Treatment of pressure ulcers
Pressure ulcers heal slowly, so that the healing period of one year is not unusual. Persons who are in charge of pressure ulcers treatment have to be acquainted with the procedure of pressure ulcers treatment, their assessment, documentation, treatment plan and the choice of bandage. The less people are involved in the treatment, the better.
Different strategies of dressing and different bandages are needed for different pressure ulcers stage. Choose the bandages according to their characteristics and the pressure ulcer stage. The assessment has to be done based on the stage, location and size of the pressure ulcer, signs of inflammation, pain, the appearance of wound edges and the wound bed, quantity of exudate, presence of dead tissue, growth of new epithelium cells and granulation tissue. the documentation should be provided with a picture or drawing of the pressure ulcer. Generally speaking, the fewer dressings the better, so that the pressure ulcer may have a chance to heal in peace. The pressure ulcers in categories from II to IV do not need aeration, because the air cools them and prevents them from healing.
Lukewarm tap water can be useful (depending on water quality). Sterile procedures have to be implemented for the ankles and orifices. Dry pressure ulcers have to be protected, moist pressure ulcers have to be kept moist, and the surrounding skin protected from getting loose (maceration); necrotic tissues have to be removed. Patients with diabetes and reduced peripheral blood circulation, with dry black necrosis on their feet, have to be treated with special care and the necrosis left intact.
If large amounts of liquid come out of the wound, making the bandage moist and leak, it has to be changed more frequently; it may be necessary to use another type of bandage.
In the case of pressure ulcers with an unpleasant smell, it is possible to use a combined charcoal and silver bandage alternatively, to prevent unpleasant smell.
If several pressure ulcers have to be dressed, the cleanest pressure ulcer has to be dressed first and the dirtiest one the last. The goal of local treatment is to ease the pain, to reduce or eliminate any unpleasant smell, to reduce pressure ulcer secretion, reduce the frequency and enable painless bandage changes. Only someone who is very well acquainted with such a procedure may clean the pressure ulcer with scissors, tweezers or curet.
Factors facilitating the healing of pressure ulcers:
- mildly acidic pH
- pressure ulcer temperature of approximately 32°
- oxygen saturation
- pain relief
- regular treatment
Pain should be relieved by the application of pressure ulcer cream or gel on the pressure ulcer area 0.5-1 hour before the planned intervention. It may be necessary to relieve the pain by perioral medications.
To prevent spreading of infections, all personnel has to adhere to the basic hygienic procedures; it is necessary to wear gloves and plastic aprons and to use liquid soap and hand disinfectant before and after the treatment.