Decubitus is a nutritional disorder of the skin and subcutaneous tissue. It is caused by prolonged pressure and compression of blood vessels. It may come to the death of the skin and infections. Bedridden people are often affected, but there are other causes as well.
Causes of pressure ulcers
The most common type of pressure ulcer is bed rest. There is a risk of decubitus on parts of the body where there is little or no muscular tissue between the skin and underlying bone. To name are mainly:
- iliac crests
Ultimately, however, pressure ulcers can occur at all points. A decubitus can also occur under poorly fitting prostheses or too narrow plaster casts.
Important factors in the development of pressure ulcers
Three factors play a decisive role in pressure ulcer formation:
- Pressure (contact pressure)
- Time (pressure duration)
- Disposition (risk factors)
Only when a certain pressure exists over a longer period of time (two hours) at an existing disposition of the patient, it comes to a damage of the skin. A factor on its own does not lead to bedsores.
The perfusion of the capillaries of the skin, the finest blood vessels, which provide for the oxygen and nutrient supply to the individual organs, is hindered as soon as the pressure on the capillaries exceeds a certain level. The pressure on the skin can be exerted externally or internally:
- External pressure: For example, folds in the bed sheet, unpadded storage rails, crumbs in the bed, but also catheters and probes if they are under the patient.
- Pressure from the inside: Through bones that lie directly under the skin without muscle and fat pads.
The decisive factor is how long the pressure on certain skin areas weighs. If the nutrition of the skin cells has been interrupted for less than two hours, they can recover. If oxygen deficiency persists, individual cells die and necrosis is formed (tissue death).
For example, the skin is damaged by:
- Fever: Sweating causes dehydration of the body and increased oxygen consumption
- Moisture: Damp skin softens and is therefore more vulnerable
- Incontinence: In the case of incontinent patients, the skin is not only affected by moisture, but also by the acidic pH of the urine and possibly by bacterial contamination (intestinal bacteria)
- Overweight: Fat patients usually sweat more, while the weight on the skin is greater
- Shearing forces: The "inclined plane" when sitting incorrectly tugs at the skin
The skin is poorly supplied with blood at:
- Anemia and heart failure, which favor a lack of blood circulation
- Diabetes mellitus: here, in addition to the circulation and the cell metabolism is disturbed
Risk factors for pressure ulcers
Pressure relief is hampered by lack of exercise (immobility), bed-rest (such as unconsciousness), paralysis such as hemiplegia and therapeutic immobilization (gypsum). Other risk factors include:
- Immune deficiency of the body due to insufficient nutrition (eg lack of protein, zinc or vitamin C)
- bad general condition
- Cachexia (wasting)
- chronic diseases that lead to fluid loss and atrophy of the skin
Course of a pressure ulcer
During the course, four levels of pressure ulcer are differentiated:
- In a pressure ulcer of the first degree you see only a circumscribed redness of the skin.
- In the second degree, a skin defect has already occurred.
- A third degree decubitus ulcer is a deep skin defect, with muscles, tendons, and ligaments visible.
- In the worst form, there is a bone involvement defect.
Complications of a pressure ulcer
A complicating factor may be infection of the wound. If the tissue dies, it must be surgically removed.
Treatment of a pressure ulcer
If a decubitus ulcer must be treated, it is usually already too late. Very important is the prevention, so that it does not even come to a pressure ulcer. Especially in bedridden patients, the skin should be well maintained. Rubbing in with blood circulation-promoting ointments and a massage of the endangered areas can prevent bedsores from the outset. In addition, care should be taken to a soft storage, possibly on special mattresses.
Good care also requires the transfer of the patient every two hours. The procedure is according to a storage plan: supine position, right lateral position, possibly prone position, left lateral position, supine position, etc. At the first signs of decubitus (redness of the skin), good skin care is the appropriate therapy.
Open wounds need to be cleaned carefully. Anti-inflammatory and healing-promoting ointments are applied to the wound surface. If there is no improvement in the symptoms after three to four days, the medication should be changed. If the skin and the surrounding tissue have already died, it must be surgically removed.