management of pressure ulcers

Management of Pressure Ulcers

Adults with pressure ulcers should be assessed and managed by healthcare professionals with the necessary skills and competencies ¹. An individualized care plan should be developed and documented, considering the risk and skin assessment outcomes, comorbidities, patient preferences, and mobility ².

Nutritional Assessment and Support

Offer adults with a pressure ulcer a nutritional assessment by a dietitian or other appropriately skilled healthcare professional ¹,². If a nutritional deficiency is identified, offer nutritional supplements ¹,². Provide advice on maintaining adequate nutritional status through a balanced diet, considering energy, protein, and micronutrient requirements ¹,². Do not offer nutritional supplements or subcutaneous/intravenous fluids if nutritional intake or hydration status is adequate, respectively ¹,².

Pressure Redistributing Devices

Use high-specification foam mattresses for adults with a pressure ulcer. If this is insufficient for pressure redistribution, consider a dynamic support surface ¹,². Standard-specification foam mattresses should not be used ¹,². For individuals who sit for prolonged periods, consider their seating needs and provide a high-specification foam or equivalent pressure redistributing cushion, especially for wheelchair users ¹,². For heel pressure ulcers, discuss and document a strategy to offload heel pressure ¹,².

Wound Management

Document the surface area and estimate the depth of all pressure ulcers, noting undermining, but do not routinely measure volume ². Categorize each pressure ulcer using a validated classification tool to guide management and repeat this assessment regularly ². Assess the need for debridement, considering factors like necrotic tissue, ulcer category/size/extent, patient tolerance, comorbidities, and risk of infection ¹,². Offer autolytic debridement with an appropriate dressing, and consider sharp debridement if healing is prolonged by autolytic methods, performed by a competent practitioner ¹,². Do not routinely offer enzymatic debridement or larval therapy, though larval therapy can be considered if sharp debridement is contraindicated or if there is vascular insufficiency ¹,².

Infection Control and Dressings

Offer systemic antibiotics only if there is clinical evidence of systemic sepsis, spreading cellulitis, or underlying osteomyelitis ¹,². Discuss antibiotic choice with microbiology to ensure effectiveness against local pathogens ¹,². Do not offer systemic antibiotics solely to heal a pressure ulcer or based on positive wound cultures without clinical infection evidence ¹,². Do not routinely use topical antiseptics or antimicrobials to treat pressure ulcers ¹,². Discuss dressing choices with the patient, considering pain, tolerance, ulcer position, exudate amount, and dressing change frequency ¹,². Consider dressings that promote a warm, moist wound-healing environment for category 2, 3, and 4 pressure ulcers ¹,². Do not offer gauze dressings ¹,². Do not routinely offer negative pressure wound therapy unless it reduces dressing changes for high exudate wounds ¹,². Do not offer electrotherapy or hyperbaric oxygen therapy ¹,².