Pressure ulcer wound care measures

First remove local pressure to cut off the source of the injury, and then select an appropriate treatment plan based on the stage of the wound, exudation situation, and the patient's basic physical condition. There is no universal "universal dressing formula". All operations must be flexibly adjusted based on individual circumstances. Blindly following the trend of using Internet-famous ointments and unifying the nursing process may aggravate the injury.

When many people see a pressure sore on their skin, their first reaction is to find medicine and apply it on it, which completely reverses their priorities. In fact, if you think about it, the essence of pressure sores is that local tissues have been squeezed by pressure and shear forces for a long time and become ischemic and necrotic. Just like a seedling that is pressed by a stone cannot grow well. If you don't remove the pressing "stone", it will be useless to apply the best medicine. Regarding the specific operation of decompression, there has been a lot of controversy in the industry over the years: in the early years, all bedridden patients were required to turn over every 2 hours. Later, a large-scale controlled study showed that as long as a qualified slow-rebound decompression mattress with a thickness of ≥10cm is used, and the patient does not have high-risk factors such as extreme weight loss, severe edema, and peripheral circulation disorders, the interval between turning at night can be extended to 4 hours, which can avoid frequently disturbing the patient's sleep. Nowadays, clinical practice is basically adjusted in this way, and there is no need to compete with oneself at stuck time points. Another thing to mention, if the skin has become red from pressure, do not massage it. The old concept in the early years said that massage can promote blood circulation. Now it has been confirmed that the subcutaneous tissue that has been damaged by pressure cannot withstand rubbing. Massage will actually aggravate the damage. Don't be fooled on this point.

Having solved the problem of pressure, let’s talk about the care of the wound itself. I have seen too many people rub iodine on any wound. In fact, this is also a common misunderstanding. If it is only a stage I pressure sore - that is, the skin is intact, but the skin is red and does not fade when pressed, there is no need to disinfect the area at all. Just wipe the area clean with warm water and apply a layer of skin protectant containing zinc oxide. If the pressure is properly reduced, the redness will generally subside in about 3 days. If it is a stage II pressure ulcer that has blistered and ruptured skin, and there is not much exudation, just put a hydrocolloid dressing on it and change it every 3 days. There is no need to uncover it every day. Repeated tossing will tear the newly grown tissue. Last year I met Grandma Li, an 82-year-old patient with a femoral neck fracture. Her family members applied iodine and changed gauze to the stage II pressure ulcer on her sacrococcygeal area every day at home. Every time the dressing was changed, the old man shed tears from the pain, and she did not see any improvement for half a month. Later, we changed her hydrocolloid dressing every three days, and it was completely healed in less than two weeks.

If it is a stage III or IV pressure ulcer with necrotic slough or even deep fascia, there are different schools of thought in treatment: the traditional surgical school advocates thorough debridement first, cutting off all necrotic tissue and then promoting granulation growth. The advantage is that it progresses quickly and is suitable for patients with good physical tolerance and no coagulation disorders; One school of thought is conservative debridement, which uses hydrogel dressings to dissolve the scab little by little, allowing the necrotic tissue to slowly fall off, with less pain and less bleeding. It is more suitable for older people with multiple underlying diseases and poor tolerance. There is no absolute right or wrong between the two options. It mainly depends on the physical condition of the patient and the wishes of the family members. There is no need to compete with each other. In addition, we no longer pursue drying and scabbing of wounds. The concept of "moist healing" has been popularized for many years. Keep the wound moderately moist and not soaked in exudate. The rate of granulation growth is 2-3 times that of dry wounds. Don't think that the wound is broken when you see exudate on the dressing. That is normal.

Don’t think that pressure ulcers are just a local problem. I have followed up on several patients and the local care has been perfect. However, the pressure ulcers have been slow to grow. After a blood test, it was found that either the albumin was only 20g/L or severely low in protein, or the blood sugar was uncontrollable above 15mmol/L all year round. Think about it, the body does not even have enough "raw materials" for growing new flesh, or the entire internal environment is "high-sugar sugar water", how can the wound grow well? Therefore, if the patient has basic problems such as low protein, anemia, and diabetes, first adjust these indicators to the normal range, and usually eat more high-quality protein that is easy to absorb, such as egg custard and lean meat puree, which is much more effective than buying imported dressings costing thousands of dollars.

In fact, pressure ulcer care is difficult to say and easy to say. The key is not to mess around. Take off the pressure first, and then choose a method based on the actual condition of the wound. Don’t just apply magic medicine to the wound randomly according to what is said on the Internet. If you really encounter a situation where the pressure sore has discharged pus, is smelly, or even has a fever, don't try to deal with it at home, but quickly seek help from a wound ostomy specialist in the hospital. Otherwise, it will lead to systemic infection.