Bedsores in bedridden patients: prophylaxis and treatment of pressure sores

Pressure ulcers are called aseptic necrosis of the skin and underlying tissues, which develops as a result of disturbances in microcirculation and nerve trophism during prolonged squeezing.

The bedsore stages

To determine the size of bedsores, there is a classification that divides decubitus by five degrees depending on the depth of tissue damage.

1. 1) There is persistent hyperemia, which does not go away after the pressure is canceled. The skin still does not lose integrity, but it is possible that the temperature rises.
   
2. 2) Minor skin disorders with detachment of the epidermis and involvement of subcutaneous tissue. Stable redness and swelling of the skin.
   
3. 3) Destruction of the dermis - the connective tissue of the skin lying between the epidermis and the organs.
   
4. 4) The decubitus takes the form of a wound as a result of complete destruction of the skin and muscle tissue.
   
5. 5) Damage to all soft tissues between the skin and bone until the latter is exposed.

It should be noted that today there are a huge number of classifications as individual authors, and generally accepted in medical circles. The classification of the Agency for Health Policy and Research, adopted in the United States more than 20 years ago, has received sufficient distribution in recent years.

It clearly reflects the dynamics of local transformations in the field of necrosis:

1. 1 degree - erythema, preceded by the formation of ulcers, but not transferring to areas of normal skin;
   
2. 2 degree - a slight decrease in skin thickness, which is due to a defect in the epidermis or dermis;the ulcer is located on top, has the appearance of a scratch or small depression;
   
3. 3 degree - loss of skin thickness up to the fascia due to necrosis of the lower tissues;
   
4. 4 degree - loss of skin thickness in full with deformation of muscles, tendons, bones, ligaments, articular capsules.

Causes of decubitus in bedridden patients

The causes of pressure ulcers in bedridden patients can be divided into: exogenous( external), endogenous, or internal, and also mixed.

To exogenous include:

1) Prolonged and strengthened influence of external mechanical factors:

• squeezing of tissues with plaster bandage;
  
• incorrectly selected corsets, prostheses;
  
• folds of clothes and sheets;

2) Rigid drainage and catheters, long staying in the wound or organ( internal exogenous causes);

3) Poor care for a sick person;

4) Being in a forced posture for a considerable time( surgery, trauma).

Endogenous factors:

• marked neurotrophic disorders;
  
• acute circulatory disturbance( strokes);
  
• too large or light weight;
  
• oncological pathology;
  
• violation of the spinal cord or large nerves;
  
• diabetes mellitus;
  
• violation of urination and defecation;
  
• immunodeficiency status;
  
• anemia;
  
• obliterating diseases;
  
• water-electrolyte disturbances.

Mixed bedsores appear against the backdrop of cachexia, when the sick person is so weakened and exhausted that he is not able to move independently, change the position of the body.

Prolonged compression of tissues in this case leads to ischemic damage to the skin in the region of the bony projections and the appearance of necrotic areas. The reasons should also be attributed to age, since in venerable years the risk of developing aseptic necrosis increases many times.

Treatment of decubitus in bedridden patients at home

Treatment of bedsores in bedridden patients should be comprehensive and performed at the proper level, as these defects very often lead to serious complications. At its core, the treatment intervention consists of three components:

• prevention of continuous pressure;
  
• topical treatment;
  
• therapy is the underlying disease.

It is necessary to monitor the skin of a sick person, it should not be - dry, oily or wet. Depending on the type, use the appropriate means:

• dry - moisturizers;
  
• oily - alcohol-containing preparations;
  
• moist - powders, talc.

At home, the discontinuity of the pressure factor is achieved by turning the patient in the bed every two hours. Widely used are systems with pressure and vibration adjustment, helping to reduce local pressure on the skin.

For the same purpose, mattresses and pillows are used with foam, air or water inside. Thus, the affected areas are released from compression and blood circulation is restored.


Local treatment involves the diligent toilet area of ​​the altered skin, the use of various medications depending on the stage of the disease, which contribute to the rejection of necrotic masses. To do this, ointments are used on the hydrophilic basis to ensure dehydration and acceleration of healing processes, bandages with hypertonic solution, proteolytic enzymes. Also good is the powder Xeroform.

Consider the popular antiseptic dressings, ointments and cream, they are prescribed depending on the stage of decubitus and the area of ​​the lesion. Before purchasing, consult your doctor.

Handwraps:

• Tegaderm;
  
• Hydrofilm;
  
• Cosmopor;
  
• Blisterfilm.

Ointments and Creams:

• Levomekol;
  
• Metronidazole gel;
  
• Ointment Iruksol;
  
• Argosulfan Cream.

Among the treatment for bedsores should be allocated antibacterial, silver-containing, anti-inflammatory drugs, means for improving microcirculation, stimulators of reparative processes.

From physiotherapy methods in the treatment of decubituses use: ultraviolet radiation, phonophoresis with antiseptics, electrostatic shower( exposure to a constant electric field of high voltage), electrophoresis of antibiotics, low-intensity laser radiation.

With purulent complications or large areas behind bedsores, surgical intervention is indicated. Usually it is necessary at the last stages.

Prophylaxis of decubitus in recumbent patients

Prophylaxis of bedsores is a complex care for a sick person, depending on the qualified treatment of the underlying disease, which caused a general severe condition.

For prophylaxis of pressure ulcers in bedridden patients it is necessary: ​​

1. 1) Reduce the pressure on the tissues in the most vulnerable places with rubber circles, pillows and other special means;
   
2. 2) Turn the sick person at least 10 times a day;
   
3. 3) Keep track of bed linen and bed linen so that it is soft and does not gather in creases;
   
4. 4) Maintain the purity of the skin;
   
5. 5) Timely change the drainage pipes in the wound;
   
6. 6) Provide adequate nutrition and abundant drinking;
   
7. 7) Maintain the optimal room temperature( in case of overheating, the risk of pressure ulcers is increased);
   
8. 8) Arrange air baths;
   
9. 9) Use diapers and pads to limit the spread of urine when it is incontinent.

To prevent the appearance of necrotic areas, it is necessary to maintain all of the above points, since they complement each other well. In addition, the material costs for the prevention of bedsores are always less than for their treatment.

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