II. Indications

  1. See Decubitus Ulcer for Risk Factors

III. Prevention: General Measures

  1. Frequent patient repositioning (every 2 hours)
    1. Pressure Ulcers may develop within 2-4 hours
  2. Daily skin care (apply topical moisture barriers)
  3. Reduce excessive moisture exposure
  4. Correct malnutrition
    1. Avoid Feeding Tubes (decrease mobility further, as well as other complications)

IV. Prevention: Tissue loads while supine

  1. Positioning in bed
    1. Avoid positioning patient on ulcer
    2. Use positioning device to keep ulcer off surface
    3. Avoid donut-type devices (may cause ulcers)
    4. Written repositioning schedules every 2 hours
      1. Often more frequent than 2 hour turning is required
  2. Prevention for patients at risk
    1. Avoid positioning immobile patients on trochanters
    2. Use pillows and foam wedges
      1. Relieve heel pressure
      2. Relieve bony prominence pressure (knee and ankle)
      3. Sheepskin does not relieve pressure
    3. Maintain head of bed at lowest appropriate level
      1. Limit time head of bed is elevated
      2. Higher head of bed causes patient to slide down
        1. Sliding leads to shear forces
        2. Sacral ulcers may result

V. Prevention: Tissue loads while sitting

  1. Avoid pressure on ulcer while sitting
  2. Properly position
    1. Consider patient weight
    2. Consider balance
    3. Consider patient stability
  3. Reposition so pressure points shifted once per hour
    1. Return to bed if this schedule can not be met
    2. Attempt to teach patient to shift weight every 15 min
  4. Appropriate seat cushion (avoid donut-types)
  5. Wheelchair related Pressure Ulcers
    1. Consider wheelchair mapping (computerized pressure readings) at wheelchair clinic

VI. Prevention: Bed Types

  1. Static Surfaces
    1. Surface types
      1. Mattress
      2. Foam
      3. Static floatation
    2. Indications
      1. Patient in many positions without loading ulcer
      2. No bottoming out of patient
      3. Fully compresses surface to <1" at injury site
  2. Dynamic Surfaces
    1. Surface types
      1. Air-fluid (costs $100 per day)
      2. Low-air (costs $65 per day)
      3. Alternate air
    2. Indications for all dynamic surfaces
      1. Stage 3 or 4 Decubitus Ulcers
      2. Conditions not met for static surface bed
      3. Pressure Ulcer not healing by 2 to 4 weeks
    3. Additional indications for air-fluid or low-air bed
      1. Large Stage 3 to 4 Ulcers
      2. Ulcers on multiple turning surfaces
      3. Ulcer fails to heal on dynamic overlay

VII. References

  1. Habif (1996) Clinical Derm, Mosby, p. 810-13
  2. Krasner (1995) Prevention Management Pressure Ulcers
  3. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
  4. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
  5. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
  6. Way (1991) Current Surgical, Lange, p.95-108
  7. Bello (2000) JAMA 283(6): 716-8 [PubMed]
  8. Degreef (1998) Dermatol Clin 16(2): 365-75 [PubMed]
  9. Findlay (1996) Am Fam Physician 54(5): 1519-28 [PubMed]
  10. Knapp (1999) Pediatr Clin North Am 46(6):1201-13 [PubMed]
  11. Raetz (2015) Am Fam Physician 92(10): 888-94 [PubMed]
  12. (1995) Am Fam Physician 51(5):1207-22 [PubMed]

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Ontology: Pressure Ulcer (C0011127)

Definition (MSH) An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stays in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.
Definition (MEDLINEPLUS)

Pressure sores are areas of damaged skin caused by staying in one position for too long. They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips. You are at risk if you are bedridden, use a wheelchair, or are unable to change your position. Pressure sores can cause serious infections, some of which are life-threatening. They can be a problem for people in nursing homes.

You can prevent the sores by

  • Keeping skin clean and dry
  • Changing position every two hours
  • Using pillows and products that relieve pressure

Pressure sores have a variety of treatments. Advanced sores are slow to heal, so early treatment is best.

