DECUBITUS ULCER / PRESSURE / BED SORE

Decubitus ulcer is also known as pressure sore or decubiti, are ulcerated or sloughed area of tissue subjected to pressure from lying on mattress or sitting on a chair for a prolonged period of time resulting in the slowing of circulation and finally death (necrosis) of tissues.

Common sites

Pressure points are those that bear weight, so that the skin over them is subjected to pressure.This may happen more frequently over the bony prominences of the body where there is no rich blood supply or nourishment and also there is a thin layer of skin.The common sites depend upon the position of the patient in the bed.

The pressure points in the supine position are back of the head (occiput), scapula, sacral region, elbows and heels.In a side lying position the pressure points are the ears, acromion process of the shoulder, ribs, greater trochanter of the hip, medial and lateral condyles of the knee and malleolus of the ankle joint.

In a prone position, the pressure points are ears , cheek, acromion process, breast (in the females), genitalia (in males), knees and toes.

CAUSES OF PRESSURE SORE

Direct or immediate causes-

Pressure

Pressure is considered to the primary cause of the pressure sore.In a sick person, the areas of tissue resting against the mattress are vulnerable areas.The pressure in these areas causes depletion of blood supply with the failure of circulation to the weight bearing area resulting in the tissue damage.The pressure over these areas are increased in the following conditions:

• When there is lumps and creases on the bed.
• Incorrect positioning of the body.
• Infrequent change of position.

Friction

Friction of the skin with a rough or hard surface can cause tissue damage. Contact with the rough surface of the bed, wrinkles on the bed clothes, hard surfaces of the plaster casts and splints, presence of foreign bodies on the bed (eg. bread crumbs, orange peelings) careless handling of bed pan, pulling sheets under the patient etc, are frequent cause of friction which cause tissue damage. Friction is also caused due to the rough sponge clothes and prolonged massage without lubricant.

Moisture

The skin contact with moisture for a period of time can lead to maceration of the skin. Patients who are sweating profusely; with incontinence of urine and stools are liable to pressure sores.

Presence of pathogenic organism

Lack of cleanliness harbours pathogenic organisms and infection settles on the skin.

DIFFERENT STAGES OF PRESSURE SORES

Stage 1

Stage 2

Stage 3

Stage 4

Deep injury

Unstageable

Predisposing causes

• Impaired circulation.
• Lowered vitality.
• Emaciation.
• Oedema.
• Obesity.

Patients susceptible to pressure sores

• Acutely ill patients, whose general condition is rapidly deteriorating.
• Elderly bed ridden patients, who make very little movements in bed.
• Obese patients.
• Very thin and emaciated patients, having very little subcutaneous tissue to pad the bony prominences.
• Sedated patients who are not moving readily.
• Paralysed patients, who have suffered spinal coed injuries eg., patients with paraplegia, hemiplegia, and quadriplegia. These patients are not able to make movements in the bed and very often they have incontinence of urine.
• Neurologic patients with lack of sensation that they cannot feel any irritation of the skin.
• Oedematous patient especially those with oedema of the sacrum and buttocks.
• Mal-nourished patients with protein and vitamin deficiencies.
• Agitated patients in restraints.
• Patients on complete bed rest or with limited movements.
• Surgical patients with limited movements.
• Patients with hyper pyrexia who sweat profusely.
• Patients with incontinence of urine and stool.
• Patients with excessive bodily discharges or drainage from the wounds.
• Diabetic patients.