How to treat bedsores (superficial and deep) in bedridden patients on the buttocks, tailbone, heel and back at home. Bedsores are pathological changes in tissues as a result of their compression while lying in one position

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Bedsores are areas of tissue necrosis that occur as a result of impaired blood circulation in them. Typically, this problem appears as a result of prolonged contact of the human body with a hard surface.

Almost all people with limited activity are susceptible to developing pressure ulcers, but they most often appear when severe exhaustion, overweight body, diabetes.

What are bedsores?

Bedsores are dangerous complication various diseases caused by tissue malnutrition or external compression with displacement. In medicine, bedsores are often called ulcers.

bedsores photo - development of the necrosis process

This disorder usually occurs when tissue innervation is disrupted due to pathology or damage spinal cord. Bedsores often affect the buttocks, heels, and other areas that receive the most pressure.

In bedridden patients, blood vessels and skin are compressed, which leads to stagnation. As a result, the tissues die. Constant pressure, which can disrupt the natural blood flow of the skin capillaries for 2 hours, provokes the appearance of initial signs necrosis. The likelihood of developing bedsores increases with increased dryness or over-hydration of the skin.

Dry epithelium provokes exfoliation of the stratum corneum, and excessive humidity leads to infection. The situation worsens due to poor circulation in the compressed areas. That is why the treatment and prevention of bedsores of a bedridden patient is a very pressing problem.

Classification of bedsores, stages and photos

Doctors distinguish several stages in the development of bedsores. Each of them has certain features:

1. Stage 1. In this case, certain areas of the skin become red. However, they do not turn white when pressed with a finger. Sometimes swelling appears in these areas. The first stage is considered the simplest form of the disease. In this case, treat bedsores bedridden at home sick people are the easiest. If measures are taken in time, necrosis can be avoided.
2. Stage 2. At this stage, bedsores are accompanied by the appearance of small blisters or ulcers. It is very important to prevent inflammation or purulent process. To solve this problem, you need to use medicated dressings.
3. Stage 3. Bedsores resemble a deep wound because the skin is affected by a necrotic process. As a result, a person's fatty tissue and muscles are visible. There is also purulent content in the affected area.
4. Stage 4. The pathology affects the tendons and bone tissue. At this stage, the inflammatory process progresses, and the wounds are filled with purulent contents.

Treatment of bedsores in bedridden patients at home

For bedsore therapy to bring results, it must be comprehensive. Essentially, therapy should include several components:

• preventing constant pressure;
• local treatment;
• elimination of the underlying pathology.

Medicines for the treatment of bedsores

Treatment of bedsores in bedridden patients at home is carried out only with initial stages, for this purpose local treatment is used - drugs and ointments. It is best if the doctor selects an ointment or cream for bedsores for a bedridden patient, based on specific situation, and will assess whether hospitalization is required.

Let's look at the drugs used. However, before applying these products, you need to treat the affected area with disinfectants and antiseptic drugs. These include the following:

• Hexicon. Active component this tool is chlorhexidine. With its help, it is possible to disinfect the wound and cope with pathogenic bacteria. Good results can be achieved in case of infection with fungal microorganisms and some viruses. At the same time, the drug does not produce a negative effect on the body.
• Solutions with silver compounds. Thanks to the effect of silver ions, it is possible to stop the growth and reproduction of bacterial microorganisms. In addition, these drugs increase the effectiveness of antibiotics, cope with pain and local discomfort - itching or burning sensation.
• Furacilin. Active substance This product is nitrofural. It binds to the proteins of pathogenic microorganisms and changes their configuration. As a result, bacterial cells lose the ability to use their own proteins for life and die.

