PRESSURE ULCERS

Pressure ulcers are avoidable in 95% of cases. A nurse has an important function in preventing them and in their correct treatment.

Many years ago I was at a nursing home in a small town and I saw for the first time a pressure ulcer in a patient. What I was surprised of, apart from the size of it, covering the entire back, was how the nurse was spreading honey all over the ulcer to heal it.

In our practice as future nurses we see the use of techniques that are not correct because they are not based on scientific evidence.

I’m going to make a reflection on the mistakes we that tend to make when we don’t follow the scientific evidence.

The most usual mistakes in prevention:

• Not using the Norton scale à You must use the Norton scale for assessing the risk of pressure ulcers.
• Applying alcohol on the skin àYou must not apply it, because it produces dryness.
• Massaging red areas and bony prominences à Don’t do it.  AGHO should be applied in areas exposed to friction, pressure or shear.
• Not to do postural changes à postural changes must be scheduled, programmed and individualized and wehave to teach the patient or caregiver to do them.
•   Raise the bed 30 ° à It must not be done.
•  Use floats as a seating surfaces à Don’t do it, because pressure is concentrated on the body area in contact with the float and produces a compressive effect.
• Bandages on the heels à foam heels are more effective than padded bandages.
• Carelessness on the sterility of productsàWe must maintain sterilit.

Most common mistakes in treatment:

• Changes on treatment before 8-10 days à We must keep it a minimum of 8-10 days to make sure it is useful.
• Dry cure à Moist wound healing provides the level of temperature and humidity suitable for biological remediation and a semipermeable barrier that prevents the evaporation of excess moisture and acts as a wall to bacteria.
• Cleaning  wound bed with antiseptic products à It must not be done. These are inactivated by contact with organic matter. They can irritate the granulation tissue. They need a minimum operation time. And the residual effect is short-lived.
• Touching wound bed when we dry  the ulcer à Do not touch, dry surrounding skin only.

·      Debridement:

o   Mixing collagenase + silver à silver is inactivated. Correct choice: collagenase + hydrogel.

o   Debridement on the heel à It’s not necessary, there is risk of osteomyelitis.

·      In Infection:

o   Using antibiotic ointments à Antibiotic treatment must be oral. Use silver dressings.

o   Improper dressing Size à it must be put on the wound and about 2-3 cm of healthy skin.

o   Placing gauze under dressings à it difficults the exudate management and can it adhere.

o   Placing adhesive dressings after applying hyper-oxygenated fatty acids à  they don’t adhere properly.

o   Putting silicone net dressing  with healing dressings for moist evironment so that the injury doesn’t stick à It only increases costs.

o   Setting cures regardless of wounds evolution à We should Schedule them depending on the state of the wound.

o   Not recording properlythe size of the lesions à We don’t have objective data of the lesion evolution.

o  Not thinking about an extra protein intakeà It should be administrated if there is no contraindication to have a protein diet with supplements of vitamin C.