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How to Prevent and Recognize Pressure Injuries

November 20, 2019

Pressure injuries are the most common secondary complication of a spinal cord injury, so understanding how to prevent them from happening and recognize them if you have one is critical to maintaining your health. To help you feel empowered and knowledgeable, we’ve put together information on how to best take care of yourself or someone in your care.

What is a pressure injury?

Pressure injuries, also known as pressure sores, skin sores or bedsores, are areas of damaged skin that are caused by constant pressure breaking down skin layers. They usually happen at places on the body where the bones are close to the surface and don’t have much natural padding or protection, like the back of the head, ears, shoulder blades, elbows, the sacrum or tail bone, hip bones, the ischials or sitting bones, knees, ankles, or the heel.

People without the ability to move around or feel their body may spend a lot of time in a wheelchair or in bed, and they may not sense when the pressure of something against their skin like clothing, bedding or hard objects, such as cells phones or tubing, is irritating their skin. This can lead to pressure injuries.

How do I prevent a pressure injury?

To prevent pressure injuries, care of your skin must be ongoing and include some daily routines that protect your skin and catch signs of an issue before it becomes a painful and difficult pressure injury.

Some important routines to integrate into your life that help prevent pressure injuries are:

  1. Practicing routine skin inspections
  2. Turning in bed at regular times
  3. Padding parts of your body to remove pressuer from bony areas
  4. Keeping your heels off the bed
  5. Considering a specialized mattress designed to reduce pressure
  6. Practicing frequent weight shifts while in your wheelchair

Regular skin inspections are key to identifying issues before they become a real problem, so it’s important to practice frequent checks of your body, paying extra attention to the typical problem areas mentioned in the previous section, such as the heel, shoulder blades, the tail bone, etc. When practicing skin inspections, keep these tips in mind:

  1. Look for any changes in skin color or texture.
  2. Do skin inspections at least twice a day, in the morning and evening.
  3. Use your eyes and hands to check your skin for changes.
  4. Practice skin checks after before getting out of bed and after getting out of your chair.
  5. If you find a pressure injury, find the cause and eliminate it.
  6. You can use a mirror or your smartphone to help with your skin check.
  7. If you need assistance, ask your caregiver to help.

Turning regularly in bed is important for preventing pressure injuries on parts of your body that touch your mattress while you sleep. If you are unable to move yourself while you’re in bed, you should have a turning schedule. A few things to consider when creating your turning schedule:

  1. Turn to a different position every two hours.
  2. Have a nurse or therapist teach you how to place padding to decrease pressure on high risk areas when you turn.
  3. Don’t forget to pad your heels so they don’t touch the bed.
  4. Turn times can be extended depending on how your skin looks, even up to six hours. Do not go more than six hours without changing positions.

Similar to turning regularly in bed to prevent pressure sores, it’s very important to practice weight shifts while in your wheelchair. There are many pressure points between your body and your chair that you want to relieve on a regular basis. Weight shifts should be done very 15 to 30 minutes. Your therapist can help you determine the best kinds of shifts for your body and equipment and how to build up skin tolerance for pressure. Each person’s routine should be unique to their needs.

In addition to these daily routines to integrate into your life, there are a few other healthy choices that you can make that will help keep your skin safe and more resilient. First of all, when deciding what clothing to wear, choose items that do not bind against your skin or have heavy seams and shoes that are two sizes larger than your usual size. Use the “1-4-8 rule” when wearing new clothing items. Before wearing new clothing for the entire day, put the new clothing item on and check your skin after one hour. If your skin is not reddened or irritated, check after four hours. If after four hours your skin remains free of redness and appears normal, continue wearing the new clothing and check at the end of the day to ensure that it is not causing skin breakdown.

Additionally, make sure that you are eating a healthy diet. When it comes to skin health, you want to make sure that you regularly eat protein because it is the main nutrient that assists in the repair of body tissues and wounds. You can find protein in meats, cheeses, fish, yogurt and beans. Drinking 2 to 3 liters of water a day is also encouraged since water helps keep your skin soft and pliable, meaning that minor bumps or scrapes will be less damaging. Use lotions to keep your skin moisturized and sunscreen when you expect to be outside for extended periods.

How do I recognize a pressure injury?

The earlier pressure injuries are found, the faster they can be treated and the earlier you can get back to your daily life. If you are following all of the prevention tips outlined in this article, then you are doing the best you can to keep your skin healthy and safe. But it’s still possible to get a pressure injury, so you will want to know how to spot one.

Pressure injuries are classified in stages 1-4, and they are based on the amount of tissue damaged and how severe that damage is. Stage 1 is the beginning of a pressure injury when the skin has changed color because of too much pressure, and if caught, there is a good chance that the damage can be reversed. Stages 2 through 4 are progressively more serious injuries that require immediate medical attention.

For an in-depth look at the four stages of pressure injuries, watch our video:

Please be advised: This video contains detailed medical images of wounds that may be difficult for some to view.