notes by dr Claudio Italiano
The long stay in one position, even for a temporary illness, slows down the
flow of blood in some areas, favoring the development of sores.
The sites of the body in which skin lesions can more easily be formed are:
- the cutaneous region corresponding to the sacrum, where the body weight rests;
- the heels, especially if the patient is in spastic contraction of the muscles;
- the hips;
- the buttocks;
- all areas where there are protrusions of the bones in points of contact with
the support surfaces.
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Bedsores
To prevent these from forming or worsening, we can act on several fronts.
Sometimes a backache or a fracture, which forces them to sleep for a prolonged period, can suffice: when a person has to maintain the same position for a long time, the tissues are subjected to a compression that hinders blood circulation, and therefore reduces the supply of oxygen. All this damages them or provokes their death: in this way a decubitus plague is formed whose gravity is proportional to the intensity of the pressure exerted, to the time in which this acts and to the type of surface on which the patient rests.
In addition to
pressure, other factors can also cause injuries:
-
friction or friction in the rubbing of the body against the surface on which it
rests, for example when the patient in a semi-sitting position slides down;
-
humidity (such as that deriving from incontinence), which causes maceration and
alteration of the pH, making the skin easily attackable;
-
age, with anatomical and functional changes and the coexistence of several
pathologies, which contribute to the impairment of general conditions;
-
reduction of mobility, which compromises defense mechanisms (how to move from
one position to another).
Decubitus injuries can cause pain, even blood infections (septicemia) and bone infections (osteomyelitis), loss of protein, anemia; they condition the mood negatively and can cause a confused state. In severe cases, they can also cause death.
Prevention must be started immediately, as soon as the patient is immobilized, both in bed and in a wheelchair.
The main prevention interventions are:
-the correct mobilization of the patient according to the parts of the body in
which there is the risk of developing lesions;
careful observation, hygiene and protection of the skin, with careful personal
care;
-
a meticulous hygiene of the bed or the wheelchair;
-
adequate nutrition;
-
the use of devices that reduce the pressure on the parts of the body at risk,
distributing the weight. There are various types such as anti-decubitus
mattresses, mattress covers, anti-decubitus cushions, silicon fiber protections
and so on.
In addition there are crossbeams and fleece protectors that can reduce friction damage.
The bed must be accessible from both sides and up to the patient's hip, to
facilitate the necessary maneuvers.
Avoid plastic crosspieces, which do not allow perspiration; better disposable
non-woven ones.
The sheets must always be dry and clean, of natural and soft material.
Do not use sheets with seams or not well stretched, to avoid that the folds may
constitute a point of friction. After each meal it is necessary to completely
discover the patient and examine the bed, because crumbs or other food material
that has fallen inside will further cause irritation of the skin.
Wet or damp sheets, especially if they are made of urine, must not be left in
contact with the patient but must be changed immediately.
The use of local pressure reduction aids must necessarily complement every other
preventive measure, but their use does not replace patient mobilization. It is
absolutely necessary to avoid the use of the donut, which hinders the
circulation of blood in the area corresponding to the hole, and moving easily
causes friction damage. The anti-decubitus aids, as well as the material for
dressings, are provided free of charge by the National Health Service in the
context of prosthetic assistance.
see >>
Bedsores: therapy and prevention