Definition (NCI) Death of tissue due to external pressure.
Definition (NCI_FDA) Death of tissue due to external pressure.
Definition (CSP) ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time; bony prominences of the body are the most frequently affected sites; ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure.
Concepts Disease or Syndrome (T047)
MSH D003668
ICD9 707.0, 707.00
ICD10 L89 , L89.9
SnomedCT 201248003, 28103007, 156424003, 90144002, 142668003, 165258002, 400192002, 399912005, 418172001, 420226006
LNC LP96870-8, MTHU021397, LA19028-2
English Bed sore, Bed Sores, Bedsore, Pressure Sore, Pressure Ulcers, Sore, Bed, Sores, Bed, Sores, Pressure, Ulcers, Decubitus, Ulcers, Pressure, Bed Sore, Decubitus ulcer, Sore, Pressure, Ulcer, Decubitus, Ulcer, Pressure, Decubitus pressure sore, Pressure sore(s), Pressure Sore Or Ulcer, Skin Decubitus Ulcer(s), decubitus ulcer, Pressure Ulcer, Pressure ulcer, site NOS, bed sore, Pressure ulcer of unspecified site, Pressure Ulcer [Disease/Finding], Pressure ulcers, contact ulcers, Ulcer;decubitus, Pressure;sore, pressure ulcers, bed sores, contact ulcer, decubitus skin ulcers, pressure sores, decubitus ulcers, Pressure ulcer, unspecified site, Decubitus ulcer, unspecified site, Pressure ulcer (diagnosis), chronic decubitus ulcer, Bed sores, Pressure Sores, Decubitus ulcers, Bedsores, Decubitus Ulcers, Decubitus ulcer (finding), Decubitus ulcer (disorder), Decubitus (pressure) ulcer, Decubitus ulcer (specify), Pressure sore, Decubitus ulcer (morphologic abnormality), Pressure ulcer (disorder), Pressure sore (disorder), PRESSURE, NECROSIS, NECROSIS, PRESSURE, PRESSURE SORES/ULCERS, SORES/ULCERS, PRESSURE, Decubitus, Decubiti, ULCERS/SORES, PRESSURE, Contact ulcer, decubitus, bedsore, decubitus; ulcer, pressure sore; sore, pressure ulcer; ulcer, pressure; sore, pressure; ulcer, skin; ulcer, decubitus, sore; pressure sore, sore; pressure, ulcer; decubitus, ulcer; pressure ulcer, ulcer; pressure, ulcer; skin, decubitus, pressure ulcer, Decubitus Ulcer, pressure sore, Pressure ulcer, Pressure ulcer (morphologic abnormality)
Spanish úlcera por presión, úlcera por presión (anomalía morfológica), úlcera de decúbito, úlcera de decúbito (anomalía morfológica), Úlcera por presión durante el decúbito, úlcera por decúbito (hallazgo), escara, úlcera de presión, decúbito, úlcera por decúbito (específica), úlcera de contacto, úlcera por presión (trastorno), úlcera por decúbito (anomalía morfológica), úlcera por decúbito (trastorno), úlcera por decúbito, Úlcera de decúbito, Escara, Llaga por Presión, Úlcera por Decúbito, Úlcera por Presión
Italian Ulcerazione da decubito, Piaga da letto, Ulcera da pressione, Decubitus ulcer, Piaghe da letto, Ulcera da decubito, Piaga da decubito
Dutch drukzweer, doorliggen, decubitus; ulcus, druk; ulcus, druk; zweer, drukulcus; ulcus, drukzweer; zweer, huid; ulcus, decubitus, ulcus; decubitus, ulcus; drukulcus, ulcus; druk, ulcus; huid, decubitus, zweer; drukzweer, zweer; druk, decubitus ulcus, Decubitus, Decubitusulcus, Doorliggen, Drukulcus
German Druckgeschwuer, Dekubitalgeschwuer, Dekubitus, Druckulkus, Wundliegen, Dekubitalgeschwür, Druckgeschwür
Portuguese Ferida de decúbito, Ferida de pressão, Úlcera por Pressão, Úlcera de Pressão, Úlceras de decúbito, Escara de Decúbito, Úlcera de Decúbito
Swedish Trycksår
Japanese ジョクソウセイカイヨウ, ジョクソウ, 褥瘡性潰瘍, 圧迫性潰瘍, じょく瘡性潰瘍, とこずれ潰瘍, 圧迫痛(褥創), 褥瘡, とこずれ, 床ずれ, 褥創, 褥創潰瘍, 褥瘡潰瘍
Czech otlakový vřed, dekubitus, proleženina, Proleženina, Proleženina z tlaku na podložku, Dekubitální vřed
Finnish Painehaava
Russian PROLEZHEN', ПРОЛЕЖЕНЬ
Korean 욕창성 및 압박부위 궤양
Croatian DEKUBITUS
Polish Odleżyna
Hungarian Felfekvéses fekély, Felfekvés, Decubitus fekély
Norwegian Trykksår, Liggesår, Dekubitalsår, Dekubitus
French Escarre, Ulcère de décubitus, Escarre de décubitus, Escarre de pression, Ulcère de pression