| Pressure Ulcers |
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At least 3 million adults in the US are reported to have pressure ulcers yearly. Pressure ulcers can have a devastating impact on health and care provisions, ranging from patient discomfort to increased healthcare costs. Pressure ulcer prevention and treatment is one of the greatest challenges facing caregivers and facilities. Pressure ulcers cost the US health care system approximately $1.3 billion every year. The prevalence rate of pressure ulcers in acute care facilities has been seen as high as 34%. The cost to heal a complex pressure ulcer may run as much as $70,000.
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Pressure Ulcers/sores (Debictus ulcers) arise due to a combination factors;
- On a cellular level, ischemia occurs to tissue when too much pressure is applied to one area for a prolonged period of time. This pressure is usually from a bony prominence on one side and a hard surface on the other side. The soft tissue between these two surfaces is subjected to abnormal pressure. .
- The ischemia produced leads to tissue necrosis and that closest to the bone is typically the first to undergo this. Therefore, visible skin discoloration or redness may actually be an indicator of underlying adipose or muscular necrosis. It has been demonstrated that the capillary pressure on the arterial side is around 30-32 mmhg and around 12 mmhg on the venous side. Sustained pressures at values higher than these may result in circulatory compromise and tissue necrosis.
Frictional and shearing forces also play roles in tissue necrosis and must be reduced or eliminated. General health, skin texture and turgor, patient's mobility (during sleep or on an OR table), nutritional status and body weight (too thin and too heavy are both problematic) must all be evaluated and corrected in order to reduce the risk of a pressure sore. |
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| Staging Pressure Ulcers |
| Pressure ulcer severity is assessed utilizing a staged scale system. With stage one being least and stage four being the most severe The following details are from the AHCPR Guidelines, which is based on the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP) Consensus Development Conference: |
Stage 1
Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators. |
Stage 2
Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater. |
Stage 3
Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue. |
Stage 4
Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers. |
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