lying position actually poses the greatest risk of pressure ulcers since it produces the most concentrated pressure due to the iliac crest.

The position with best pressure distribution is a 30 degree lateral position (more flat than side lying), this distributes the weight more evenly over a larger area with more padding between the dermis and the bony prominences.

That may be true in theory, but I can only tell you what I saw in practice. I worked in an ICU for 4 years where we had NO pressure ulcers using side positioning. Also it is critical to maintain the q2 hour schedule. If you keep someone on their side for more than 2 hours than that would probably be detrimental, but that is also true for any kind of position.