At a time when more elderly patients are cared for from nursing homes or through home care by families, dealing with bedsores has been one of the most concerning. I have had to face this issue when a family member became bedridden due to a deteriorating disease. Even though I have tried to hold to the recommended strategies, I began to feel at a loss when I did not stay ahead of pressure ulcers that continued to develop.
After I explored different strategies and checked for guidance online, there seemed to be limited solutions to this ongoing problem for many people caring for others. Here, I would like to offer a strategy which seemed to be effective for me.
How Bedsores Develop
Bedsores occur when a person is in an immobile state from a chronic illness. It occurs when the body has focused the weight of a particular skin area between a boney prominence (elbows, shoulders, buttocks, heels, etc., against the bed or chair surface for a sustained period of time (2-3 hours). The blood supply that feeds the skin, muscles, and nerves within the region between bone and support surface, eventually impairs needed blood flow. The area served by that blood supply then weakens and lose restorative supply. This results in wasting of the skin and underlying integrity.
Bedsores start to develop at the surface of the skin and deepen as the damage continues. When strategies are not taken to address untreated bedsores, the damage to tissue continues to progress until it affects underlying muscle and bone. In these later stages, the risk of infection is high. When treating deep layer damage, the healing process takes much longer for recovery and often requires intensive medical care, even surgery if severe. Complications emerge quickly when there is not a careful routine in place to keep pressure areas healthy.
Where bedsores tend to develop
Typical Locations for bedsores include buttocks, heels of the feet, shoulder blades, back of the head, behind and beside the knees.
What are the common risk factors for bedsores?
Since bedsores occur where there exist sustained contact pressure between bone and support surface, immobility is the most contributing factor. Others include poor nutrition and poor skincare.
Stages of Bedsores
Reddening area which is warm to the touch; often changing color to blue or purple tint.
Verbal patients will often complain of feeling burns, itches or nonspecific pain in these areas.
At this stage, the area affected is more localized and begins to resemble a scrape, a blister or take on a more crater-like appearance. Patients often describe having a stinging, sharp pain.
This is where the initial wound deepens and resembles a crater with sharp borders that extends below the skin surface
This is considered a severe condition where a large wound opens that may expose underlying muscle, tendons, bones or joints. Infection is very significant at this stage and must be evaluated by a medical professional for an appropriate approach to treatment, In immobile patients, these lesions may require removal of dead tissue, surgery, and I.V. antibiotics in order to prevent system-wide infection.
Common prevention of bedsores
Preventive strategies need to be in place on a routine basis. This includes repositioning or turning clients frequently (every 15 to 120 minutes), using soft paddings as a protective barrier, keeping the skin clean and dry, and assuring adequate fluid and nutritional needs are met.
One strategy which I have tried is using a round tire air cushion with an open center. This seemed to help to keep the wound area from direct contact to the support surface (bed or chair). However, I became aware of surrounding areas becoming more affected by the ring after a few days of use. I believe this can be attributed to the displaced air pressure that became more pronounced along the ring where the skin made contact.
Be aware of skin reactions to padding
After using the tire air pillow, I noticed a burn-like lesion that formed in an arch pattern where the skin made contact with the pillow. I recognized that this particular lesion, which resembled a long narrow blister was not due to the dispersed pressure, but it was a reaction to the vinyl material, due to allergic reaction from the skin contact. This was remedied quickly when I put the cushion inside of a pillowcase before use.
After considering the benefit of air displacement in the tire pillow, and the unwanted contact pressures which resulted in the surrounding contact areas, I wondered if pressure displacement would be better minimized by having a separate air barrier as additional contact support to the skin surface. I found a baby floatation raft the had two separate rings, one within the other, that would be able to provide less localized pressure while minimizing air dispersion pressures along a narrow surrounding weight-bearing area.
In order to use this float best, I was happy to find that both the inner and outer tubes had separate intake valves. I was able to inflate the inner tire float with less pressure while inflating the outer tube with more pressure. After using this float for a few days, I began to see a considerable benefit in addressing the pressure ulcer problem.
This strategy does not diminish the need for frequent turning and repositioning during bedrest, but it does seem to provide a much better outcome in bed ulcer healing and prevention.
The cost of this infant float? I paid about 4$ from a drug store! Sounds reasonable.
I hope you will find some benefit through this information.
“Bedsores.” Johns Hopkins Medicine Logo, 31 December 2018, https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores.
“Bed Sores / Pressure Sores / Pressure Ulcers / Decubitus Ulcers.” Nursing Home Law News, 20 November 2014, https://www.nursinghomelawcenter.org/news/common-nursing-home-injuries/bed-sores-pressure-sores-pressure-ulcers-decubitus-ulcers/.
“Information and help.” Home, 20 February 2019, https://www.cancerresearchuk.org/about-cancer/coping/physically/skin-problems/pressure-sores/causes-and-prevention.