Pressure injuries: be in the know

8 Dec 2018 Written by Nicola Rodgers

What’s in a name?

You might know pressure injuries as pressure ulcers, pressure sores or bed sores. Over time the names have changed but they are still referring to the same thing.

What causes pressure injuries?

Your skin can get squashed between your bones and the surface you’re sitting on or lying on.

Over time, this stops blood reaching the area, and the skin and tissue can start to die without the vital oxygen and nutrition that blood provides. The longer the oxygen is blocked, the worse the skin and tissue damage will be.

The layers of tissue beneath your skin can also become stretched and break down. For example, if you slide down a chair or bed, or you often use your heels to push yourself up into a comfier position on the bed. This is known as shearing.

Who is at risk?

You could be at risk if you:

  • Aren’t very mobile or immobile, or you become less mobile through illness or injury
  • Can’t feel parts of your body, or have reduced sensation to parts of your body
  • Aren’t able to change your position yourself
  • Are underweight or losing weight
  • Have had a pressure injury before

Which body parts can be affected?

It’s usually your ‘bony bits’ that are most at risk. The three most common areas are:

  • The bottom of your spine or tailbone
  • The bones that you sit on (covered by your buttocks)
  • The bony parts of your heels or feet

Think about the parts of your body which are in direct contact with the bed or chair that you spend time in. What positions do you normally sit or lie in? Do they change during the day or night?

You might lean on your elbows a lot, or you might sleep on your side at night and rest on your ankle bone on the mattress.

Working out which parts of your body are at risk will help you to better protect your skin in those areas.

What do pressure injuries look like?

This depends on how advanced the injury is.

  1. Pressure injuries start as a dark red or discoloured mark, depending on the natural colour of your skin. It may also look bruised, and feel warmer and harder than the surrounding tissue.
  2. As the pressure injury gets worse, the skin becomes damaged. This may look like a blister or an open wound.
  3. If left untreated, the injury will become deeper. In very advanced cases, the wound might reach as deep as muscle or even bone.

So what’s a normal red mark and what’s not?
It’s normal for pale or lightly pigmented skin to turn red or a deeper colour after sitting or lying on it, but this should disappear after about 20-30 minutes.

In very dark or black skin, colour change is harder to identify but if damage is starting to occur the skin will feel warmer or harder and you may see a deepening in colour.

When to take action

Your skin should turn a lighter colour when you press it with your finger. If it doesn’t, it could be an early warning sign that a pressure injury is happening.

You should avoid putting pressure on the area until the red mark disappears to stop it getting worse. Try to reduce the amount of time you sit or lie on the area in future.

How can I protect myself from a pressure injury?

  1. Get to know your skin
    Check it every day to help you identify changes sooner.
  2. Check the surface you’re lying on
    Does it feel too hard?
  3. Keep moving
    Change position at least every 2-4 hours.
  4. Keep skin clean, dry and moisturised
    Damp skin can be more vulnerable to damage.
  5. Eat well and drink plenty of fluids
    Keeping your weight stable and eating a varied diet will help your skin stay healthy.

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