Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - xi

CLINICAL PRACTICE GUIDELINE

Summary of Recommendations
Risk and Risk
Assessment



Knees (medial aspect especially during
side-lying position)



Occiput

1. Conduct an assessment of pressure ulcer risk
factors in individuals with SCI at every
appropriate opportunity.



Calcaneous



Assess and document risk on admission and
reassess on a routine basis, as determined
by the health-care setting, institutional
guidelines, and changes in the individual's
health status.
* Demographic
* SCI-related, such as incontinence
* Comorbid medical
* Nutritional

4. Turn or reposition individuals with SCI initially
every 2 hours in the acute and rehabilitation
phases if the medical condition allows.


Avoid overstretching and folding of skin/soft
tissues while positioning and shearing when
individuals are repositioned or transferred.



Avoid positioning individuals who are sidelying in bed directly on their tronchanters.

5. Evaluate the individual and his or her support
surface environment for optimal maintenance of
skin integrity.

* Psychological, cognitive, contextual,
and social
* Support surface for bed, wheelchair, and
all durable medical equipment (DME)
surfaces, such as shower/commode chair
or bathroom equipment related




Prevent moisture accumulation and
temperature elevation at the skin-support
surface interface.



Utilize pressure redistribution support
surfaces preventively to protect soft tissues
from injury.

Use both a validated risk-assessment tool
and clinical judgment to assess risk.



When off-loading the calcaneous with pillow
or cushion, ensure the proper position of
the pillow or cushion. It should be placed
lengthwise under the lower extremity from
the malleous to the knee, thus lifting the
calcaneous off the bed surface.



Do not use donut-type devices.



Monitor the performance, i.e., continued
effectiveness, of support surfaces for the
bed and wheelchair specific to pressure
ulcer prevention.

Prevention Strategies
Across the Continuum
of Care
2. Implement pressure ulcer prevention strategies as
part of the comprehensive management of acute
and chronic SCI and review all aspects of risk
when determining prevention strategies.


Initiate pressure redistribution as soon as
emergency medical conditions and spinal
stabilization status allow.

3. Conduct daily comprehensive visual and
tactile skin inspections with particular attention
to the areas most vulnerable to pressure ulcer
development, including, but not limited to,
the following:


Ischial tuberosities



Sacrum



Coccyx



Greater trochanters



Ankles (malleoli)

6. Provide an individually prescribed seating system
designed to redistribute pressure.


Employ a power weight-shift system
when manual pressure redistribution is
not possible.

7. Implement an ongoing exercise regimen to
promote maintenance of skin integrity and
prevent contractures.
8. Assess nutritional status, including dietary intake,
anthropometric measurements, biochemical
parameters (prealbumin, total protein, albumin,
hemoglobin, hematocrit, and total lymphocyte
count) fasting blood sugar, liver function panel,
folate, and vitamin B12.

xi
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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