Pressure Ulcers,
Wounds and
Dressings
Lynn Wright RGN, Ba(hons)
International NPUAP-EPUAP
Pressure Ulcer Definition (2009)
“A pressure ulcer is localised injury to the skin and/or
underlying tissue usually over a bony prominence, as a
result of pressure, or pressure in combination with shear.”
A number of contributing or confounding factors are also
associated with pressure ulcers; the significance of these
factors is yet to be elucidated”.
NICE clinical guideline 179
guidance.nice.org.uk/cg179
• As pressure ulcers can arise in a number of ways,
interventions for prevention and treatment need to be
applicable across a wide range of settings including
community and secondary care. This may require
organisational and individual change and a
commitment to effective delivery.
• Pressure ulcers are often preventable and their
prevention is included in domain 5 of the Department of
Health's NHS outcomes framework 2014/15. The current
guideline rationalises the approaches used for the
prevention and management of pressure ulcers. Its
implementation will ensure practice is based on the best
available evidence. It covers prevention and treatment
and applies to all people in NHS care and in care
funded by the NHS.
Duration of pressure
“High pressure over bony prominences, for a
short period of time and low pressures over
bony prominences, for a long period of time,
are equally damaging.
The ability of pressure to cause tissue damage
is related to duration of application and intensity
(amount) of pressure applied.
Pressure areas at risk – semirecumbent
Pressure areas at risk Seated position
Pressure areas at risk –
supine position
KEEP MOVING
Repositioning
Mobilising, positioning and re-positioning
interventions should be determined by:
• general health status
• location of ulcer
• general skin assessment
• acceptability (including comfort) to the
patient
• the needs of the carer.
KEEP MOVING
Repositioning
Frequency of re-positioning should be determined
by the patient's individual needs and recorded –
e.g. a turning chart.
KEEP MOVING
Repositioning
• Inspect the skin for additional damage
each time the individual is turned or
repositioned while in bed.
• Do not turn the individual onto a body
surface that is damaged or still reddened
from a previous episode of pressure
loading, especially if the area of redness
does not blanch
KEEP MOVING
Moving and handling
• It is important that manual handling
devices are used correctly in order to
minimize shear and friction damage.
• After manoeuvring, slings, sleeves or other
parts of the handling equipment should
not be left underneath the patient.
Wounds and
Dressings
Acute v Chronic
• Do we choose the wound care product
related to a stage of the healing process ?
• Acute
o Support biochemical environment
o Accommodate physiological changes
o Passive coverings
• Chronic
o Remove barriers to healing
o “Active/intelligent” dressings
The Chronic Wound
WOUND
Healing
Cascade
-Inflammation
-Proliferation
-Maturation
Healed
Wound
Non-Healing
Chronic Wound
TIME Framework
What is TIME?
The TIME framework explores the principles of
Wound Bed Preparation and allows clinicians to
examine key elements through a structured
Approach
T- Tissue non-viable or deficient
I - Infection or inflammation
M - Moisture imbalance
E - Edge of wound non-advancing
Dressing Selection
The ‘ideal’ dressing
o Non-adherent
o Impermeable to micro-organisms (both directions)
o Maintain moist environment (but remove excess
exudate)
o Sterile
o Allow gaseous exchange
o Thermally insulating
o Non-toxic
o Non-allergenic
o Comfortable
o Conformable and easily mouldable
The ‘ideal’ dressing
o
o
o
o
o
o
o
o
o
o
Provides mechanical protection
Highly acceptable to patients
Free from particulates
Requires infrequent changing (long wear time)
Indicates when needs changing
Cost-effective
Long shelf-life
Range of shapes
Range of sizes
Widely available
The End.
• Any Questions?