management of pressure ulcers

Clinical answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Management of Pressure Ulcers

Adults with pressure ulcers should be assessed and managed by healthcare professionals with the necessary skills and competencies . An individualized care plan should be developed and documented, considering the risk and skin assessment outcomes, comorbidities, patient preferences, and mobility .

Nutritional Assessment and Support

Offer adults with a pressure ulcer a nutritional assessment by a dietitian or other appropriately skilled healthcare professional ,. If a nutritional deficiency is identified, offer nutritional supplements ,. Provide advice on maintaining adequate nutritional status through a balanced diet, considering energy, protein, and micronutrient requirements ,. Do not offer nutritional supplements or subcutaneous/intravenous fluids if nutritional intake or hydration status is adequate, respectively ,.

Pressure Redistributing Devices

Use high-specification foam mattresses for adults with a pressure ulcer. If this is insufficient for pressure redistribution, consider a dynamic support surface ,. Standard-specification foam mattresses should not be used ,. For individuals who sit for prolonged periods, consider their seating needs and provide a high-specification foam or equivalent pressure redistributing cushion, especially for wheelchair users ,. For heel pressure ulcers, discuss and document a strategy to offload heel pressure ,.

Wound Management

Document the surface area and estimate the depth of all pressure ulcers, noting undermining, but do not routinely measure volume . Categorize each pressure ulcer using a validated classification tool to guide management and repeat this assessment regularly . Assess the need for debridement, considering factors like necrotic tissue, ulcer category/size/extent, patient tolerance, comorbidities, and risk of infection ,. Offer autolytic debridement with an appropriate dressing, and consider sharp debridement if healing is prolonged by autolytic methods, performed by a competent practitioner ,. Do not routinely offer enzymatic debridement or larval therapy, though larval therapy can be considered if sharp debridement is contraindicated or if there is vascular insufficiency ,.

Infection Control and Dressings

Offer systemic antibiotics only if there is clinical evidence of systemic sepsis, spreading cellulitis, or underlying osteomyelitis ,. Discuss antibiotic choice with microbiology to ensure effectiveness against local pathogens ,. Do not offer systemic antibiotics solely to heal a pressure ulcer or based on positive wound cultures without clinical infection evidence ,. Do not routinely use topical antiseptics or antimicrobials to treat pressure ulcers ,. Discuss dressing choices with the patient, considering pain, tolerance, ulcer position, exudate amount, and dressing change frequency ,. Consider dressings that promote a warm, moist wound-healing environment for category 2, 3, and 4 pressure ulcers ,. Do not offer gauze dressings ,. Do not routinely offer negative pressure wound therapy unless it reduces dressing changes for high exudate wounds ,. Do not offer electrotherapy or hyperbaric oxygen therapy ,.

Key References

Related Knowledge Topics