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Take Steps to Prevent Pressure Ulcers

A pressure ulcer/injury is a sore caused by too much pressure on the skin and underlying tissues. Too much pressure for too long will cause damage. The result is a wound that can be serious. Spinal cord injuries and disorders put you at lifelong risk for developing pressure ulcers/injuries. There are steps you can take to help prevent these sores or catch them early, when they are easily treatable. Your spinal cord injury or disorder (SCI/D) team has probably discussed pressure ulcer/injury prevention with you. It’s up to you to put what you learned into practice to keep your skin healthy and catch skin problems early.

Why pressure ucers/injuries develop

Having a spinal cord injury or disorder affects your ability to feel and to move. It also causes skin changes that make your skin easily damaged. These factors are what make pressure ulcers/injuries a problem for people with SCI/D. The forces that lead to pressure ulcer/injury development include:

  • Pressure. Pressure forms anywhere your body presses against a surface or medical device (cast, oxygen tubing etc.).

  • Shear. This occurs when you are sitting or lying down. Pressure develops when your body is in contact with external surfaces such as lying on a mattress, sitting in a wheelchair cushion, leaning against the back of the wheelchair, resting your foot on the footrest or wearing oxygen tubing over your nose or ears, or lying on top of your urine catheter. Or you may have accidental pressure from things like keys in your pocket or a book under your body in bed. 

  • Sliding. This is also called “shearing”. It happens from the force of the skin sliding against a surface. Examples are sitting in a wheelchair or when the head of the bed is elevated (with pressure on the underlying bone). This should be avoided. Shearing may be affected by moist skin, poor nutrition or circulation, and other health issues. 

Pressure ulcers/injuries usually form over bony bumps. These are places where bones are felt right under the surface of the skin. These include your tailbone, sitting bones, hips, heels, ankles, and shoulder blades.

Steps to prevent pressure ulcers/injuries

To maintain healthy skin and help prevent pressure ulcers/injuries, these two steps are vital:

  • Change positions regularly. Your care provider will give you guidelines for how often to shift your weight when you’re in bed or in your wheelchair. In general, turn in bed several times each night, and shift position in a wheelchair every few minutes. When changing position, turning, or transferring, lift, don’t drag, to prevent friction. If you can’t move yourself, have someone help you. Consider setting an alarm on your phone or other mobile device to remind you to shift positions.

  • Check your skin twice a day. Look at and feel your skin carefully. Check especially over your bony bumps. Use a mirror to see skin in areas you can’t normally see or where you can’t reach. If you can’t use a mirror, ask someone else to check the area. Inspect your skin once in the morning and once in the evening (consider setting an alarm on your phone or other mobile device to remind you to shift position). Look for any of the warning signs listed in the box below.

In addition, you should:

  • Keep skin clean and dry. Clean and dry yourself after sweating or a bowel or bladder accident. Avoid harsh soaps or alcohol that dry out the skin. For dry skin, use a moisturizer that does not contain scents, perfume, or alcohol.

  • Use the right equipment and check it regularly. Your SCI/D team can help you find the devices and equipment that are best for you. Be sure to check that your wheelchair back and cushion have not worn out. Padded bathroom equipment is important to avoid pressure injuries. Make sure that you sit straight and your posture has not changed. You should be evaluated by a seating specialist at least once a year at your designated VA spinal cord center.

  • Eat well and stay active. Keep your skin and body healthy, so pressure injuries are less likely to form. Avoid excessive weight or too much weight loss in a short time.

Your SCI/D team will help outline the pressure injury prevention plan that’s best for you.

Pressure ulcer warning signs

Check your skin two times a day. If you notice any changes or problems, let your SCI/D team know right away. Look for the following:

  • Skin redness that doesn’t go away (fade) in a few minutes

  • New red, purple, bruised or darkly pigmented/discolored skin areas (skin over bony areas such as heel, hips etc.)

  • Soft, warm, or cool spots

  • Swelling or hard areas

  • Scrapes, cuts, blisters, boils, or pimples

  • Any new openings in the skin

  • An area of the skin that hurts or has a change in sensation (this may not happen if your sensation is impaired)

Pressure ulcers/injuries can begin deep below the surface of the skin. So an open wound is not necessary for a pressure ulcer/injury to be present. This is why it is important that you pay attention to all changes in skin appearance and what you can feel with your fingers. Almost everyone who lives with an SCI/D develops a pressure ulcer/injury at some point. The main goal is to avoid serious, deep, and large pressure ulcers/injuries. Catch problems early, stay off the area, and call your SCI/D team immediately.

A lifelong goal

With an SCI/D, preventing pressure ulcers/injuries is a lifelong process. Put what you’ve learned about caring for your skin and staying healthy into practice each and every day. By doing what you can to prevent pressure ulcers/injuries, you’re helping yourself stay healthy and active. If you need help along the way, don’t hesitate to ask for it. Get support from your family and caregivers. Whenever you have questions or need assistance, call your SCI coordinator, local SCI team, or SCI Center. They are there to help you care for yourself so you can live well. Go back to your SCI Center every year for an annual evaluation. 

To learn more

For more information, go to the Pressure Ulcer/Injury Resource mobile app.

Author: StayWell Custom Communications
Last Annual Review Date: 8/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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