Best Practice for Pressure Ulcers

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Best Practices for Pressure
Ulcers to Promote
Uncomplicated Healing
Introduction



Pressure ulcers are major health problems
in the U.S.
Affects approximately 1.3 to 3 million adults
yearly.
Over 11 billion dollars is use to treat ulcers
per year.
Introduction (cont.)


Increased awareness is important in the
health care setting to prevent ulcers.
It is imperative to find the best research to
prevent and treat the occurrences of ulcers
in the healthcare setting.
Sources


We found 2 sources that were ranked high
on level of evidence that had
comprehensive information.
The first source is a Retrospective cohort
study with convenience sampling.
Sources (cont.)





There were 4 themes that were examined in this
study:
The relevance of nutrition to wound healing.
Pressure ulcers cleaned with saline or soap
compared to those cleaned with other cleansers
such as antiseptic, antibiotic, or commercial
cleansers.
The therapeutic effectiveness of debridement on
the wound bed.
Evaluating whether dry or moist dressings is more
advantageous to healing.
Sources (cont.)


Our second source is a clinical guideline.
We used this article to support the
evidence found in our other source.
This clinical guideline identified the best
practices for pressure ulcer management
from 41 studies and articles related to
pressure ulcer treatments.
Nutrition


Nutrition is considered a significant factor in
both the prevention and treatment of
pressure ulcers.
Protein, carbohydrates, vitamins, minerals,
and trace elements are required for wound
healing.
Nutrition


A nutritional assessment
should be performed on all
newly admitted patients and
whenever there is a change
in a patient condition.
Nutritional support should be
given only to patients with
identified nutritional
deficiencies, and only when
not contraindicated.
Infection




Pressure ulcers need to be assessed and reassessed
for signs of infection.
Infection complicates the healing process of pressure
ulcers.
Early recognition along with prompt and effective
interventions is needed to address the infection.
Assessment of the wound must be done to evaluate the
healing and the treatment of the wound.
Infection (cont.)


Necrotic tissue must be removed and
present infection must be treated for
healing to occur.
The necrotic tissue may be removed by
different types of debridement.
Debridement

Why is it needed for pressure ulcers?




To promote healing
To allow the healing process to occur
To protect against bacteria
To remove dead tissue
Types of Debridement

Enzymatic

Surgical

Autolytic

Mechanical
Debridement (cont.)

Enzymatic debridement



Use of exogenous
proteolytic enzymes to
removed dead tissue.
Used in wounds with large
amount of debris.
Advantages




Minimal damage to
healthy tissue
Bleeding disorders
Very effective in most
patients
Disadvantages



Expensive
Topical agents
Needs to be softened
Debridement (cont.)

Surgical debridement
 Removal of layers of
necrotic tissue using a
laser, scissors forceps, or
curette using sterile
technique.
 Sharp debridement can be
done by nurses with
training.

Advantages


Best used for larger
wounds and infected
pressure ulcers.
Disadvantages

Painful
 EMLA cream as a local
anesthetic
 Costly
 Contraindicated in patient
receiving anticoagulants,
and clotting disorders,
lack of experience, sepsis
Debridement (cont.)

Autolytic debridement





Stimulation of natural enzymatic
activity by the use of the
endogenous enzymes used to
digest the dead tissue.
Used for larger pressure ulcers
and deep wounds.
Semi-occlusive or occlusive
dressing using transparent films,
hydrocolloids, hydrogels
Advantage
 Selective
 Painless
Disadvantages
 Time
 Risk for infection
Debridement (cont.)

Mechanical debridement
 The removal of slough or
necrotic tissue by use of
wet-to-dry dressing or
whirlpool treatment.
 Used in wounds with a
great amount of necrotic
tissue.
 Advantages


Cost
Disadvantages





Painful
Takes off healthy tissue
Trauma to wound
Infection (whirlpool)
Least recommended
Dressings

Select the appropriate dressing for the wound



Consider the wound’s characteristics: location, phase
of healing, infection, frequency of dressing changes,
product availability, cost.
The choice of the dressing should change as the
wound heals.
Moist wound dressings

Advantages



Keeps the wound bed moist.
Eliminates dead space.
Controls the exudates.
Dressings (cont.)
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Nondraining Wounds


Use transparent film,
hydrocolloid, or
hydrogel dressings.
Draining Wounds

Use foam, alginate, or
collagen dressings.
Dressings (cont.)

Hydrocolloid dressings



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Shown to have a lesser risk of infection than gauze dressings.
Should not be used on infected wounds or wounds with
undermining, tunneling, or sinus tracts.
Hydrocolloid dressings have a greater affect on wound healing
than saline gauze or paraffin gauze.
Infected wounds


Do not use occlusive dressings when an anaerobic bacterial
infection is present or suspected.
Positive correlation between gauze dressings and rates of
infection, because they lower wound temperature and impede
fluid evaporation.
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