What is a pressure sore?
A pressure sore (or bed sore) is an injury to the skin and tissue under it. Sitting or lying in the same position will begin to cut off the flow of blood to that area, blocking oxygen and vital nutrients from maintaining healthy tissue. When the tissue becomes starved to too long a period of time it begin to die and a pressure sore starts to form.
Pressure sores will also be referred to as pressure ulcers or decubitus ulcers. Damage from a pressure sore will range from slight discoloration of the skin to open sores that go all the way to the bone (severe).
The affected area may feel warmer than the surrounding tissue. In light-skinned people, the discoloration may appear as dark purple or red. In darker-skinned people, the discoloration will appear darker than the surrounding tissue.
A pressure sore is serious. It must not be ignored. With proper treatment, most pressure sores will heal.
A pressure sore is any redness or break in the skin caused by too much pressure on your skin for too long a period of time. The pressure prevents blood from getting to your skin so the skin dies. Normally the nerves send messages of pain or feelings of discomfort to your brain to let you know that you need to change position, but damage to your spinal cord keeps these messages from reaching your brain.
You may need to learn new ways to change your position to prevent too much pressure. Pressure sores can occur, for example, when you sit or lie in one position too long. Shearing is also a kind of pressure injury. It happens when the skin moves one way and the bone underneath it moves another way. An example of this is if you slouch when you sit.
Another type of injury, an abrasion, can occur when pulling yourself across a surface instead of lifting. This is an example of a friction injury. In addition, short exposure to high pressure, such as a bump or fall, may cause damage to the skin that may not show up right away.
Lateral tilting beds
These are mains powered beds which will turn the person from side to side, thus eliminating the need for turning by carers, for example where turning needs to continue throughout the night, or where a carer may be frail. They provide pressure relief and assist postural drainage, i.e. drainage of fluid from the lungs. These beds can be large pieces of equipment. The amount of independence they give the user in the choice of positioning varies, i.e. whether turning can be programmed or transfer facilitated. This is reflected in the price. Many are controlled by a carer from a panel at the end of the bed or by foot control, although some can be controlled independently by the person in bed, or the turning facility can be programmed to carry out an automatic turning cycle.
If the cycle is automated, take care that the person is turned to a comfortable position if he/she cannot move him/herself. Cot sides or safety rails may make the person feel more secure.
Lateral tilting turning units
These can be used on top of a domestic bed. A longitudinally sectioned mattress is alternately inflated and deflated, which has the effect of tilting the person from side to side.
These units can be controlled by the person or the carer using a handset or can be set to automatically turn at pre-programmed intervals. It is advisable to use most of these units with bed rails, as they do not have built-in side protection.
Low air loss beds and mattresses
These beds and air mattresses have air sacs that support the user on a cushion of air. Pressure relief is provided when the supporting surface is deep and soft enough to allow the user to partially sink into its surface. They help reduce the build-up of heat and moisture and allow pressure to be evenly distributed along the supporting surface. The beds may be variable posture, i.e. can be profiled to alter the position of a user.
These beds and mattresses are for people who have high dependency needs and who may already have a vulnerable skin condition. They can be used with or without a cover or sheet although plastic or rubber backed pads or sheets should not be used as they prevent airflow.
They are costly items and, where they are required in a domestic setting, they would normally be rented from the individual companies. The companies should also be approached regarding the appropriate siting of the beds in view of their weight and size, which may make them unsuitable for use on anything other than the ground floor in a domestic setting.
Some of these beds or mattresses are not solid enough for emergency resuscitation (CPR) to be effective. Some have emergency valves that will deflate the mattress in an emergency. If the person is at risk from heart attacks, check with the company as to the suitability of the mattress.
Sources:
http://www.nelh.nhs.uk/guidelinesdb/html/pressure_devices/guidelines.asp
http://www.sci-info-pages.com/skin_pres.html
http://www.assistireland.ie/index.asp?locID=181&docID=6563#_Toc98911856
http://www.emedicine.com/pmr/topic179.htm
http://www.pegasus-uk.com/Page.asp?PageNumber=130
February 06
