Bedsores – when are they at risk, how to treat and prevent them?

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Healthy people associate bed with rest and regeneration of the body. Unfortunately, this is not always the case. Seriously ill people who have to stay in bed for a long period are exposed not only to ailments related to the underlying disease, but also to pain and suffering caused by pressure ulcers.

Bedsores – definition

Pressure ulcers arise as a result of constant pressure on arterial and venous vessels, which causes local ischemia and, as a result, tissue necrosis. Difficult to heal, open wounds, which are prone to infections, develop. Sometimes it takes as little as 2–3 hours without movement for a pressure ulcer to develop. On the other hand, treatment of pressure ulcers, despite the progress in medicine, is a very difficult process, lasting from several to several months and not always effective. Therefore, patients who are immobilized in bed must have anti-bedsore prophylaxis introduced immediately, because it is better to prevent than to cure.

A decubitus ulcer is nothing more than a limited tissue necrosis resulting from blood circulation disorders caused by prolonged or repeated pressure exerted on the patient’s body and, consequently, on the venous and arterial vessels. This condition can affect the epidermis, the entire thickness of the skin, subcutaneous tissue, as well as muscles and bones.

The area surrounding the pressure ulcer is usually inflamed and there is often a recess with purulent discharge reaching in various directions, sometimes over a considerable distance. The problem of bedsores concerns mainly bedridden people with mobility difficulties. As a result of prolonged pressure on the skin and subcutaneous tissue and the action of abrasive forces, patients may suffer from disturbances in blood circulation, and then cell death, tissue necrosis and even ulceration.

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Factors contributing to the formation of pressure ulcers

The main factor causing pressure ulcers is pressure on the soft tissues by the substrate on the one hand, and by the skeleton on the other hand. In a healthy person, such prolonged pressure causes discomfort and forces a change of position. Sick people are often unable to change their body position, despite the pain they experience, because they have paresis or reduced mobility.

Some sedatives can also cause reduced mobility. There are also nervous system disorders (paralysis, sensory disturbance), which make the patient feel no pain and therefore do not feel the need to change position. The risk of developing pressure ulcers is greatly influenced by the general health of the patient related to the deficiency of blood, protein or electrolytes, the deficiencies of which increase the likelihood of necrosis.

People with diabetes, atherosclerosis, respiratory diseases and poor metabolism are more likely to suffer from pressure ulcers. In malnourished people, whose subcutaneous tissue is very thin and the skin almost covers the bones, the risk of pressure ulcer development is relatively high. Obese people, whose body weight exerts a lot of pressure, are also more likely to develop pressure ulcers.

People who have trouble passing urine and stools are at high risk. Damp and contaminated skin macerates very quickly.

Another important factor in the development of pressure ulcers is the old age of the patient. Pressure ulcers are twice as likely to develop in people over the age of seventy than in people under the age of seventy. An external, direct factor influencing the development of pressure ulcers is proper care and care of the patient. Both the dry skin and its constant dampness (sweat, urine) are conducive to the development of bedsores. Bedsores are also favored by improper underwear and improper bedding and its unevenness (folds, creases).

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How do pressure ulcers develop?

The emergence of pressure ulcers is associated with many different factors. Among them, however, three most important can be distinguished. These are:

1. local pressure (pressure);
2. friction;
3. lateral shear forces.

In patients who stay for a long time in one specific position (sitting or lying), the tissues die. Until recently, pressure with a pressure greater than 20 mmHg was considered pressure to shut off the blood supply to cells and thus tissue death. At present, however, also lower values ​​are assumed as long as the pressing force is sufficiently long.

Simultaneously with the process of closure of the lumen of blood vessels, endothelial microcirculation damage occurs, caused by shear forces, which act in a parallel plane and cause it to shift in relation to deeper structures. In addition, the process of bedsores formation is accelerated by abrasions, which are direct damage to the skin.

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Classification of pressure ulcers

There are five stages of pressure ulcer development according to Torrance’s classification:

1. XNUMXst degree – redness fading under pressure, preserved microcirculation and continuity of the epidermis;
2. XNUMXnd degree – non-blanching redness, discoloration and warmth of the skin in the form of inflammation, swelling, possible presence of small blisters and erosions;
3. XNUMXrd degree – damage to the full thickness of the skin, the wound may be covered with yellowish masses of disintegrating tissues or a dry thin scab;
4. IV degree – damage to the skin and subcutaneous tissue, reaching the fascia;
5. V degree – deep damage extending beyond the fascia to muscles, bone structures, joints and tendons.

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Bedsores – prevention

Decubitus prevention is aimed at preventing the development of pressure ulcers through the use of appropriate methods and measures in four basic areas: assessment of the risk of pressure ulcers, proper diet, reduction of pressure in neuralgic places and proper hygiene of the patient.

The risk of pressure ulcers it depends mainly on the general health of the patient and his mobility. The areas of pressure ulcer formation also depend on the patient’s condition, different in people sitting down and different in people immobilized on the bed.

In the patient’s diet, special attention should be paid to protein, vitamin C and zinc, the deficiencies of which are conducive to the formation of pressure ulcers (already existing ones are more difficult to heal) and proper hydration of the body.

At the same time, it is imperative to strive to normalize body weight, not to allow malnutrition or excess weight. Patients who are lying down need 30 to 35 kcal per 1 kg of body weight. The diet for such people should therefore be easily digestible and high in protein (protein affects the healing of wounds). For this purpose, approximately 1,5 g of protein per 1 kg of the patient’s body weight is recommended. The patient should eat regularly and eat four to five smaller meals a day, rich in vitamins and minerals – especially (except C) A and E, as well as zinc and silicon, which enhance tissue regeneration.