Ointments for bedsores, list

Currently there are quite a few medicines For local application. To cope with bedsores in the treating patient, ointments are often used to treat the affected areas. To the most effective drugs include the following:

• Argosulfan. The effect of this product is due to the presence of silver ions in the composition. Thanks to the use of this ointment, it is possible to relieve pain, eliminate burning and tingling sensations. To obtain desired results, before applying the ointment, the affected area should be treated with an antiseptic and dried.
• Iruksol. The active component of the product is the enzyme collagenase. It also contains antibacterial components. Due to the presence of a proteolytic enzyme in the composition, it is possible to achieve a gentle and high-quality cleansing of the affected area without damaging healthy cells.

Antibacterial ingredients provide additional wound cleansing, which helps accelerate tissue regeneration.
It is recommended to apply the product in the form of a bandage, and then carefully fix it on the area where the bedsore is located.

• Zinc ointment. This remedy has a pronounced anti-inflammatory and antiseptic effect. Thanks to its use, it is possible to achieve a drying effect and protect the affected area from external factors.

• Levosin. This medicine includes several components. Antibacterial substances, such as sulfadimethoxine and chloramphenicol, produce a disinfecting effect and stimulate healing processes. Trimecaine is an anesthetic and perfectly relieves pain syndrome. Methyluracil starts skin regeneration processes.

A useful property of the ointment is the ability to absorb excess moisture, which speeds up the cleansing of dead cells and pus. To get the desired result, it is recommended to use the product daily. After applying the ointment, the treated surface should be covered with a bandage or a clean napkin.

• Solcoseryl. The effectiveness of the product is due to the presence of the blood of dairy calves in its composition. When applied to the affected area, the ointment starts the process of tissue restoration.

An important feature of the product is its protective effect. This helps prevent negative impact external factors on the skin. It is important to remember that the ointment should not be used when copious discharge pus from the wound.

When bedsores form additional method therapy often becomes the use of folk remedies. With their help, it is possible to clean wounds and start the process of regenerating new tissue. Before using any folk remedy, you should consult a doctor, as they can provoke allergic reactions.

To the most effective recipes include the following:

• Squeeze juice from lungwort leaves and treat the area of ​​the bedsore several times a day.
• Cut the leaves of medicinal Kalanchoe into 2 parts and apply the cut side to the affected area. Secured with a bandage, it is recommended to leave them overnight.
• Scald black elderberry leaves with hot milk and apply to the affected area twice a day.
• Grind a tablespoon of calendula flowers and mix with 50 g of Vaseline. Treat bedsores twice a day.
• Chop fresh potatoes and mix with honey in equal parts. Apply to an area prone to bedsores.
• Treat diseased areas of the skin with sea buckthorn or tea tree oil. It is recommended to do this several times a day.
• Combine aloe and celandine juice with honey in a ratio of 2:2:1. Apply the resulting mixture to the affected area twice a day.

Doctors' advice helps treat bedsores in bedridden patients at home:

1. It is important to control the cleanliness of the skin. At the same time, it should not be wet or dry, therefore it is necessary to periodically use air baths.
2. For hygiene purposes, you should not use antibacterial soap as it kills beneficial bacteria. To wash the patient you need to choose regular soap, natural sponge and water. It is not recommended to rub the skin. After washing, you need to gently pat it dry with a towel.
3. It is necessary to monitor the condition of the skin. If it is dry, moisturizers should be used. If the skin has high humidity, you should use powders or ointments with a drying effect.
4. If redness appears, do not massage this area. However, it is permissible to massage around the affected area.

To prevent such problems from occurring, you should use an anti-bedsore mattress. Doctors say that this device helps eliminate the main cause of such problems - compression of certain areas of the body.

Complications of bedsores

Main danger this state lies in the development of necrotic processes and the subsequent addition of infection. This leads to the following complications:

• lower limb amputation;
• excision of large areas of soft tissue;
• development of periostitis or osteomyelitis;
• weakening immune system;
• problems in treating the underlying pathology.

