Bed sore

What is a pressure sore/ bed sore ?

Pressure sore/ bed sore is a local injury to the skin and underlying tissues over the bony prominence due to continuous and longstanding pressure while someone is lying on the bed or sitting on the chair.

What are the sites of bed sore.

Most common:

  • Lower back called sacral sore (due to pressure of sacral bone )
  • Upper outer side of thigh called trochentric sore(due to pressure by trochentric bone)
  • Upper inner part of thigh called ischial sore (due to pressure by ischia bone)
  • Heel of foot (due to pressure by heel bone)

Other less common sites are:

  • Back of head called occipital sore
  • Inner and outer sides of knees
  • Inner sides of elbow
  • Upper back

Which Patients are prone to develop bed sores?

1) Paraplegic pts:
These patients partly or fully unable to move or feel their body parts especially arm hands thigh legs etc and can’t take turn or sit on their own in the bed and wheelchair.

2) Physically weak, sick and bed ridden patients:
but they are not paraplegic Patients, who are bedridden, may be due to age, some fractures, acute illness, major operations etc

How the bed sores develop in these patients while not in normal individual

In a Normal Person, if there is prolong pressure at some site of the body the patient will start feeling discomfort and little pain, and the patient will react and change the position accordingly and get rid of developing bedsore.

But in case of paraplegic or bedridden patient, the patient will not be able to move the part by himself/herself that leads to decrease in Blood and Oxygen supply to the area, death and Gangrene formation in that area, initially it affects skin and underlying fat but as the pressure continue to increase the deep muscles and bones will also get involved.

What are the signs and symptoms of bed sore?

  • Initially affected area looks slightly reddish, dry and may be some peeling of superficial skin
  • Develop some more redness , blister formation more peeling and some watery discharge
  • Dry blackish discoloration in the center with surrounding redness , no demarcation
  • Blackish area become wet and leathery , foul smell discharge , crack in the area
  • Whole tissues become gangrenous and start separating
  • Develop large deep wound

Staging of bed sore

  • Stage 1

    Skin of the area is slightly red but intact

  • Stage 2

    There is some blisters, peeling of skin and increase redness

  • Stage 3

    Dry blackish discoloration of skin minimal discharge

  • Stage 4

    Wet leathery skin foul smelling discharge and cracks

Associated risk factors

  • Poor nutrition
  • Diabetes
  • Ch.liver , kidney disease
  • No control of urine and feace
  • Smoking
  • Poor circulation in limbs (Peripheral vascular disease)
  • Poor nursing care / help
  • Coma patients
  • Fracture patients
  • Mentally uncooperative patients
  • Financially weak patients

Can bedsore be prevented in these patients?

Big YES but Needs lots of care and understanding

How to prevent bedsores?

Avoid continue and longstanding pressure on the sites of bedsores using following measues:
Frequent change of patient position by the nurse/ helper / attended round the clock

  • Offload the pressure by

    *keeping the part in the air eg. foot to avoid heel sore
    *Using foam, rings and special mattresses
    *sitting on bed or on wheelchair

  • Physiotherapy

    Require regular physiotherapy to prevent joint stiffness and deformity and strengthen the muscles

  • care of back

    *cleaning oiling
    *Gentle massage

  • Nutrition

    Adequate high protein diet as per doctor advise

  • Proper care of primary disease

    Treatment of Primary disease due to which patient is ill must be continued by the qualified doctor

  • Care of urine and faeces

    * No leakage and soiling of urine and faeces
    * Proper catheterization as per need
    * Proper care of stool

  • Nutrition

    Adequate high protein diet as per doctor advise

  • Care of risk factors

    Like diabetes, heart kidney etc

What to do if patient develop bedsore

Most Important
It is happening because there is some deficiency in preventive care. (Practically sometime not possible due to various reasons)

1) Continue all preventive care for early bedsore stage 1or 2
Local care of area with application of some ointment or little dressing. for bedsore of stage 3 &4

In this skin and underlying tissues are dead and gangrenous so require surgical removal of dead tissues and regular dressing , antibiotics etc. In large sores it finally lead to large deep wound.

What is the treatment of these wounds in bedsores?

If small and not much deep- Can heal with dressings
If large and deep- Can heal with dressing (But take months)
BETTER IS- Wound closure by surgery if possible

What is VAC Dressing & how it is useful in treating bed sore wounds?

Ans. VAC dressing is an specialized FOAM dressing which is attached to a pipe and to a negative pressure function machine which works for round the clock. It has many advantages over normal dressings:

  1. Promote fast growth of healing tissues
  2. Suck the muck and pus etc continuously
  3. Decrease infection from the wound
  4. VAC dressing has to be changed every 4th day or so.
  5. Ultimately clean and heal the wound much faster than normal dressing.

What are the drugs and material used in bedsore dressing?

  • Normal saline Betadine
  • Bactigrass eusol
  • Antibiotic ointment
  • Gauge pads sterile
  • Micropore tap
  • Sterile gloves
  • Sterile container
  • Disposable dressing set

Can I do bedsore dressing of my patient at home as I am non medicos?
Yes, but to some extent and need little understanding what to do and what not to do that too under supervision of medical expert.

Bed sore has iceberg or bottleneck type phenomena. What is that?
It mean that on the skin what damage visible is much less then on the deeper part. Pressure causes much more damage to deeper tissue.