RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Nursing Best Practice GuidelineAHCPR (1994) recommends careful monitoring of sacral dressings near the anus, as they are difficult tomaintain. The sacral location is challenging because of inherent moisture from perspiration, incontinence,and shear forces (Ovington, 1999). A randomized controlled trial (Day et al.,1995) examined 103 patients withStage II and III sacral pressure ulcers in a prospective, controlled, multi-centre clinical study to evaluateand compare dressing performance, safety and efficacy. Patients were randomized to treatment with atriangle-shaped hydrocolloid border dressing, to a different, oval shape hydrocolloid dressing, or to apressure management surface. It was found that wear time was longest for wounds dressed with thetriangle dressing (point applied down), however incontinence reduced the interval between dressingchanges in both groups. Healing was more likely to occur in wounds dressed with the triangle borderdressing, as those ulcers showed a greater reduction in ulcer width as compared to wounds dressed withthe oval dressing.Adjunctive TherapiesRecommendation 3.6aRefer to physiotherapy for a course of treatment with electrotherapy for Stage III and IV pressureulcers that have proved unresponsive to conventional therapy. Electrical stimulation may also beuseful for recalcitrant Stage II ulcers.Level of Evidence – IbRecommendation 3.6bChronic pressure ulcers may be treated by:■■■■■■■Electrical stimulation Level of Evidence – IbUltraviolet light C Level of Evidence – IIaWarming therapy Level of Evidence – IbGrowth factors Level of Evidence – IbSkin equivalents Level of Evidence – IVNegative pressure wound therapy Level of Evidence – IVHyperbaric oxygen Level of Evidence – IVLevel of Evidence – Ib-IVDiscussion of EvidenceCandidates for adjunctive therapies include individuals with chronic wounds who have failed to respondto optimal standard wound care, those with pre-existing medical conditions that delay wound healingand/or who prefer a non-surgical, conservative option to facilitate wound healing. Prior to initiating anadjunctive therapy, the health care provider must ensure that the patient does not have anycontraindications for that treatment modality (Houghton & Campbell, 2001).Electrical current has been shown to induce cellular action in virtually all phases of the wound-healingcascade (Houghton & Campbell, 2001). Ovington (1999) in her review of the AHCPR (1994) recommendations,identified an additional RCT that supported the use of electrical stimulation for the treatment of pressureulcers. This double-blind study randomized patients to active treatment or sham treatment. After eightweeks of treatment, 58% of actively treated ulcers reached complete healing and 3% of the sham-treatedulcers healed completely. The study concluded that pulsed low-intensity direct current represents a usefulapproach for the treatment of Stage II and Stage III chronic pressure ulcers by increasing the healing rate.The growth of fibroblasts and keratinocytes may be enhanced by pulsed low-intensity direct current due to45