Pressure Ulcers

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DEFINITION

The National Pressure Ulcer Advisory Panel,U.S (NPUAP) defines a pressure ulcer as an area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis.

The terms decubitus ulcer (from Latin decumbere, “to lie down”), pressure sore, and pressure ulcer often are used interchangeably

PATHOPHYSIOLOGY

In 1873, Sir James Paget described the production of pressure ulcers remarkably well, and his description is still quite accurate today.

Many factors contribute to the development of pressure ulcers, but pressure leading to ischemia and necrosis is the final common pathway.

Pressure ulcers result from constant pressure sufficient to impair local blood flow to soft tissue for an extended period. This external pressure must be greater than the arterial capillary pressure (32 mm Hg) to impair inflow and greater than the venous capillary closing pressure (8-12 mm Hg) to impede the return of flow for an extended time.Tissues are capable withstanding enormous pressures for brief periods, but prolonged exposure to pressures just slightly above capillary filling pressure initiates a downward spiral toward tissue necrosis and ulceration.

Other factors contributing to pressure ulcers include-

• Friction

Friction is the resistance to motion. It may occur when the skin is dragged across a surface, such as when you change position or a care provider moves you. The friction may be even greater if the skin is moist. Friction may make fragile skin more vulnerable to injury.

• Shear

Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.

 SITES

The areas most susceptiblle to pressure in recumbent position include:

• SUPINE : 

1. Occiput
2. Scapulae
3. Vertebrae
4. Elbows
5. Sacrum
6. Coccyx
7. Heels

• PRONE :

1. Ears (head rotated)
2. Shoulders (anterior aspect)
3. Illiac crest
4. Male genital region
5. Patella
6. Dorsum of feet  

• SIDE-LYING -   

1. Scapulae
2. Vertebrae
3. Elbows
4. Sacrum
5. Coccyx
6. Heels
7. Ears
8. Shoulders (lateral aspect)
9. Greater trochanter
10. Head of fibula
11. Knees (medial aspect from contact between knees)
12. Lateral malleolus
13. Medial malleolus (contact between malleoli)

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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Resources

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