Preventing bedsores

Bedsores are much easier to prevent than to try to cure them. To do this you need to carry out preventive actions to prevent bedsores in a bedridden patient:

• Every two hours the patient must be turned, changing the position of his body.
• Several times a day you should massage the skin in areas high blood pressure. However, it is prohibited to treat reddened skin.
• It is best to buy a special bed for the patient that can be adjusted. Thanks to this, it will be possible to significantly facilitate hygiene procedures.
• All bedridden patients definitely need a special mattress with a compressor. It allows for constant tissue massage, which improves blood circulation and speeds up healing.
• Bed linen should be made from natural materials with a smooth texture.
• It is important to follow the rules of hygiene - regularly change underwear, use absorbent diapers, use urine bags and diapers.

A bedsore is open wound on the surface of the skin. In especially advanced cases it reaches deep muscle layers, and is characterized by abundant necrotic tissue lesions, often with connection bacterial infections. Bedsores are formed due to mechanical compression of a local network of small blood vessels when the patient remains in one position for a long time. Such disorders, as a rule, occur in bedridden or sedentary patients who cannot or for some reason do not want to regularly change the position of their body.

Stages of bedsores and reasons contributing to their appearance

Mobility impairment is one of the most common reasons, causing development bedsores as a result of compression effects on the blood vessels of the subcutaneous tissue. Most often, bedsores are observed in visually impaired patients under anesthesia, suffering from severe psychopathological conditions, with a history of severe pathologies of the musculoskeletal system or central nervous system. nervous system recovering from major surgery or injury. Patients, for a number of reasons, cannot change the position of their body often enough, and the influence of their own body weight puts serious pressure especially on those areas of the skin that protrude above the general surface.

The second most important cause of the development of bedsores is the rupture of small blood vessels that supply a certain area of ​​​​tissue due to dragging the patient across the bed, pulling out wet underwear or sheets from under him, or pushing up the bedpan.

There are several complicating factors that, among other things, contribute to the development of pressure ulcers.

• Limitation of joint mobility (contractures) and increased tone skeletal muscles (spasticity)

Prevents normal movement of the patient's body. Joint contractures most often occur with tendon injuries, arthritis, scar formations on the surface of the skin or disorders nervous regulation central genesis. Severe damage to the cerebral or spinal apparatus often leads to a spastic state muscle mass in the area of ​​the extremities and abdominal cavity.

• One of the most important stimuli for changing body position is pain.

Various neurological disorders or long-term use of painkillers can significantly reduce pain threshold, thereby not informing consciousness about the need to reposition the body.

• Increased pain sensitivity due to surgical or traumatic wounds

This may force the patient maintain a static position at all times.

• A significant role in counteracting pathological processes as a result of squeezing blood vessels and nerve endings plays physiological state skin

Strong, elastic skin is sufficiently resistant to the development of bedsores. On the contrary, a thinned, atrophied epithelium, due to a reduced ability to regenerate, is quickly destroyed with an increasing deficiency of nutrients supplied by the blood. Such phenomena often occur when taking certain medications that affect water-salt metabolism in the body and hormonal drugs.

• Decreased regenerative functions skin epithelium

Thinning of the skin-epidermal junction and organic destruction of the capillaries of the subcutaneous tissue are typical for patients old age. That's why The development of bedsores in older people always occurs faster and is fraught with complications.

• The skin becomes more susceptible to even minor traumatic forces as a result of de-epithelialization, which usually occurs due to friction and shear forces when the patient is pulled

Worn areas on the skin have a reduced barrier of protection against bacterial contamination, and are also characterized low content transepidermal water, which leads to maceration of the skin with subsequent stratification.

• Constant exposure to high humidity on the skin

May occur as a result of insufficient patient care also lead to damage to the outer skin. The situation is aggravated by the aggressive effects of substances contained in the patient’s feces and urine.

• Dirty laundry

This is one of the main reasons for the development pathogenic microflora in the formed ulcerative lesions on the skin. The temperature and humidity of the ulcer creates the most favorable conditions for the development of pathogenic microorganisms that are quite resistant to local therapy antibiotics. The neglect of such processes often leads to a transition from a localized purulent-infectious process to a generalized form. In weakened patients Bacteremia, sepsis, myonecrosis or... often develop.

