How are pressure ulcers treated?

The nurse and doctor will examine the ulcers and recommend a plan to treat them. This plan includes the following recommendations:

Relieve pressure on the area near the ulcer

• Do not allow the person to lie or sit on a pressure ulcer. Move and change the person’s position regularly.
• Use pillows, special foam cushions, or medically approved sheepskin to reduce pressure and keep bony areas from touching each other.  Do NOT use ‘donut’ cushions.
• Sometimes special air beds may be ordered.

Treat the pressure ulcer itself

• Keep the pressure ulcer and skin around it clean. A Stage I pressure ulcer can be cleaned with warm (not hot) water and a mild soap. An open pressure ulcer can be cleaned by rinsing the area with normal saline solution (salt water) and gently dabbing the area with a clean gauze pad. Avoid antiseptics, such as hydrogen peroxide and iodine, as these can cause irritation and delay healing. The nurse can show you how to clean a pressure ulcer.
• Many types of dressings are used to treat pressure ulcers. The doctor or nurse will choose the right dressing for the pressure ulcer. Make sure to change the dressing as often as the doctor or nurse tells you. Some dressings must be changed every day. Other dressings can stay on for several days at a time.
• Watch for signs of infection. These include pain, red skin around the sore, bad smell, and increased fluid that looks like pus. Tell the doctor or nurse immediately if you think the pressure ulcer is infected.
• The doctor may prescribe medicine that you apply directly to the pressure ulcer if it is not healing properly. Sometimes antibiotics are given (by mouth or injection).
• Sometimes a pressure ulcer has dead tissue that must be removed before it can heal.  Removing the dead tissue is called debridement.  The doctor will select the best method of debridement for the pressure ulcer.  One way is to rinse the sore when changing the dressing.  Another way is to use a special dressing that helps the body dissolve the dead tissue.  Surgery is sometimes needed.  If debridement is painful, the doctor or nurse can suggest a pain reliever that the person can take before the procedure.
• Some pressure ulcers may need plastic surgery to fix them.

Improve nutrition

Good nutrition is necessary for the pressure ulcer to heal. The nurse or dietitian can give advice about a healthful diet.  If the person loses or gains any weight, tell the doctor or nurse.

Communicate the patient’s progress

Check the person’s skin every day for new pressure ulcers. The nurse will keep a log or chart (see the sample) that tells how each pressure ulcer is healing (e.g., it should be getting smaller, have healthier tissue and less drainage). This will help the doctor or wound care specialist to prescribe the best treatments for the person.  The nurse may also use a special form, such as the Pressure Ulcer Scale for Healing or PUSH tool, to track the pressure ulcer’s progress. He or she can provide you with copies of this tool or one like it.

When to call the doctor or nurse

Call the doctor or nurse if a pressure sore gets worse or if a new one shows up the next time you check the patient’s skin. Call immediately if you think a pressure sore is infected.  Signs of infection include pain, red skin around the sore, bad smell, fluid that looks like yellow or green pus, fever, and the person may seem weak or confused. Ask the doctor or nurse for the name and phone number of who to call for help.