Pressure Offloading

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Pressure offloading in Wound Care

In this presentation, we’re going to talk about pressure offloading. Including redistribution, repositioning the support surfaces. So our objectives are going to be to understand the concepts of pressure redistribution, repositioning and offloading. We want to know the mechanical forces that are involved in the development of pressure ulcers, and we want to be able to identify various categories of support surfaces. And finally we want to learn to correctly choose a support surface based on the needs of the patient itself.

Factors That Contribute To Pressure Injury

So pressure ulcer development is a very complex problem with lots of factors that influence the development of pressure ulcers and includes the skin integrity, the moisture control, when we talk about incontinence and people that are confined to bed, involves tissue profusion and how well the blood supply is, how often the patients are being repositioned or if they’re being repositioned, or how best to be repositioned, the mechanical load itself which creates the actual pressure, friction and shear forces that are playing a part in and causing the skin damage and affecting the mechanical load, and a multitude of other factors.

So some items to consider when choosing a support surface are 1) is the pressure redistribution, that’s commonly what we think of when we think of support services. How is the pressure taken away from the area where the wound might be created and redistribute it over a broader or more diverse area? Moisture control because skin that has too much moisture, that’s macerated, is prone to break down. How do we control that moisture and hopefully improve that situation? Temperature control because as we increase the temperature, we change the properties of how metabolism occurs in the skin itself, so we have to be able to control the temperature so it doesn’t get too hot or too cold. Friction control because it’s a factor in the production of shear forces, and then also the life expectancy of the patient.

While there may be a very effective, expensive mechanism by what we can use to prevent the worsening of a pressure ulcer, it may not really matter if it’s uncomfortable for the patient and the patient only has a few days to live. So we have to be judicious in how we use some of those resources.