I WISH caregivers can spend a minute or two reading on this as pressure sores are so commonly seen in ankles and heels of bed-bound patients, yet not many knows it is actually PREVENTABLE. With prevention, it helps to reduce patients’ suffering.
In most of the wound care cases that we encountered, the most common area where pressure sores develop in bedridden patients is not just the tailbone (coccyx), but also the ankles and heels, which are often overlooked by most of the caregivers.
In one of our case, the bedbound patient’s ankles and heels are presented with multiple blisters and open sores. Her history of diabetes made the wound healing even more challenging.
There is a risk of developing pressure sores when patient lies in the same position for a long period of time, and the protruded bony areas, i.e. ankles and heels are under prolonged pressure.
So, what could be done to prevent pressure sores from developing in ankles or heels of patient?
The best way is to ensure the heel is not in contact with the bed – the so-called “Floating heel.”
How do you achieve a "floating heel"?
Here are some key points which I concluded in short from the latest wound care guideline by National Pressure Injury Advisory Panel (NPIAP) and European Pressure Ulcer Advisory Panel (EPUAP):
1. First and foremost, there are several ways to "lift" the heel off the bed.
The most common being to use a soft pillow or foam cushion along the full length of the lower leg, leaving the heel suspended.
However, this is only suitable for patients who have not develop any pressure sores or with mild pressure sores (Stage I & II only).
(For more information on the four stages of pressure sores, click here )
2. Another approach is to use commercially available heel support devices, namely Heel Off-Loading Devices (HOLDs). The devices help to completely relieve pressure in Stage III, IV or even more severe pressure sores.
There are three common types of heel off-loading devices:
Medical grade latex-free foam-based
3. The use of anti-decubitus foot rings is NOT recommended because the high pressure areas created by the edges of these rings can damage skin tissue.
4. Use of prophylactic dressings - Medical soft silicone foam dressings as a prophylactic measure to prevent friction is recommended in the guideline.
Studies have shown that the use of prophylactic dressings can reduce heel pressure injuries compared to no dressing. Along with the use of prophylactic dressings, it is also recommended that other important prophylactic measures, such as heel off-loading devices should be continued.
The caregiver should also assess the skin for signs of pressure sore formation at the time of daily dressing changes.
5. Intermittent decompression - Assist the bedridden patient to turn every 2 hours and change the patient's position at a 30° angle of inclination.
This will prevent prolonged pressure on either ankle or heel.
Pressure Ulcers are Preventable and Curable.
These are the 5⃣ proven-effective ways as shown above.
Besides, check the skin condition of the bedridden patient's feet at least once a day can also help to detect and treat pressure sores early.
(For more information on how to check for signs of pressure sores, read here )
Article by: Pharmacist Khang Phing Goh
At Remeds, we have an unwavering belief that bedsore is definitely CURABLE and PREVENTABLE with proper nursing care and caregiver education. The same goes for diabetic ulcers and other wounds.
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