What are pressure injuries?
Pressure injuries are areas of skin damage caused by a lack of blood flow. You may
also hear them called bedsores, pressure sores, or pressure ulcers. The skin in the
area can die and leave an open sore (ulcer).
The decreased blood flow and resulting damage are due to pressure. The pressure is
combined with rubbing (friction), moisture, changed blood flow patterns, and pulling
on the skin. Pressure injuries often occur over bony parts of the body. These include
the hips, heels, the base of the spine (tailbone), shoulder blades, the backs and
sides of the knees, and the back of the head.
What causes pressure injuries?
Pressure injuries can occur when you are restricted to a bed or chair and don’t change
positions on a regular basis. When you rarely move, your body weight limits the blood
flow to your arms, legs, neck, and back. The lack of blood flow to the skin and tissues
under the skin may cause them to break down until a sore appears.
Who is at risk for pressure injuries?
People at greatest risk for this type of injury are those who use wheelchairs for
much of the day, or those who must stay in bed for long periods of time. Pressure
injuries often occur on parts of the body where the skin is mashed between a bone
and a surface such as a wheelchair or mattress. Pressure injuries can develop quickly,
sometimes in just a few hours without movement.
Pressure injuries are most likely to occur in older adults, particularly those who
live in nursing homes. Studies show that more than 1 in 10 nursing home residents
have had a pressure injury.
People are also at greater risk for pressure injuries if they:
If found and treated quickly, pressure injuries should heal in a few weeks. But if
left untreated, they can quickly worsen.
What are the symptoms of pressure injuries?
Pressure injuries start as red, blue, or purplish patches on the body that don't turn
white when touched and get worse over time. These patches can quickly turn into blisters
and open sores. The sores can then become infected and grow deeper until they reach
muscle, bone, or joints.
Pressure injuries are found on parts of the skin that are closest to bone and have
little fat to pad them. This includes the heels, hips, elbows, ankles, back, base
of the spine, and shoulders. The affected skin may feel warm, smell bad, and look
swollen. A fever, chills, or confusion can develop if the infection spreads to the
bloodstream. If untreated, a very serious condition called septic shock can occur.
In the worst cases, pressure injuries can become life-threatening. That's why it's
vital to contact a healthcare provider at the first sign of a pressure injury. This
is often a soft, red patch of skin that stays red for 30 minutes even after the pressure
is eased. People with dark skin tones should call a healthcare provider if a patch
of skin turns darker or is warm to the touch.
How are pressure injuries diagnosed?
Healthcare providers working with people in the hospital can spot pressure injuries.
So can health aides helping with cleansing and dressing. If you are restricted to
bed at home, watch for any reddish patches or sores on your body. Ask family and friends
who visit to check for an injury to bony areas and other areas.
Pressure injuries are organized into 1 of 6 categories. These range from an early
warning signal to the most severe:
Stage 1. A red, blue, or purplish area first appears like a bruise on the skin. It may feel
warm to the touch and burn or itch.
Stage 2. The bruise becomes an open sore that looks like an abrasion or blister. The skin
around the wound can be discolored. The area is painful.
Stage 3. The sore deepens and looks like a crater. There are often dark patches of skin around
Stage 4. The damage spreads to the muscle, bone, or joints. It can cause a serious bone infection
called osteomyelitis. It can also lead to a possibly life-threatening blood infection
Unstageable full thickness pressure injury. A stage 3 or 4 injury is covered with black dead tissue (eschar) or creamy yellow,
gray/black, or white thick slimy tissue (slough). The severity of the injury is difficult
to see because of the covering.
Deep tissue pressure injury. A very dark red, maroon, or purple colored area of the skin that doesn't disappear
when pressed on or a dark deep wound or blister filled with blood that is seen through
a separation in the skin.
How are pressure injuries treated?
Bedsores should be treated right away, even in the early stages. That’s because they
can quickly get worse. Prop up the leg or area near the injured body part with a pillow
or foam cushion. This will help relieve pressure on the area so it can start to heal.
To reduce friction between the skin and the bed, powder the sheet with a special formula
that can be found in medical supply stores.
If the injury has become an open sore, follow a healthcare provider’s instructions
on how to clean the area to prevent infection. Generally, pressure injuries are cleaned
with saline or saltwater to remove dead tissue. In some cases, surgery is required
to remove the dead tissue. The injury may also be covered with a special bandage.
A healthcare provider can prescribe special dressings and therapies that speed up
Nutrition plays an important role in healing pressure injuries. To heal correctly,
the body needs enough calories, protein, and nutrients such as vitamin C and zinc.
In some cases, supplementation is needed to promote healing.
The most severe sores may require a hospital stay to fight infection or surgery may
be needed to add muscle flaps or skin grafts.
Can pressure injuries be prevented?
If on bed rest. To prevent pressure injuries, ease pressure on the skin by changing your body position
at least every 2 hours. Check to make sure that the bedding is smooth and that one
leg isn't lying on top of the other. Put a pillow between your legs if lying on one
side. Raise your heels slightly off the mattress with a pad or foam underneath the
lower legs (don’t use doughnut-shaped pads).
If using a wheelchair. Shift positions every 10 to 15 minutes. If that isn't possible, have someone move
you at least once an hour. If you have a neuromuscular disease, it may be helpful
to shift to a standing wheelchair at certain times. This can ease the pressure on
your buttocks. Doing wheelchair "pushups" can also help.
If you are immobile or are caring for someone who is. Think about buying an alternating air mattress. This can greatly reduce the pressure
against the skin. This type of mattress has cells that alternately inflate and deflate
to increase blood circulation. You might also ask your healthcare provider about new
technologies to find pressure injuries. Check with your insurance company or Medicare
to see what is covered.
If lifting someone who is immobile. Use sheets, harness, or lifting device rather than pulling on the person's arms or
legs. This is because skin is often fragile and easily injured.
Here are other good habits that can help:
Take good care of skin in general. Wash soiled areas right away with warm (not hot) water and soap. Moisturize dry skin.
It's also vital to keep skin warm and dry. Too much moisture can increase the risk
for skin infection.
Eat a well-balanced diet and drink 8 to 10 cups of water a day. This will help keep you hydrated and keep blood flowing correctly, which helps prevent
sores from forming.
If possible, exercise daily. If you are immobile, ask caregivers to move your limbs gently to exercise them.
Don’t smoke. And stay away from secondhand smoke. This is also important for wound healing and
Key points about pressure injuries
Pressure injuries are areas of skin damage caused by a lack of blood flow. They are
also called bedsores, pressure sores, or pressure injuries.
They can occur when you are restricted to a bed or chair and don’t change positions
on a regular basis.
The skin in the area can die and leave an open sore.
They often develop over bony parts of the body such as the hips, heels, base of the
spine, shoulder blades, and back of the head.
It’s important to get treatment right away, even in the early stages because the sores
can quickly get worse.
The most severe sores may require a hospital stay to fight infection. In some cases,
Or surgery may be needed.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.