Interventions for Prevention and Treatment of Pressure Ulcers.
Five Sections of the NPUAP present interventions that are used for both prevention and treatment of pressure ulcers. Nutrition, repositioning and early mobilization, addressing heel pressure, support surfaces and medical device management are all areas of care that are implemented both as a preventive measure, and to promote healing of existing pressure ulcers.
Nutrition for Pressure Ulcer Prevention and Treatment.
Multivariable analyses of epidemiological data indicate that a poor nutritional status, indicated by low body weight or poor dietary intake among other signs, is a factor impacts upon pressure ulcer risk. All individuals at risk of pressure ulcers should have their nutritional status screened. A comprehensive assessment should be conducted where risk of malnutrition is identified, and in individuals with existing pressure ulcers. This section of the guideline includes comprehensive recommendations on strategies that can promote nutritional status, thereby reducing pressure ulcer risk and/or promoting wound healing. The importance of ensuring adequate caloric, protein, vitamin, mineral and fluid intake is highlighted.
Repositioning and Early Mobilization
Repositioning involves a change of position in the lying or seated individual, with the purpose of relieving or redistributing pressure and enhancing comfort. Repositioning and its frequency should be considered in all at risk individuals and must take into consideration the condition of the individual and the Support Surface in use. Repositioning should maintain the individual’s comfort, dignity and functional ability. The importance of correct manual handling technique, pressure relief schedules for seated individual with existing pressure ulcers, and the importance of avoiding positioning individuals on areas of existing non-blanchable erythema.
Repositioning to Prevent and Treat Heel Pressure Ulcers
Heel pressure ulcers are a challenge to prevent and manage. The small surface are of the feel is covered by a small volume of subcutaneous tissue that can be exposed to high mechanical load I individuals on bedrest. The recommendations in this section of the guideline address the importance of regular inspection and correct positioning in order to relieve heel pressure while avoiding potential complications such as Achilles tendon damage, foot drop and deep vein thrombosis (DVT).
Support Surfaces
Support Surfaces are specialized devices for pressure redistribution and management of tissue load and microclimate. The recommendations in this section address and bed use, seats and cushions, and other forms of support surface (e.g. overlays) The importance of using a high specification pressure redistribution support surface in all individuals at risk of pressure ulcers or with existing pressure ulcers is heightened. The evidence on various high specification support surfaces is presented; however, it is evident that there is insufficient research to identify any specific type of high specification support surface as superior. The use of pressure redistribution cushions for both prevention and treatment of pressure ulcers is discussed, along with guidance on product selection and use. Safety and maintenance issues are addressed.
Medical Device Related Pressure Ulcers
Individuals with a medical device in situ are at a high risk of pressure ulcers related to the device. These pressure ulcers often conform to the pattern or shape of the device and develop due to prolonged, unrelieved pressured on the ski, often contributed to by associated moisture around the device, impaired sensation or perfusion and/or local edema, as well as systemic factors. The recommendations in this section address assessment of skin that is placed at risk due to a medical device, strategies to redistribute pressure associated with a device, and skin protection (e.g., in terms of design, size and individual fit) is highlighted.
~NPUAP’s Preventions and Treatment of Pressure Ulcers: Clinical Practice Guideline~