Practical Info On Pressure Sores/Ulcers

Risk factors

There are several factors that put a person with SCI at risk for pressure ulcers. Some are a direct consequence of the SCI, and some are not.

SCI-related risk factors
Paralysis and sensory impairment (if you are unable to feel things normally, you won’t know if something is irritating your skin). Changes in collagen metabolism (the way your skin and connective tissues are able to build new tissue and heal) caused by SCI. Wound healing may take five times longer below the level of SCI due to these changes. Muscle atrophy (shrinking) can leave the bony prominences on your backside (or other areas) less padded, so that there is less protection over these areas. Altered circulation can reduce the blood supply to tissues, which not only increases your risk for skin problems, but slows the healing process if you do develop a pressure sore.

Other risk factors not related to your SCI
Hypogonadism (low testosterone), which is more common in men with SCI than those without, can inhibit or slow wound healing. It’s important to get your testosterone level checked at least every couple of years. Ask your provider to do this if he or she isn’t aware that this is a problem for people with SCI. Diabetes. Fevers or illnesses. Malnutrition. Protein stores, vitamin C levels, and zinc levels, are particularly important in healing wounds and maintaining healthy skin. Smoking contributes to peripheral vascular disease, which makes it more difficult to heal a wound and more likely to develop a wound. Aging, which we unfortunately can't escape, often increases your risk. Skin gets thinner as one ages and tends to be less tolerant to trauma and shearing (dragging or rubbing) forces. People tend to lose some strength as they age, so transfers that were going really great when you were 25 might not be going as well when you're 75. When you aren’t as strong, you might be more likely to drag your bottom across a surface and injure your skin.

Prevention

Inspect your skin carefully twice daily
Perform pressure reliefs every 15 to 30 minutes. Turn frequently in bed. The usual recommendation is to turn every two hours in bed, but this can sometimes be stretched out to longer periods (usually up to four hours) eventually. Use wheelchair cushions and mattresses that distribute pressure well and are inflated and maintained correctly.

Keep clothing and linens wrinkle-free.
Maintain good transfer technique — make sure you aren’t dragging your lower limbs or back side across a surface when transferring.
Protect hands, legs, feet and arms from trauma.

Positioning
Make sure your positioning, posture and seating are correct. Consult your health provider or a seating specialist if you aren’t sure.

Moisture
Maintain clean, dry skin. Maintain bowel and bladder continence.

Mental status
Many medications commonly prescribed for individuals with SCI can cause sedation (sleepiness) or even confusion. Talk to your health provider about managing your medications so these kinds of side effects do not keep you from maintaining good skin care.

Alcohol and recreational drugs
Alcohol or other drugs used for recreation or abuse can reduce your alertness, judgment, and attention to doing pressure reliefs and good transfers.

Smoking
There are lots of reasons not to smoke. Skin health is definitely one of them.

Low testosterone
Men should have their testosterone checked every few years.

Anemia and nutrition
Make sure you're eating a diet that's high in protein, iron, and vitamin C. (Learn about nutritional guidelines for persons with SCI. Make sure your provider is watching your different vitamin levels.

Info sourced from here.