Decubitus

What is a pressure ulcer?

Pressure sores are caused by prolonged pressure on a certain area of the body. This first damages the skin and then the underlying tissue. There is a risk of bedsores for bedridden people and people in wheelchairs. A pressure sore is also known as a pressure ulcer or decubitus ulcer. Pressure sores usually develop in areas where the skin lies directly over the bone without a fat pad or muscle layer. The areas of the body particularly at risk of bedsores are:

• Elbow
• Heels
• Ankle
• Femur in the hip area
• Region around the sacrum
• Back of the head
• Upper arm bone in the shoulder area
• Back of the knee (for wheelchair users)

It is always the skin areas that lie directly on the mattress, depending on the position – back or side – and where no body cushioning can have a slight cushioning effect. Everyone unconsciously changes position frequently when lying down and sleeping, thus naturally preventing one area of the body from being under pressure for too long. For the elderly, physically and sensory impaired, severely injured or paralyzed, the ability to move and turn at will is limited or completely impossible. If professional countermeasures are not taken, there is a risk of pressure sores.

In addition to pressure, so-called shear forces can also trigger bedsores. They are caused by the bedridden person pulling themselves up, sliding down or turning over on the mattress. Different layers of skin are displaced against each other, the blood vessels twist and the supply to the tissue is cut off.

Pressure ulcers: causes and risk factors

A pressure ulcer develops where the blood vessels are compressed by prolonged pressure and the tissue is less well supplied with oxygen and nutrients. Toxic metabolic products accumulate, the body defends itself against hyperacidity, dilates the blood vessels and ensures that these areas are supplied with more blood. Flexible people can sense when they need to change their position because pressure is making them uncomfortable. This prevents damage to one area of the body. If this natural mechanism can no longer be carried out, the undersupplied tissue dies after a certain time.

There is a particular risk of pressure sores with

• Paralysis and reduced sensitivity to pain,
• Diabetes and poor circulation,
• Skin diseases and poor skin care,
• Overweight as well as underweight,
• old age and the consequences such as poor circulation, urinary incontinence and wrinkled skin without a water cushion,
• Incontinence and poor care.

Other risk factors can be

• Malnutrition or malnutrition
• Weak immune system due to chemotherapy
• Fluid deficiency
• Sensory disturbances

Symptoms: Decubitus

The first sign of a pressure sore is a reddened area of skin that remains red even after you have pressed on it with your finger. Unfortunately, those affected or their carers usually do not notice at this stage that a bedsore is already developing. The reddened area may be sensitive to pain, it may have a different temperature than the surrounding area or it may feel hardened. Other symptoms may include itching, burning or pain. Unfortunately, bedsores are often only discovered when they have already reached an advanced stage. Experts divide pressure ulcers into four degrees of severity:

• Pressure ulcer grade I – reddened area, redness does not disappear even after the area has been relieved, skin area may feel different to the surrounding area.
• Pressure ulcer grade II – superficial pressure ulcer with blister, skin abrasion or a spreading wound
• Decubitus grade III – a wound ulcer has already formed which extends across all skin layers and has spread to the underlying muscular area. Parts of the skin may already be necrotic (dead).
• Decubitus grade IV – at this stage, the wound extends deep down to the bone, the affected tissue is dead and discolored blue-black, and muscles, tendons and bones may already be damaged.

Pressure ulcers - diagnosis in hospital

We examine the affected skin areas with the pressure test described above or classify the condition of the affected area according to the stages described. During the examination, we will also check whether tissue fluid is already leaking or whether pathogens have already spread in the wound. A blood test may then also be useful. If damage has occurred in the area of the bone, an X-ray or magnetic resonance imaging is advisable in order to be able to assess the damage more precisely.

Pressure ulcers – diagnosis by relatives

Especially if you yourself are involved in the care of a relative, you should know the most important signs of pressure sores. Bedsores can always happen, even with the best care they often cannot be avoided. However, it is all the more important to react early in the event of a case and initiate appropriate medical measures immediately. What you should look out for as a caregiver:

• Regular skin checks all over the body
• Check the condition of the heels, low back and hip area
• Test redness with finger pressure

If you discover a reddened area of skin, you can rest assured if you press on the red area with your finger and look at it.

• a white border forms around the redness – there is no pressure ulcer
• a white spot remains briefly visible when the finger is removed – there is no pressure ulcer

However, if the redness cannot be “pressed away”, you should contact us immediately. This will save your loved one a great deal of suffering and pain, as it can take weeks or months for a pressure ulcer to heal completely. A daily finger test should therefore become routine in care.

Pressure ulcers: prevention, early detection, prognosis

Everything that can be done in care to prevent bedsores is called pressure ulcer prophylaxis. The important building blocks of pressure ulcer prevention are:

• Mobilization and promotion of movement
• Correct positioning, storage
• Pressure relief and pressure distribution
• Correct bed climate
• Skin care

As long as people who are bedridden or have limited mobility are able to move around a little, they should be encouraged to do so regularly. Relatives and caregivers should do everything they can to promote or restore mobility and avoid movement restrictions.

Prevention through repositioning

If someone can no longer move and reposition themselves, the carers have to do it. The intervals are determined individually and experts distinguish between different positioning techniques. In nursing today, we also speak of micro-positioning, in which minimal changes are brought about at short intervals, for example by placing a rolled-up towel briefly under the knee and then under the shoulder. These small changes in positioning also have a prophylactic effect.

There is a whole range of technical aids on the market that can be used to relieve pressure and prevent bedsores. These include special anti-decubitus mattresses that are soft or viscoelastic or dynamically change their hardness with air pressure. Micro-stimulation systems are also helpful as they promote body awareness and the bedridden person’s own movements. Gel and air cushions have proven effective for this purpose. All pressure-relieving systems do not replace repositioning by an assistant, but they can extend the intervals somewhat.

Prevention through skin care

Particular attention should be paid to the bed climate. Many incontinence sheets have the side effect that the bedridden person is constantly sweating and lying damp. Air-permeable mattresses as well as breathable bed linen and bed clothing prevent damp skin from softening and becoming vulnerable.

Another important pillar of prevention is proper skin care. This does not prevent bedsores, but the skin is nourished and strengthened and is therefore better able to fulfill its protective function. A water-in-oil preparation does a good job of keeping the skin surface intact.

Nursing science today advises against

• Skins and fur shoes
• Water mattresses and water pillows
• Seat rings and absorbent cotton bandages

Pressure ulcers – progression and prognosis

The treatment of decubitis is a lengthy process. By checking the skin daily, you as a relative (and caregiver) can ensure that bedsores do not occur in the first place. Providing relief for the risky skin areas and encouraging the bedridden person to move as much as possible are important measures. Successful therapy also depends on how well the affected person and the caregivers and relatives work together. If you as a loved one take the right steps at the first signs, you can help to avoid a complicated and painful course.

Pressure ulcers: Treatment

Even if therapeutic intervention is immediate, the treatment of pressure sores is very lengthy. Even if the ulcer heals well, there is a risk that a new wound will form on the affected area after a short time. The following are important in the treatment of pressure ulcers

• Relief with appropriate aids,
• Mobilization and positioning,
• special wound care,
• Avoid malnutrition,
• Pain treatment and
• psychological support.

In case of a surgical intervention, the Institute of Anesthesiology will select the anesthesia procedure that is individually adapted to you.