Pressure ulcers occur when the skin touches an object for an extended period of time causing friction. Device related pressure ulcers occur when medical devices, such as monitors or braces, are left on an individual for an extended period of time in the same location.
Assessment
Individuals in an inpatient setting should have a skin examination periodically for pressure ulcers related to medical devices, especially if there is a risk factor present. The frequency of review will vary based on age, mobility, underlying illness and other risk factors that are present. When the assessment is completed, the condition of the skin should be documented.
Visual review of the body may reveal a pressure sore related to a medical device. The appearance of a pressure ulcer will vary based on the severity. A stage I pressure ulcer will have a reddened appearance. A stage II pressure ulcer will have blisters and/or sore with possible redness. A stage III pressure ulcer will have damage to not only the skin but the tissue underneath. A stage IV pressure ulcer will have damage to the skin, tissue, muscles and possibly bone.
There are no tests for pressure ulcers, only recognition of visual signs and symptoms. The Braden scale is an assessment used to determine the severity of a pressure ulcer. The assessment allows medical professionals to rate on a scale of one through four the severity of conditions such as sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The acceptable range before treatment is recommended will vary based on the individual’s device, medications, underlying condition and location of the pressure ulcer.
Prevention
Eating a healthy diet and staying hydrated is a critical step in the prevention of prevent pressure ulcers, particularly those from medical devices. If they do occur, a healthy diet will aid in the healing process.
Frequent rotation of any medical devices between different areas of the body will reduce the risk of a pressure ulcer. As an example, alternating the arm that a medical device is on will reduce the risk. If this is not possible, as in the case of leg braces, make sure that the medical devices are removed for a portion of every day to give the skin a rest from any friction caused by the device.
Treatment
Treatment of device related pressure ulcers is essential to prevent infection, pain and recurrence.
Treatment can be in the form of the following:
- Pain medication to reduce or eliminate pain from the pressure ulcer.
- Antibiotics to prevent an infection of the damaged skin and/or tissue.
- Removal of the damaged skin and/or tissue to aid in the healing process.
- Reducing pressure ulcer risk factors, such as anemia, that may worsen the already present pressure ulcer.
References
National Guidelines Clearinghouse: Pressure ulcers in the long-term care setting: https://www.guideline.gov/content.aspx?id=12381
MedlinePlus Medical Encyclopedia: Pressure Ulcer: https://www.nlm.nih.gov/medlineplus/ency/article/007071.htm
State of Indiana: Braden Scale: https://www.in.gov/isdh/files/Braden _Scale.pdf
National Guidelines Clearinghouse: Prevention of Pressure Ulcers and Skin Tears: https://www.guideline.gov/popups/printView.aspx?id=12262
