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Preventing pressure injuries

 

What is a pressure injury?

A pressure injury is a place where the skin is damaged from pressing against a bed, chair, or other surface.  Pressure injuries are sometimes called bedsores or pressure ulcers. They happen when an area of pressure does not get enough blood flow. Pressure injuries can be red spots or dark, dry spots if your child has dark skin. They can also look like blisters, bruises, or open sores. You might see yellow fat, white bone, or a black scab.

What causes pressure injuries?

All of the following can cause pressure injuries:

  • Lying in bed or sitting in a chair or wheelchair without changing positions often.
  • Medical equipment pushing against the skin – Such as catheters, blood pressure cuffs, surgical wraps, or IV lines.

What can make pressure injuries worse?

  • Moving your child so their body drags on the bed, chair, or sheet – Your child might also drag their body on something.
  • Moving your child without lifting them completely off the bed.
  • Scratching or rubbing skin against body parts or objects – For example, your child might rub their heel against their leg, the bed, or something else.
  • Letting skin become dry – This makes it tear more easily.  
  • Too much moisture on the skin – Like sweat or urine.
  • Rubbing or massaging an area of redness on a bony part of the body.

Why are pressure injuries harmful?

Skin is our first line of defense from infections. When your child’s skin is open from a pressure injury, they can get an infection. Your child’s immune system may be weaker than normal because of cancer, another disease, and treatment, so they are more likely to get infections than other people.  If your child had a stem cell transplant, they might have rashes and extremely dry skin. They are more likely to get pressure injuries and infections.

What prevents pressure injuries?

Your child should walk, sit, and stand as much as possible if they can get out of bed. Your doctor or nurse will tell you if your child should not do these things. St. Jude staff will have your child change position every 2 hours if they cannot get out of bed. We will also use cushions or dressings to keep pressure off the bony parts of the body.

You can help by keeping your child’s skin clean, dry, and soft with lotion. Staff will check your child’s skin often and show you how to do this. The nurse also can help you find a cushion to use if your child is in a wheelchair.

Preventing pressure injuries

Check your child’s skin

  • Look at your child’s skin every day. Take off their socks, pajamas, diaper, and anything else they are wearing to check the area underneath. Pressure from tight clothing can damage the skin.
  • Check your child’s whole body, especially bony areas like the back, back of the head, elbows, heels, collarbone, tailbone, hands, feet, and hips. Look for red or dark areas or anything that looks like a blister or sore. Pay close attention to areas that your child says are sore, even a little bit. Pressure injuries can be open or closed sores. The nurse or other St. Jude team member can show you how to check.

Care for your child’s skin

  • Give your child a bath every day, but not more than one (1) time a day unless directed to do so by your care team. Use mild soap and water or a pre-moistened washcloth, such as Theraworx®. Use soap without any perfumes or dyes. Ask a nurse if the soap you have at home is OK to use. Never scrub or rub the skin, and pat it dry gently.
  • Clean the skin right away if your child wets the bed, has a bowel movement in bed, or wears diapers. Use mild soap and water or a pre-moistened washcloth. Gently wipe downwards from the hips to the knees. Use diapers or blue pads to keep urine, sweat, and other fluid off the skin.
  • Use a moisture barrier, such as Sensi-Care cream®, Critic-Aid® ointment, or calmoseptine ointment, as recommended, if your child wears a diaper or pull up, or is incontinent (leaks urine).
  • Tell the nurse if your child gets diaper rash or has diarrhea.
  • Use lotion after baths and cleanup if your child’s skin tends to become dry. The doctor or nurse might tell you to use unscented lotion. If you have lotion from home, ask the nurse if it is OK to use.
  • You might need certain medicines or bandages if your child already has a pressure injury. If so, do not use any lotion from home on the ulcer.
  • Never rub bony parts of the body if you think your child might have a pressure injury.
  • Keep lips moisturized. Your child’s doctor can prescribe lip moisturizers to keep your child’s lips from getting dry and cracked.
  • Keep your child from scratching, because it can break the skin. Your St. Jude team can find ways to stop your child from scratching such as putting socks or mittens on their hands, tucking them under the sheets, or distracting them.

Move your child the correct way

  • Help your child walk and move around as much as possible if they can get out of bed. Regular movement can help prevent pressure injuries.
  • The nurse might tell you to turn your child every 2 hours if they cannot change positions. The 3 positions are right side, left side, and back side. Nurses will help you turn your child at least every 2 hours in the hospital. Never leave your child in the same position longer than 2 hours if they cannot move on their own.
  • Use a sheet and at least one (1) helper to lift your child all the way off the bed when you move them. Then lay them down in the new position. Your St. Jude team can show you how to turn your child. Never slide or drag them across a bed or chair.
  • If you need to hold onto your child, use your whole hand (palm), not just your fingers.

Use the right bed and pillows

Do not use egg crate mattresses or donut cushions at home or in the hospital. These can create more pressure. The nurse can tell you what kind of cushions, pillows, and sheets to use and how to use them.

Help your child stay warm

Keep your child’s room warm if they have a pressure injury. “Warm” means you should be comfortable wearing just a T-shirt. Cold air can slow down the healing process.

A warm room is especially important when you give your child a bath or change the pressure injury bandage.

Help your child eat right

Nutrition is important to help a pressure injury heal. Protein is especially important, such as beef, chicken, fish, beans, and eggs.  

Is my child at risk?

Your child has the most risk of pressure injury if they:

  • Cannot change positions without help,
  • Do not have normal feeling (sensation),
  • Have damp skin most of the time from urine, sweat, or other fluids,
  • Toss, itch, or thrash in bed,
  • Eat less than normal, or
  • Have low blood pressure or less oxygen in their blood than normal.

If your child has a pressure injury

Tell St. Jude staff right away if you think your child has a pressure injury. A nurse will check the area and treat it. The staff may use medicated lotion on the area, bandage it, or give you certain products to use on your child’s skin. They will also help you keep the skin from becoming dry and help your child stop scratching if the skin itches. Pressure injuries can heal quickly if the pressure stops and your child gets proper care for any open wounds.

Questions?

If you have questions about pressure injuries, talk to your child’s doctor or nurse.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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