• Malnutrition, insufficient protein intake, and anemia

Reflect general state the patient to resistance against skin lesions of infectious and non-infectious types. Poor nutrition inhibits the body's immune system against pathogens. In addition, anemia results in poor oxygen carrying capacity of red blood cells. The situation is getting even worse with the development cardiovascular pathologies and hypovolemia.

• Reperfusion

Restoring normal blood flow in the ischemic area, according to many experts, also contributes to the prolongation of necrotic processes. Accumulated during the period venous stagnation Metabolic products spread throughout the affected area, thereby increasing toxicity in that area.

In patients with normal sensitivity, mobility and the absence of psychopathological abnormalities, bedsores form extremely rarely. Feedback from subcutaneous receptors signaling to the brain about the onset of ischemic processes in the area of ​​​​compressive effects on blood vessels, forcing a person to change body position at a conscious or unconscious level.

The development of bedsores occurs in stages, and the further the stage, the more difficult it is to provide therapeutic effect for ulcerative-necrotic formations.

• First stage characterized by the integrity of the skin in the area of ​​compression and the presence of persistent hyperemia long time after releasing the pressure.
• Second stage - hyperemia of the subcutaneous tissue against the background of the early stages of physical damage to the epithelial surface layers. Observe keratinization and detachment of the skin epithelium at the site of compression.
• Third stage - the formation of a deep, weeping ulcer with complete disruption of all layers of the skin and transition pathological processes necrosis in subcutaneous tissue and muscle tissue.
• Fourth stage characterized by a very deep spread of pathological processes, right down to the bones and muscle fascia.

Pathophysiological basis of pressure ulcer formation

For the first time, the pathological processes of the formation of bedsores were described in 1873 by D. Paget, who quite accurately determined the development of necrotic processes as a result of compression of the local subnetwork of small blood vessels. The development of bedsores is influenced by many factors, but the process is always based on ischemic phenomena, leading to the destruction of the cell membrane, and subsequently to cell death as a result of insufficient tissue trophism.

From this point of view, bedsores develop from prolonged, constant pressure on the same area, which impairs the blood circulation of the same area of ​​tissue.

• For the development of ischemia it is necessary compression effect for arterial capillaries no less than 32 mm Hg and from 12 mm for venous capillaries.
• Constriction of arterioles contributes to a lack of fresh blood flow, oxygenated and nutrients, and compression of the venules significantly impedes the blood outflow, rich in the products of tissue metabolism.
• Accordingly, in addition to ischemic manifestations, they also observe stagnant processes in compressed tissues, which significantly complicates the pathological process.

Typically, the tissues of a living organism are normally able to withstand much greater pressure than the indicators indicated above. This is facilitated by sufficient elasticity and strength of the cell walls. However, compression effects on the area for more than 2 hours overlap the tissue capabilities with trophic deficiency.

The development of bedsores most often occurs in areas of the skin that come into most close contact with surfaces. Indicators of pressure on specific anatomical areas patient, depending on body position. Thus, when lying down, those most at risk of developing bedsores are:

• sacrum;
• heels;
• back of the head

They are exposed to a pressure of about 40-60 mmHg. The chest and knees account for about 50 mm if the patient is lying on his stomach. In a sitting position, the ischial tuberosities are most subject to compression - about 100 mm Hg. It should be noted that the human constitution does not play a significant role in the development of bedsores - than bigger man, the more developed its cellular stroma is. The exception is overweight patients, but in them the pressure on the blood vessels is compensated using the additional shock-absorbing qualities of the fat layer.

Upon reaching the third stage, the pathological process accelerates, it is characterized by more severe damage muscle tissue, which is more demanding in providing oxygen and removing metabolic products. For this reason, the “point of no return” period is set at 2 hours, after which the irreversible changes in muscle tissue. As for individual skins, they can withstand compression for up to 12 hours.

