(Pressure Sores; Pressure Ulcers; Bed Sores; Decubitus Ulcers)
Debra Wood, RN
A pressure injury is a lesion that develops on the skin and underlying tissues, usually over bony areas. It is due to unrelieved pressure in combination with shear.
A Pressure Injury Can Penetrate to the Bone
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Pressure injuries result from lying or sitting in one position for too long a time, with or without with a shear force. The skin and tissues need enough blood supply for oxygen and nutrients. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to become damaged and dies.
Several factors contribute to the development of pressure injuries including:
Pressure—Pressure injuries can result from the inability to change position or to feel discomfort caused by pressure. People with normal mobility and sensation change position automatically, without thinking.
Friction—Even friction from pulling someone across bed sheets can damage small blood vessels that supply the skin tissue.
Moisture—This can come from sweating due to fever or leakage of urine or stool.
—Extra weight increases pressure on the skin over the bones and joints.
This condition is more common in older adults and people of African American or Hispanic descent. Other factors that may increase the chances of pressure injuries:
Immobility such as being bed- or chair-bound
Poor nutrition, which may be the result of a lack of protein, vitamins A and C, zinc, and iron
Low body weight
Chronic or complex medical problems such as:
Anemia Infection Poor circulation Neuropathy Dementia Cancer Diabetes Stroke Spinal cord injury or
paralysis Bone fracture
Swelling or water retention
Symptoms of a pressure injury may include:
Skin tissue that feels firm or boggy
Local redness, warmth, tenderness, or swelling
Reddish or purplish skin discoloration, often over a bony area that does not fade within 30 minutes of removing the pressure
Pain or itching of the skin
Blistering, sores, skin breakdown, or drainage
You will be asked about your symptoms and medical history. A physical exam will be done. Pressure injuries are staged according to the depth and tissues that are involved.
Your bodily fluids may be tested. This can be done with:
Imaging tests may be done with:
Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure injuries. In many cases, a caregiver will provide care for your pressure injuries.
Avoid placing any weight or pressure on the wound.
Change position at least every 2 hours, around the clock.
Maintain good body alignment.
Make sure bedclothes are clean and without wrinkles.
If needed, use a special mattress.
Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as advised.
You or your caregiver will be taught how to tend to the wound. Some basic instructions include:
Cleaning the sore, removing dead tissue, and applying a dressing.
Not putting anything else on the sore.
Washing hands before and after performing wound care. Wearing disposable gloves.
Cleaning the wound every time the bandage is changed.
You may need to take pain medication a 30-60 minutes before dressing changes.
Eat a well-balanced meal. Your doctor may recommend vitamins, minerals, or supplements.
Surgery and Other Procedures
The doctor may surgically remove dead tissue. Skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.
Phototherapy using ultraviolet light may have some benefits when used in combination with other treatments. In some, it has been shown to reduce healing time.
Most pressure injuries can be prevented by being aware of the risk. To help reduce the chances of pressure injuries:
Follow these tips when repositioning:
Change position in bed at least every 2 hours or, in a wheelchair, at least hourly. If you are able to move yourself, shift position every 15 minutes. Maintain good body alignment. Talk to your doctor about whether you should elevate the head of your bed. Find a sitting or lying position that is 30° toward one side or the other, but not squarely on the hip. Place a pillow under your calves to keep the heels off the mattress. Place a pillow between the knees. Do not use donut-ring cushions, which can cut off circulation.
Talk to the doctor about using:
A special foam mattress designed to reduce the risk of pressure sores A mechanical mattress or overlay that inflates and deflates to change the pressure on the body Sheepskin overlay Use a special cushion for a wheelchair.
Wear special pads to protect skin that is resting against braces and other devices.
Keep the skin clean and dry. Use pH-balanced skin cleansers.
Do not massage bony areas.
If incontinent, use a protective cream on skin that may come in contact with urine or stool. Promptly clean any stool or urine that comes in contact with the skin.
Check the skin at least daily for signs of pressure problems.
Keep sheets clean and free of wrinkles.
Maintain good nutrition.
Use skin moisturizers daily.
Family Doctor—American Academy of Family Physicians
National Pressure Ulcer Advisory Panel
http://www.npuap.org CANADIAN RESOURCES:
The College of Family Physicians of Canada
Pressure ulcer. EBSCO DynaMed Plus website. Available at:
. Updated October 27, 2017. Accessed March 13, 2018.
Pressure ulcer staging illustrations. National Pressure Ulcer Advisory Panel website. Available at:
...(Click grey area to select URL) Accessed March 13, 2018.
Taking care of pressure sores. University of Washington Medicine website. Available at: sci.washington.edu/info/pamphlets/pressure_sores.asp. Updated March 13, 2018.
5/27/2011 DynaMed Plus Systematic Literature Surveillance. Available at:
: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention.
Cochrane Database Syst Rev.
11/25/2013 DynaMed Plus Systematic Literature Surveillance. Available at:
: Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2013;8:CD009362.
8/11/2014 DynaMed Plus Systematic Literature Surveillance. Available at:
: Chen C, Hou WH, Chan ES, Yeh ML, Lo HL. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev. 2014;7:CD009224.
6/22/2015 DynaMed Plus Systematic Literature Surveillance. Available at:
: Qaseem A, Mir TP, Starkey M, et al. Clinical Guidelines of the American College of Physicians. Risk assessment and prevention of pressure ulcers; a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):359-369.
Last reviewed March 2018 by
EBSCO Medical Review Board
Marcie L. Sidman, MD Last Updated: 3/13/2018