1. Skin Care Issues & Prevention of Pressure Ulcers in Spinal Cord Injury Presented by: Sushrut Nimbkar, RN, BSN, WCC & Sean Leahy, RN, ADN, WCC

2. Why Is This Topic Important? w People with SCI are at lifelong risk for developing pressure ulcers. w Pressure ulcers are a serious problem that affects health and well-being. w Many pressure ulcers can be prevented. w The earlier pressure ulcers are found, the more easily they can be treated.

3. w What is a pressure ulcer?

4. What is a pressure ulcer? w A Pressure Ulcer is an area of the skin or underlying tissue that is dying or dead (necrosis) as a result of the loss of blood flow to the area.

5. w How do pressure ulcers develop?

6. How do pressure ulcers develop? w The most common is when you or rest on a bony area for a prolonged period of time. The extended pressure leads to a pressure ulcer. w Remember that pressure ulcers don’t always start on top of your skin where you can see them.

7. Other Risk Factors w Impaired mobility (ability to move) w Impaired sensation (ability to feel) w Friction/Shear w Moisture (excessive perspiration or incontinence) w Decline in health status (poor nutrition, smoking, diabetes, vascular disease, etc.)

8. Other Risk Factors w Age w Severity of SCI w Activity w Mental Distress w Drugs & Alcohol w Autonomic Dysreflexia w Inappropriate, worn-out or inadequate equipment

9. Warning Signs: w The skin is warmer or cooler to the touch w The area may feel boggy or mushy related to fluid underneath the tissue w Area may hurt or itch w Different color skin: pink or red for light skin; red, blue or purple for dark skin

10. Why is skin inspection so important? w Prevent pressure ulcers w Prevent infection of open areas

11. What are some skin inspection tips?

12. w Check skin twice a day. w Check all bony prominences. w If you can’t check your skin by yourself even with a mirror get someone else to check. w Check for reddened areas & darker areas for darker skinned people w Feel over bony areas for change (lumps or spots) that are firmer than the skin around it

13. What are some skin inspection tips? w Thick seams especially on jeans w Binding in the groin area with pressure on the scrotum w Check under the foley catheter w Tight shoes especially if feet swollen w Socks with elastic tops that are binding w Drainage system straps that may be too tight w Condoms that have been applied too tightly w Check pressure areas that can be caused by a wheelchair

14. What are some skin inspection tips? w Avoid clothing too tight or too big w Avoid clothing with heavy seams w Use clothing made of soft material that can breathe (cotton; jogging suits) w Avoid buttons, snaps, & heavy seam pockets on back of pants w Wear shoes with 100% white cotton socks w Shoes should be 1 size larger than worn before SCI

15. What are some skin inspection tips? w Never get out of bed without shoes or foot supports w Dress appropriately for the weather. Due to changes in temperature regulation of the body after SCI, the body assumes the temperature of environment. w Never place objects in back pockets. w Monitor your weight

16. What are some skin inspection tips? w Always be aware of how close paralyzed body parts are to possible hazards. w When transferring, be careful not to bump into things. w Don’t do fancy maneuvers in wheelchair unless trained. w Be careful about heat

17. Common Pressure Sore Sites w Sacrum (tailbone; lowest part of spine) w Trochanter (hips) w Ischium (base of buttocks, “sitting bones”) w Feet/Heels

18. Pressure Relief/Weight Shifts w If up in a wheelchair, you should shift or be assisted with weight shifts every 15-30 minutes. w If in a bed, you should turn and position every 2 hours (prone position is suggested if tolerated).

19. Effective Pressure Relief in a Wheelchair w Pressure relief should be done every 15 minutes. w Sitting-up w Tilting backward w Tilting forward

20. Wheelchair Tips w Use correct cushions w You should be centered and sitting back in wheelchair with good body alignment. w Foot rests, arm rests, & other equipment must be correctly positioned. w Hips & knees should be at the same height when in wheelchair. w Check pressure areas that can be caused by a wheelchair.

21. Positioning/Turning in Bed w Use a firm supportive mattress w Maintain a regular turning schedule. w Use a draw sheet to lift persons for turns. w Use pillows or wedges to prevent pressure to bony areas.

22. Positions in Bed w Prone (face down) if tolerated w Right side w Left side

23. Points on the Body More Susceptible to Pressure when Side Lying

24. Body Parts Susceptible to Pressure when Laying on Your Back

25. Watch Out for Bottoming Out Over time bed and chair surfaces wear out (get compressed and flattened). Mattresses and overlays should be checked once per month and air-filled static mattresses and wheelchair cushions checked once per week. (<1 inch = bottomed out).

26. Body Parts Susceptible to Pressure in a Wheelchair

29. The End Thank you!