It is worth noting that, in addition to the immediate lack of blood supply, the processes of regulation of tissue activity in the compressed area are disrupted due to compression of the nerve endings.

Features of the localization of bedsores, symptoms and diagnosis

Pressure ulcers are usually described in terms of the location of the pathological area and the depth of involvement of the underlying tissue.

• About 70% of all places where bedsores most often form are in areas of the ischial tuberosities, greater trochanters of the femur.
• On heels, iliac crests, shoulder blades and elbow joints accounts for about 15-25%.
• The remaining percentage is distributed to any parts of the patient’s body that come into contact with any surfaces for a long time, for example, when plaster casts are applied incorrectly.

It is worth noting that the formation of bedsores in oral cavity often found in the field of dentistry. The areas most often occur at pressure points of dentures, as well as in the interdental crevice space on the gum, which is facilitated by the packing of dense formations from food masses.

Usually, diagnosing a bedsore is not particularly difficult - visually and organoleptically it is possible to determine with a sufficient degree of confidence the development of ischemic processes in the area subject to compression. However, in cases where there is no improvement with correct treatment of pressure ulcers, it may be necessary additional diagnostics in order to identify third-party pathologies, including oncological ones. Besides, osteomyelitis must be excluded , especially in cases of deep pressure ulcers.

Complete blood count with differentiation can show increased content white blood cells, which allows us to judge the possible generalization of the pathological process beyond the bedsore, as well as the development of an invasive infection. The erythrocyte sedimentation rate is higher than 120 mm/h and the leukocyte count is more than 15,000 cells/µl, forcing a series additional research for osteomyelitis.

Food quality, as an integral factor in favorable pressure ulcer therapy, is determined by the presence of albumin, prealbumin, transferrin and the amount of total protein in the blood serum.

A biopsy of wound tissue is performed if there is no improvement despite proper care of pressure ulcers. This examination is carried out to determine the species of bacterial flora that populate the wound surface, as well as to exclude malignant cell growth. Whenever there is an exacerbation of a pressure ulcer that has been in remission for several months or years, a biopsy must be performed. This effect is most often observed with the development of malignant processes in old wounds.

Briefly about the treatment and prevention of bedsores

It is worth noting that there is no panacea for treating bedsores. A number of consistent measures are required to promote speedy deliverance from the developing pathological area.

1. The need for maximum restoration of blood circulation and innervation at the site of compression.
2. Removal formed necrotic masses in the pathological focus.
3. Promoting speedy healing formed wounds.

You should always remember that the appearance of a bedsore is an indicator of the patient’s neglect in terms of proper care and the correctness of the therapy used. Therefore, if the patient is unable to independently change body position, he must be secured service staff, preferably in the person of the same person who will always be in the know individual characteristics development of possible pathological processes. Unfortunately, in the conditions of a modern Russian hospital, functioning with state support, this is an almost impossible task.

Absolutely all patients whose movement is limited by a wheelchair, bedridden patients, those suffering from paresis or paralysis need additional services individual parts body, as well as diseases that reduce the level of brain activity. Special attention required for people with the following pathologies:

• urinary and fecal incontinence;
• are at the stage of exhaustion;
• obese;
• people with diabetes;
• with a history of stroke complications.

What are the basic principles for preventing the development of bedsores?

• Reduced compression, friction or lateral shear effects of the body.

If the lateral surface is subjected to compression, bedsores occur on the shoulders, elbows, lateral surfaces of the thighs and pelvis.

Factors influencing the formation of bedsores

Bedsores are a very dangerous complication for already seriously ill patient, which worsens the treatment of the underlying disease and requires separate long-term treatment, especially in the final stages.

Phlegmon

Acute inflammation of the cellular space is accompanied by, treatment is difficult due to the unclear boundaries of the inflammatory process. The causative agent is staphylococcus, Escherichia coli. The main signs are pain, swelling, redness,... Treatment is by opening the lesion and using antibiotics. wide range actions.

