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Rehabilitation Institute of Chicago: LIFE Center

Skin Care: Preventing Pressure Injuries

Reviewed June 2016
Author: Rehabilitation Institute of Chicago - Nursing Practice Council
Keeping skin healthy is important for anyone with a disability that involves limited movement and/or sensation. Staying in one position for long periods of time can cause skin damage, known as pressure injuries. Skin tolerance is defined as the period of time a person's skin can remain in one position without any damage. Patients in a rehabilitation setting learn their tolerance for sitting and lying down positions. Tolerance is affected by wheelchair and mattress cushioning, as well as overall health.

Other Factors that Can Cause Pressure Injuries
• Wet skin from sweat, urine or stool.
• Poor diet low in iron and protein.
• Slouching position in bed or in the wheelchair.
• Fever.
• Bumps or other skin injuries.
• Friction to skin caused by being pulled across a surface. This is known as shearing.
• Clothing, braces and splints that are too tight
• Worn out or incorrect equipment

Increasing Skin Tolerance
Skin tolerance can be improved by slowly increasing the amount of time spent sitting or lying in one position, doing regular pressure relief and doing frequent skin checks.

• Do not increase sitting or lying time by more than one half hour every two to three days. If there are no problems while sitting for 30 minutes twice a day, increase the time to 45 minutes.
• Perform skin checks at one tolerance for a few days before increasing sitting or lying time again.
• With any newly healed pressure sore, start with 30 minute sitting times and slowly increase.
• Ask a doctor or nurse whether a pressure injury is healed before continuing to sit or lie on it.
• If skin becomes red or wounded, avoid putting any pressure on the area until it is healed.

Avoiding Pressure Injuries
• Keep wheelchair foot pedals at the right height.
• Use a good cushion on the wheelchair seat. Do not sit on a worn out cushion.
• Sit up straight in the wheelchair, since sliding can cause early skin breakdown on sitting areas.
• Do not use a rubber air ring or doughnut. These cause a lot of pressure and block the flow of blood to skin inside the ring.
• When in the wheelchair, shift weight every 30 minutes. Follow your therapists' instruction.
• Do not put items in pockets or on the seat of the wheelchair.
• Avoid clothes that are tight or have heavy seams. Also avoid nylon underwear.
• Wear shoes that fit well – usually one half size larger than before injury.
• Make sure elastic stockings (TED hose) or Ace wraps are put on evenly without wrinkles that cause extra pressure.
• Keep skin clean and dry. Skin that remains wet with urine, sweat or stool will have more problems.
• Apply lubricating cream often on dry skin. Do not use alcohol.
• Use a firm, but not hard, mattress, which supports the body. A foam pad over a regular mattress will spread weight more evenly.
• Stick to identified turning tolerance.
• Remember that even small shifts in position help relieve skin pressure.
• Float heels (or suspend) off pillows while in bed.

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