If a given patient has high vitamin and mineral deficiencies confirmed by tests, it is worth considering introducing supplementation to the diet, of course under the supervision of a doctor. In a diet aimed at the prevention and treatment of pressure ulcers, you should also take care of an adequate supply of fluids and the amount of fiber to prevent constipation and regulate the functioning of the intestines. On the other hand, foods that are difficult to digest, bloating and fatty, especially those rich in animal fats, should be avoided.

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The caregiver of the sick person requires special care to reduce pressure in exposed areas and to properly care for the skin. Every two or three hours the patient has to change his position, at the same time mobilizing the patient to perform passive movements. In order to improve circulation in the tissues, gentle massages and patting places exposed to pressure are performed. It should be remembered that you must not massage bone protrusions and places where skin changes have already occurred (redness, eczema).

It is worth using ZinoDr. – a barrier-protective ointment with zinc, which supports the skin in its natural regeneration.

In order to eliminate constant pressure on the body support points, it is worth using specialized measures that reduce such pressure. These include anti-bedsore mattresses and pillows. Dynamic, chamber mattresses under the influence of pressure changes in individual chambers ensure blood supply to all parts of the body. You can order the anti-bedsore set (mattress + compressor) today at Medonet Market.

Polyurethane foam discs and wedges, or blown, are used under the elbows, knees and ankles. Inflatable bands are also used for the limbs. Sponge discs or inflatable rubber discs work well for the hips and buttocks.

At Medonet Market you can buy a rubber anti-decubitus disc Treatment for Sanity pressure ulcers or Anti-decubitus anti-decubitus ring with foam – Treatment for pressure ulcers. Both products are perfect for the prevention of pressure ulcers and as an auxiliary in their treatment.

Changing the position of a seriously ill person requires not only skills but also strength from the caregiver. Sliding mats, placed under the sheets, make this activity much easier. The most common bedsores are in the sacrum and buttocks. This is due to the fact that patients usually have no control over urination and stools.

The humid and warm environment inside the diaper pants destroys the skin’s natural hydro-lipid barrier. Therefore, the area around intimate places must be especially carefully looked after. For washing, do not use ordinary, perfumed soaps that irritate the skin, only gentle agents with a pH of 5,5. After washing, the skin should be carefully dried (avoid rubbing) and protected with moisturizing and lubricating agents.

When caring for sick people, it is worth using specialized agents that make it easier. Disposable wet wipes are very helpful. Due to their large surface they are convenient to use. Enriched with vitamin E and allantoin, they gently cleanse the skin and soothe irritations. In order to effectively protect places at risk of bedsores and chafes, use barrier creams each time after cleansing the intimate areas, before putting on an absorbent product. Choose creams that contain the SINODOR ingredient, which neutralizes the unpleasant smell of urine.

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Treatment of pressure ulcers

Treatment of pressure ulcers must be carried out strictly according to the doctor’s instructions and under his supervision. Currently, in the treatment of pressure ulcers, traditional gauze dressings are not used, but only dressings that create a moist environment. Ready-made dressings are easy to use and do not require frequent changes. At Medonet Market, you will find various types of dressings that are great for treating pressure ulcers. Try it out:

1. Activon Tube – a tube dressing with manuka honey that does not stick to the wound, does not cause pain or irritation, and has antiseptic, antibacterial and anti-inflammatory properties,
2. Suprasorb H hydrocolloid dressing is applied for 7 days; it enables adequate air circulation around the wound, and at the same time protects it against the harmful effects of external factors,
3. Suprasorb A calcium alginate fiber dressing, which provides the wound with a moist environment, thus accelerating its regeneration and preventing the development of infection,
4. Suprasorb P sensitive border lite silicone foam dressing is suitable for acute and chronic wounds and is available in two sizes.

Before applying the dressing, the wound should be properly decontaminated. For this purpose, order Microdacyn Wound Care – a preparation for disinfecting wounds, which additionally accelerates their healing. For lubrication, you can use, for example, Mediskin Aqua Cream for diaper irritation and bedsores, which can be purchased at a promotional price at Medonet Market.

The choice of dressings depends on the assessment of the pressure ulcer by a doctor. A very important criterion is the color of the pressure ulcer. Black wounds with necrosis are treated with a hydrogel or a hydrocolloid gel (a combination of a hydrogel and a hydrocolloid). On the other hand, yellow wounds with accumulated cell masses are treated with hydrocolloid dressings or dextranomers. Alginate or hydrofiber dressings are used for red wounds, where the cell growth phase, i.e. granulation, occurs most often. In the last stage of healing, pink wounds are protected with a hydrocolloid dressing.

L-Mesitran zinc honey ointment with anti-inflammatory and antibacterial properties can also be used for bedsores.

In modern treatment of wounds with specialized dressings, it is very important to change them in a timely manner (depending on the type, the dressing may remain on the wound for a maximum of 4 to 7 days). The principle applies here, the less often the better. We must provide the wound with a constant temperature of about 37 degrees C, without unnecessary cooling with too frequent changing of the dressing.

As an auxiliary in the treatment of bedsores, compresses made of chamomile flower can be used.

Find out more: Bedsores, chafing and abrasions. How do they arise and how to treat them?