Gangrene

This complication is accompanied by rapid tissue necrosis. On palpation, a specific crunch is heard, the color of the epidermis is predominantly dark, and a putrid odor emanates from the wound. Intramuscular injections penicillin give a good result, but mainly to avoid damage to neighboring tissues. The affected part of the body, usually a limb, must be amputated. This complication accompanies, with insufficient or ineffective treatment, bedsores at stage 4 of development.

Sepsis

The fight against this complication is effective only if early stages. Since this is a systemic inflammatory process that affects the body as a whole, further development infection leads to fatal outcome. Detoxification of the body and anti-inflammatory treatment using glucocorticoids are carried out. Septic infection of the body can accompany treatment for grade 3 and 4 bedsores.

Preventive actions

1. Analyze the medical history and ensure maximum exclusion of the causes leading to the formation of bedsores.
2. Use a functional bed for immobile patients, with an anti-decubitus mattress and

Bedsores are a common problem caused by tissue death resulting from prolonged pressure on certain parts of the body. They occur in people who are limited in movement due to illness.

At improper care Bedsores can affect deeply soft fabrics, which leads to the formation of deep wounds. Most often, this problem occurs in older people, since blood circulation deteriorates at this age, making it more difficult for tissues to recover.

Causes of bedsores

The main factor is the pressure of the hard surface on the protruding areas of the body. The most commonly affected areas are:

• sacrum;
• thoracic region;
• shoulder blades;
• back of the head

The vulnerability of these areas is due to the fact that there is a weak layer of muscle and fatty tissue between the bone and skin.

Let's celebrate! When lying on the side, the main part of the mass presses on the area of ​​​​the femur and ilium. Frequently lying on your stomach is dangerous for chest area. Sedentary patients are susceptible to the formation of pressure sores in the area of ​​the ischial tuberosities, sacrum, feet, heels, shoulder blades and fingers.

Another cause of bedsores is friction and slipping. It occurs when the skin interacts with the sheet when the patient changes position himself, is either turned over or transplanted.

The main risk group for the disease includes people whose limited movement is associated with:

• operations;
• diseases and injuries requiring bed rest, or being on a wheelchair;
• paralysis;
• coma.

Other factors include:

• sensory impairment associated with neurological diseases. In this case, the patient does not feel discomfort or compression of soft tissues;
• elderly age. The older a person is, the thinner the skin becomes, we lose elasticity and the ability to heal quickly;
• poor nutrition and insufficient fluid intake;
• muscle atrophy and low weight. Adipose tissue together with the muscles, it creates a layer that normally protects bone protrusions and skin;
• increased moisture on the skin or dryness;
• urinary or fecal incontinence. In patients with this problem, the skin is often wet, which creates an environment for bacteria to multiply;
• muscle spasms. They lead to involuntary movements, the skin suffers from friction with the bed or clothing;
• bad habits. Smoking leads to narrowing of blood vessels, hence the lack of oxygen.

All this leads to slow wound healing processes.

Stages and photos of bedsores in bedridden patients

There are four stages of development of pressure ulcers.

Stage 1 - initial

Formed as a result of impaired blood circulation in the skin. Significant external signs no, since cell death has not yet occurred.

First, the affected area turns pale, then redness appears, which develops into swelling of a bluish or bluish tint.

Stage 2

Characterized by the formation of the first signs of cell death. The process takes place on the surface of the skin, without affecting muscle tissue.

At this stage, fluid bubbles and peeling may appear.

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Stage 3

The development of necrosis descends to the depth of the dermis and affects the subcutaneous fatty tissue.

Deeper blisters continue to form in areas of thinned skin. At improper treatment infection and the formation of purulent foci may occur.

Stage 4

The most severe and advanced stage. All layers of tissue are affected, right down to the bones. At this stage, the bedsore looks like a deep wound through which tendons and bone tissue can be seen.

