Pressure Injury Prevention

What is a pressure injury?

A sore caused by pressure for a long time on a certain spot or area of skin is called a pressure injury. Rubbing, moisture, and heat on the skin may also cause pressure injuries. The skin gets pressed between the body (usually at a bony area) and the surface you are sitting or lying on. The pressure stops the blood flow to the area. When the blood cannot get to the skin, the skin dies and an injury develops.

How can I take care of my skin?

Taking care of your skin is very important. When you have feeling (sensation), your body sends a message to the brain to tell the brain that pressure must be relieved. Then the brain sends a message to the body to move and to relieve the pressure. When you do not have feeling (sensation) or movement in a part of your body, your brain does not receive the messages it should to protect your skin. Think ahead to protect your skin from pressure injuries. 

Sores happen very quickly and heal very slowly. Preventing pressure injuries is the key. Here are some tips:

1.  When you are sitting, relieve pressure from your bottom by lifting your bottom from the seat of your chair often (at least 3 times every hour). You can do this by:
   • Doing "push-ups" on the arms of the chair for several seconds.
   • Leaning forward or to the side for a couple of minutes.
   • Getting out of the chair and lying down. This puts your weight over a different, larger area. When lying down, you need to turn every 2 hours.
   • If your wheelchair has tilt in space, use it to change your position and relieve pressure. If you do not have tilt in space, someone can tilt the wheelchair back at a 45 degree angle and hold it for a few minutes. Ask your therapist to show you this.
   • The staff will help you with these techniques if you need help.
2.  Sit up straight in your chair. Do not sit on your tailbone. Do not let your weight rest all in one area on the seat. Your weight should go on your bottom and the back of your thighs.
3.  Be careful not to rub your skin as you move:
   • Do not slide your bottom when you transfer. Lift your bottom little by little to transfer from one seat to another.
   • If you scoot or crawl on the floor, be careful not to get "rug burns" by wearing long pants, socks and shoes.
4. Get to know what your skin looks like:
   • Check your skin at least once a day, preferably before you dress or bathe.
   • You will need to use a mirror to check your bottom.
   • Check bony places with extra care: hips, elbows, knees, ankles, heels, shoulders, tailbone, and bones you sit on in the middle of your bottom are important places to look.
   • Look for red marks, any color change, blisters, or sores.
   • Feel for any bumps or hard areas.
   • Call your doctor right away for advice on taking care of any sore. The earlier you catch and treat a sore, the
     better.
5. Give your skin good nutrition to stay healthy.
   • Drink lots of liquids.
   • Eat foods that have protein (for example: meat, fish, eggs) twice a day.
   • Eat foods with Vitamin A and C. (Oranges, grapefruits, tomatoes, potatoes, strawberries, broccoli, carrots, cantaloupe and watermelons are good sources of Vitamin A and C.) Also include vitamin enriched cereals. Give your body good nutrition so you are not too thin and not too heavy.
   • Fats and sweets are to be eaten sparingly. Your calorie needs can vary depending on your medical condition. Ask your doctor for the best advice about your diet.
6. Clothing can create problems for your skin:
   • Be sure that clothes, sheets or other things touching your skin are not bunched up in one spot to cause pressure.
   • Be sure that shoes are not too tight, but wear socks and shoes to protect your feet.
   • Avoid clothes with back pockets and do not sit on buttons or seams.
   • Use a pouch, "fanny pack", or money belt instead of sitting on your wallet. Do not store things under/on your cushion.
   • Do not wear fabrics that make you sweat.
7. Use a good cushion on your chair.
   • Sling seats without cushions are not recommended because they promote pressure injuries.
   • Your doctor or therapist probably recommended the proper cushion for you when your wheelchair was prescribed.
   • Make sure your cushion is not worn out so that it does help prevent problems. Even a good cushion is not a substitute for frequent pressure relief. 
8.  Make sure all parts of your wheelchair are in good shape. There should not be any loose or worn parts. Make sure nothing is sticking out from the chair that would injure you. Always lock your brakes for transfers.
9. When you get a new wheelchair or any new equipment, be sure there are no pressure areas from the new equipment (for example: straps, tray, etc.).
   • If you see red spots from new equipment, contact the distributor so it can be corrected right away.
10. If you wear braces or splints, check to be sure you are not getting any red spots or open areas where the brace or splint touches your skin.
    • If you see red spots from your splint/brace, contact the person who made the splint/brace so it can be corrected right away.
11. Keep your skin clean and dry.
    • Frequent contact with urine and bowel movement will make the skin get sore.
    • Use mild soap and water and dry thoroughly.
    • Do not use alcohol on your skin.
    • Follow your bowel and bladder program to avoid having urine and bowel movement on the skin.
    • Consider using a padded toilet seat if you usually sit on the toilet for more than 15 minutes.
    • If using diapers, make sure they are changed promptly and use a barrier cream.
12. Be careful not to bump or cut your skin.
    • Cut nails carefully straight across.
    • Carry things in a backpack on the back of your chair instead of on or under your chair cushion.
    • Wear your seat belt on your chair and in your car.
13. Exercise as much as you can. Exercise increases circulation of the blood to help keep your skin healthy.
14.  You may need to use a pillow and/or lamb's wool when lying down to get pressure off of certain areas. You may make a "bridge" for bony areas out of pillows so there is less pressure. Ask your nurse, doctor, or therapist how to do this.
15. If your skin gets dry or rough (especially in the winter), you may need to use a moisturizing cream. Also, if you get a rough spot or callus on your skin, a cream can help.
    • Cocoa butter or Eucerin® cream is a good cream to use to moisturize or soften the skin if needed.
16. Remember, the first sign of a pressure injury is a red spot or darker than normal skin color that lasts for 30 minutes or more after the pressure is relieved.
    • Call your doctor if you are getting a pressure injury.
    • The best treatment is staying off the injured area.
    • If you do not stay off the area, the injury may get worse with a very pink or red color and cause open, oozing skin.
    • The injury can progress and get deeper as the injury goes through fat and muscle and can go down to the bone.

It takes a long time for a pressure injury to heal, so prevention is the real cure!