Decubitus prophylaxis

People in need of care who have limited mobility and spend a lot of time sitting or lying down are particularly at risk of developing position-related skin and tissue damage. Pressure ulcers, or bedsores, are particularly feared. How do pressure sores develop? How can it be prevented? Why is pressure ulcer prevention so important? This article answers these and other questions.

Table of contents

1 What is a pressure ulcer?

A pressure ulcer is localized damage to the skin or underlying tissue caused by pressure, possibly in combination with shear forces. People in need of care who cannot move or can only move to a limited extent are at risk. Initially superficial redness can develop into deep, poorly healing wounds.

2 How does a pressure sore develop?

Even your own body weight can be enough to compress the small vessels (capillaries) in the skin to such an extent that the tissue is not supplied with enough oxygen and nutrients. If the tissue lacks an adequate supply, this can lead to superficial redness and even tissue damage. Healing can be very problematic and protracted.

3. risk factors

The development of a pressure sore depends on the pressure applied and the duration. Particularly vulnerable areas of the human body are bony prominences where there is little muscular tissue between the skin and bone. In the supine position, these are the heels, elbows, coccyx / sacrum, spine, shoulder blades and the back of the head. In the lateral position, the ankles of the ankle joints, the greater trochanter, the head of the fibula, shoulders and auricles are particularly at risk.

Particular attention should be paid to pre-existing conditions with sensory disorders such as strokes, multiple sclerosis, diabetes mellitus and circulatory disorders. Being underweight due to the lack of a fat pad over the bony structures and being overweight due to the increased pressure on the skin also have an unfavorable effect.

4 What measures are there to prevent pressure sores?

Targeted measures can help to stabilize and protect the skin and thus prevent pressure ulcers:

• Mobilization: in order to avoid permanent pressure on particularly vulnerable areas, the patient should be motivated to get up again and again if possible and supported in doing so if necessary. Movement exercises that are performed sitting up in bed or in a wheelchair and passive movement exercises can also be integrated into the daily routine.
• Positioning: There are various positioning techniques. It is important to take care to protect the tissue in order to avoid dangerous tensile and shearing forces. The 30-degree inclined position is often used. In 135-degree positioning, the bedridden person lies at an angle on the front part of the body.
• Pressure relief: In order to reduce the pressure on the overlying surfaces, the vulnerable parts of the body can be placed underneath for protection. Water or gel cushions, heel protectors or absorbent cotton pads can be used for this purpose. The position should be changed after every two hours.
• Skin care: Poor skin condition favors the development of a pressure ulcer. Natural oils such as coconut oil, olive oil or almond oil provide the skin with deep moisture.
• Promoting circulation: The addition of essential oils enhances the effect of skin care oils. Rosemary oil can promote circulation, cypress oil can stimulate lymph flow and peppermint can refresh and activate.
• Nutrition: A balanced diet with sufficient fluid and protein intake plays a key role in maintaining skin structure and wound healing.

5 Complications due to pressure ulcers

If a pressure ulcer is not treated, serious complications can arise:

• Inflammation that penetrates to the bone and causes ostitis (bone inflammation) or osteomyelitis (bone marrow inflammation).
• Tissue death (necrosis).
• If the germs spread via the bloodstream, organs can be affected by inflammation or blood poisoning (sepsis) can occur.
• Sometimes an operation is necessary to remove damaged tissue.

6 Other consequences of immobility

In addition to the development of painful pressure sores and chronic wounds, immobility can have other health consequences:

• A lack of sunlight and exercise can reduce bone density, increasing the risk of osteoporosis.
• Joints lose their mobility and stiffen.
• The metabolism slows down, which can lead to loss of appetite, digestive problems and weight fluctuations.
• The risk of pneumonia and heart failure increases.
• The lack of exercise increases the risk of thrombosis.

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