If an infection occurs, bones and joints may be affected.

Pain and crunching in the back over time can lead to dire consequences- local or complete restriction of movements, up to disability.

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Complications of bedsores

Improper care and untimely treatment Bedsores in patients can lead to serious consequences.

Such as:

• circulatory disorders;
• formation of gangrene;
• sepsis;
• cancer diseases;

Let's celebrate! Of course, such cases are extremely rare. But it must be remembered that there is still a risk, so maximum efforts should be made to overcome bedsores in the early stages of development.

Treatment of bedsores

Treatment is prescribed depending on the degree of damage to the body. Stage 1 and 2 bedsores can be treated at home. More complex cases with deep and purulent lesions require surgical intervention.

At stage 1 of bedsores you need to:

• cleanse with camphor alcohol every couple of hours;
• treat the skin several times a day with sea buckthorn oil;
• support sore spot clean and dry

It is important not to massage sore areas; even during treatment, it is not recommended to use any force. The skin in such places is very thin and can be easily injured, which can lead to infections.

Stage 2. At this stage, alcohol and oil alone will not help. It is necessary to add special medications.

• treat the wound with chlorhexidine several times a day, it has an antiseptic effect;
• After treatment, immediately apply a special ointment;
• apply hydrogel bandages to sore spots;
• use special applications that promote rapid wound healing. Hydrogel dressings and applications are expensive products, but their use significantly speeds up the healing process.

Stages 3 and 4. At these stages, significant wounds usually appear that require surgical intervention.

This is how it is done:

• cleansing the wound and body area;
• applying bandages with a healing effect;
• if present in the wound large quantity pus, use special kind dressings, such as Biaten. After the wound has dried, special medications can be applied to it.

Treatment at home

It should be remembered that treating bedsores at home must be done with extreme caution. At stages 1 and 2, wound treatment with Kalanchoe is allowed. The leaf is cut and tied to the wound. The juice of this plant removes harmful fluids from the wound, dries it and speeds up the healing process. Agave juice will also be a good helper. Compresses from it are applied to bedsores for 20-25 minutes.

Note! Potato starch is also used as a preventative measure. It removes excess moisture from the surface. Experts recommend treating the affected areas with sea buckthorn oil, since among all the listed drugs it has the best effect.

Prevention measures

When caring for bedridden patients, checking the condition of the skin is a mandatory procedure.

Particular attention should be paid to places that are prone to the formation of bedsores:

• to prevent the formation of wounds, it is necessary to change the patient’s position every 2-3 hours, and it is important to do this with extreme caution in order to avoid unnecessary friction and stretching of the skin;
• choose bedding and clothing from natural fabrics, preferably without buttons or other elements that could create a risk of skin damage;
• maintaining the optimal temperature in the patient’s room. It should be neither low nor high;
• the bed should be clean and dry. If necessary, use diapers or diapers.

Bedsores are damaged areas of the skin that occur as a result of tissue compression during prolonged contact with a hard surface (bed, wheelchair, tire, etc.). Bedsores appear as a result of bleeding and necrosis of tissue at the site of skin compression.

Causes of bedsores

As you know, nutrition and saturation of the skin with oxygen occurs due to the presence of blood vessels in it. The smallest of them, called capillaries, penetrate every centimeter of the skin and nourish it. With prolonged compression, the vessels are pinched and blood does not flow. This leads to certain areas of the skin becoming bleeding, and tissue necrosis occurs.

Another reason for the formation of bedsores is displacement upper layers skin. This occurs when they try to drag the patient along the bed, or when they are pulled under by a bedpan or wet underwear. All this can lead to disruption of blood supply, resulting in the formation of bedsores.

Risk factors for pressure ulcers

People most susceptible to developing bedsores are those who have excess weight or, conversely, exhaustion, eat poorly and drink little, have a history of diabetes or heart disease, sweat a lot, have brain and spinal cord injuries, and suffer from urinary and fecal incontinence. Dirty skin, folds and seams in the bed, the presence of crumbs and small objects, as well as allergies to skin care products are also considered unfavorable factors.

