ii PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY Contents iii v vi vii ix xi 1 Foreword Preface Acknowledgments Panel Members - Original Pressure Ulcer CPG Reviewers Summary of Recommendations The Consortium for Spinal Cord Medicine 1 GUIDELINE DEVELOPMENT PROCESS 1 METHODOLOGY 4 5 11 11 11 12 13 14 14 15 15 Methods (Second Edition) Introduction Recommendations RISK AND RISK ASSESSMENT DEMOGRAPHIC RISK FACTORS SCI-RELATED RISK FACTORS COMORBID MEDICAL RISK FACTORS NUTRITION PSYCHOLOGICAL, COGNITIVE, CONTEXTUAL, AND SOCIAL FACTORS: SUBSTANCE ABUSE AND ADHERENCE/COMPLIANCE SUPPORT SURFACES FOR BED AND WHEELCHAIR RISK-ASSESSMENT TOOLS 17 17 17 19 20 21 23 23 28 PREVENTION STRATEGIES ACROSS THE CONTINUUM OF CARE PRESSURE REDISTRIBUTION VISUAL AND TACTILE SKIN INSPECTIONS TURNING AND REPOSITIONING EFFECTIVE SUPPORT ENVIRONMENT INDIVIDUALIZED PRESSURE REDISTRIBUTION SYSTEM EXERCISE NUTRITION EDUCATION-HEALTH CARE PROFESSIONALS, PERSONS WITH SCI, FAMILY, CAREGIVERS 29 29 30 ASSESSMENT AND REASSMENT FOLLOWING PRESSURE ULCER ONSET ASSESSMENT OF THE INDIVIDUAL WITH A PRESSURE ULCER ASSESSMENT AND REASSESSMENT OF THE PRESSURE ULCER 34 34 34 35 37 43 44 TREATMENT - NONSURGICAL CREATING A PHYSIOLOGIC WOUND ENVIRONMENT Cleanse Debridement Selection of Wound Care Dressing Electrical Stimulation Adjunctive Therapies and Biologics 45 MODIFICATION OF TREATMENT PLAN 46 46 48 52 TREATMENT - SURGICAL REFERRAL FOR PRESSURE ULCER SURGERY PREOPERATIVE ASSESSMENT POSTOPERATIVE CARE 54 COMPLICATIONS OF PRESSURE ULCER SURGERY 55 55 57 58 62 65 66 PRESSURE REDISTRIBUTION AND SUPPORT SURFACES BED POSITIONING BED SUPPORT SURFACES WHEELCHAIR SEATING AND POSITIONING WHEELCHAIR SUPPORT SURFACES SUPPORT SURFACES FOR BATHING AND TOILETING OTHER SUPPORT SURFACES 67 68 82 83 Future Research References Glossary Index