Pressure Sore Prevention

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After a spinal cord injury, you are at high risk of getting a pressure sore (bed sore). A pressure sore is a wound caused from constant pressure to the skin. When you have a spinal cord injury, you might not feel parts of your body very well. Because of this, you don’t feel discomfort from constant pressure on your skin. When you have full feeling in your body, you are always moving a little or shifting your weight to feel better. When you don’t have full feeling, you need to get in the habit of shifting your weight. If you do not have full movement, remind your caregivers to help you change position frequently.

Importance of Avoiding Pressure Sores

If you’re not careful, a pressure sore can develop in just a few days. Sores caused by pressure do not heal like normal skin. Once you have one, it can take many months to heal. To heal a pressure sore, you need to avoid putting weight on it. You need to clean and care for it every day. Skin that has had a pressure sore is never as strong as it was before. The best thing to do is prevent pressure sores from happening in the first place.

Pressure sores greatly affect the things you can do. Sometimes they can’t heal on their own and need surgery. Pressure sores are dangerous because they put you at high risk of infection. In extreme cases, these infections can even cause death.

High risk areas
Pressure sores can happen anywhere on your body. High risk areas are under constant pressure or are often moist or wet. Pressure sores are most common over bony areas:

  • Tailbone
  • Sitting bones of the bum
  • Hips
  • Elbows
  • Ankles
  • Heels
Daily skin checks

The best way to spot a pressure area is to do skin checks. This should be done twice every day. Do skin checks in the morning when you wake up and at night before bed. Pay special attention to bony areas. Also pay attention to any skin that is red for more than 30 minutes. Use a mirror with a long handle to help you see hard to reach areas. If you can’t do skin checks alone, ask your caregiver, friend, or family member to help you do them.

Pressure sores are also called bed sores, pressure ulcers, or decubitus ulcers.
Warning Signs

There are early signs of pressure that you can see before it becomes an open sore. As a rule, always pay special attention to skin that gets red. If you notice any warning sign, you must take action or it will get much worse. Here’s what to look for:

A well-defined red area (or blue on dark skin). Usually red areas on your skin will become pale when you press on them. This is called blanching. A red spot that doesn’t blanch is an early pressure sore. Treat it seriously.

Swelling or skin that feels firm and filled with fluid. Pressure sores often develop between your bones and skin. Sometimes, the sore starts under your skin and you can’t see it. This is called a deep tissue injury.

Broken skin or blisters. Blisters on skin can be an early sign of a pressure sore. If your skin has broken because of pressure, see your doctor right away for treatment.

What to Do if You See a Warning Sign

If you have a warning sign of a pressure sore, you must act right away. Find out what is causing the pressure area and remove it. Keep pressure off the area until the skin returns to normal. If your skin is broken or does not return to normal in 24hrs, see your doctor right away.

If you have a warning sign Things not to do
Keep pressure off the area DO NOT massage the area
Check the area regularly DO NOT apply heat
See a doctor if it lasts for >24hrs DO NOT put heavy things on your lap
Keeping Your Skin Healthy

Relieve pressure regularly. The best way to make sure that you don’t get a pressure sore is to relieve pressure often. You should shift your weight to relieve pressure every 15 minutes. When doing a pressure relief movement, it should last for least 1 to 2 minutes. When sleeping, make sure you have as little pressure as possible on bony areas. Pillows placed in the right areas can help. Check out the Spinal Cord Essentials Pressure Relief Techniques handout for more tips. Here are a few things you can do to reduce pressure on your skin:

  • Leaning forward or to the side in your chair.
  • When in your chair, do a ‘push-up’ to lift your bum off the chair.
  • Use pillows in your bed to take pressure off bony areas.
  • Use the tilt feature on your chair.
Pressure Relief: Shift your weight to relieve pressure every 15 minutes. When doing a pressure relief movement, it should last 1-2 minutes.

Keep your skin clean and dry. Wet skin is more delicate than dry skin. Pressing and pulling on wet skin can easily cause a pressure sore.

  • Wash your skin daily using a mild, liquid, unscented soap.
  • After bathing, gently dry your skin with a soft towel. Pay special attention to areas where skin surfaces touch (bum, groin, etc…).
  • Avoid sweat from staying your skin for long periods of time.
  • If a bowel or bladder accident occurs, wash and dry your skin right away.

Wear loose clothing. Tight or bunched-up clothing can add pressure to your skin. Sometimes seams and buttons on clothing can add pressure. Straps and tubing for leg bags can do this also. Wear loose fitting clothing with few seams and buttons. If you use a leg bag, pay attention to the skin around tubing and straps.

  • Avoid thick seams or buttons that can press on your skin.
  • Wear loose clothing and shoes.
  • Wear your leg bag on a different leg every other day. Make sure your pants are not too tight around the leg bag.

Reduce friction and rubbing. Your skin is more sensitive after spinal cord injury. Skin can be damaged when sliding or dragging across surfaces. Pulling your body across surfaces can cause sheering of the skin. This can happen when transferring from one surface to another (e.g. bed to chair). Always use a good transfer technique where you lift your weight before moving.

Check your mattress and cushions. Make sure all the surfaces you sit or lie on are gentle on your skin. Having a proper posture in the right support surfaces is important for preventing pressure sores. Inspect your wheelchair every few months. Make sure it is properly set up for you to sit properly. Make sure the cushion is not damaged or deflated.

  • Use your cushion or a softer padding while driving or flying.
  • Use padded toilet seats, padded bath bench and specialized mattresses.
  • Limit time sitting up in bed. Sitting is best done in a chair that is properly set up.
After a spinal cord injury, you are at high risk of pressure sores. Pressure sores can take months to heal and limit what you can do. Do whatever you can to avoid them.

Avoid hard surfaces. Sitting, lying and putting weak arms on hard surfaces can cause pressure to build up quickly. Be aware when parts of your body are on hard surfaces. Always use soft padding under parts of your body with reduced feeling. If you need to sit on hard surfaces (e.g. commode), do it for a short time.
Eat a well-balanced diet and drink plenty of fluids. Your skin needs protein and vitamins to stay healthy. To keep skin healthy, make sure you eat lots of protein every day. Drink plenty of water and other fluids to keep your skin hydrated. Follow Canada’s Food Guide to be sure you have a healthy diet.

  • Keep alcohol and caffeine intake low since they can dehydrate you.
  • Eat plenty of protein rich foods like meat, dairy, eggs, fish, nuts, beans, or tofu.
  • Keeping a healthy weight helps reduce pressure.
Fact: Pressure sores don’t always start on top of your skin. They can start deep inside the tissues closer to the bone. What you see on the surface may only be a small part of the actual size below. Take small red areas and small wounds seriously.
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