Places of formation of bedsores

Areas of the body over bony prominences that come into contact with hard surfaces are most susceptible to the formation of pressure ulcers. This can be explained practically complete absence in these places there is subcutaneous fatty tissue, which can reduce pressure on the tissue.

If a person lies on his back for a long time, bedsores form on the sacrum, ischial tuberosities, shoulder blades, back of the head, heels and elbows.

When lying on your side, bedsores form on the thighs in the greater trochanter, on the knees and ankles.

Prolonged position on the stomach leads to the formation of necrosis on the pubis and cheekbones.

Severity of bedsores

Depending on the severity, bedsores are divided into six stages:

Stage I – redness of the compressed areas of the skin occurs;

Stage II - the skin swells, becomes covered with blisters, necrosis (death) of the upper layer of skin begins;

Stage III - ulcers appear on the skin;

Stage IV - ulcers grow and penetrate into the muscle layer;

Stage V - necrosis and destruction of muscles occurs;

Stage VI is the most severe stage, the ulcer reaches the bone, which can become damaged and become infected.

Prevention of bedsores

Prevention of bedsores includes whole line measures aimed at reducing tissue compression and maintaining normal blood circulation in the skin.

For bedridden patients great importance has meticulous care. To reduce tissue compression, bedridden patients need to purchase a soft and elastic mattress. There is a special mattress for sale against bedsores, which has a massage effect, improving blood circulation in certain areas of the skin. You can also use a foam mattress if you are unable to purchase an anti-bedsore mattress. It is necessary to change the position of the patient’s body as often as possible, and this must be done carefully enough to avoid friction and displacement of soft tissues. The patient's bed should be smooth and clean, free of crumbs and foreign objects. Under areas of the body where bedsores usually occur, it is necessary to place cushions or soft foam pads. You can place a special rubber circle under the sacrum. All these devices (rollers, bedsore mattress) increase the area of ​​the body that comes into contact with the surface on which the patient is located. This significantly improves blood circulation in the tissues and reduces the risk of bedsores.

Prevention of bedsores also includes correctly and gently turning the patient over, minimal risk damage and friction of soft tissues. If you can't cope alone, look for an assistant. You should not yank or pull wet linen and sheets from under the patient; first you need to lift him. All skin care procedures and bedding must be carried out carefully and gently.

To reduce skin irritation, use soft linen (the more washes, the softer the bed) without seams, patches or buttons. For skin care, use soft, low-allergenic cosmetical tools. Clean your genitals and perineum more often, as urine and feces tend to irritate the skin. Provide optimal temperature regime in the room, cover and dress the patient depending on the temperature, avoiding overheating. Sweat irritates the skin and increases the risk of ulcers.

Proper skin care is one of the means of preventing bedsores. Don't let your skin get too wet or dry and keep it clean. Use moisturizing and nourishing creams, powders, and drying ointments. Do not rub the skin when washing and drying the patient, but blot lightly. Sponges and washcloths should be soft. For urinary incontinence, use diapers or urine bags (for men).

Treatment of bedsores

No remedy for bedsores will completely eliminate the problem until the tissue compression is eliminated. The main treatment for bedsores should be aimed at restoring blood circulation in damaged tissues. To do this, use all measures to prevent bedsores.

Used to slough off dead tissue various means from bedsores. Good effect has Iruksol ointment. For more fast healing wounds need to be used gauze bandages, soaked in Vaseline. You can apply special hydrocolloid dressings if you have the opportunity to buy them (they are quite expensive). There are also special healing agents for bedsores, in the form of various ointments. Can be used sea ​​buckthorn oil. If a secondary infection develops, which often happens when bedsores occur, antibacterial agents must be used.

Treatment of bedsores that have a large area and are difficult to heal is carried out only surgically(tissue transplantation).

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