Evidence Based Notes on Pressure Ulcers

NPWT

Negative Pressure Wound Therapy increases rate of closure in stage 3 and 4 pressure ulcers

(Ubbink, Westbos, Evans, Land, & Vermeulen, 2008)

Level of evidence B

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010,  Pg 34

Support Surfaces

Individuals at risk should be placed on a pressure redistribution surface.

(RNAO, 2005; NICE, 2005)

Level of evidence B

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010,   Pg 18

Nutrition

Early nutritional assessment is critical to identify patients at risk for malnutrition

(Dorner, Posthauer, & Thomas, 2009)

Level of evidence C

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010, Pg 10

Surgical Intervention

Evaluate the need for surgical interventions with stage 3 and 4 pressure ulcers that don’t respond to conservative pressure ulcer treatments.

(Sorensen, Jorgensen, & Gottrup, 2004)

Level of evidence C

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010,  Pg 35

Co-morbidities related to delayed healing in Pressure Ulcers

Pressure Ulcer healing is complicated by co-morbid conditions including malignancy, diabetes, CVA, heart failure, renal failure, pneumonia.

(Berlowitz & Wilking, 1989)

Level of evidence C

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010, Pg 12

Wound Conditions related to delayed healing in Pressure Ulcers

Wounds that are larger, deeper, infected, had large amount of exudate, and /or covered with slough or eschar are less likely to heal with in 3 months and likely to heal after five to six months of treatment.

(Jones et al., 2007)

Level of evidence C

Guideline for Prevention and Management of Pressure Ulcers, WOCN Clinical Practice Guideline Series 2, 2010, Pg 12

 

Benchmark for Pressure Ulcers greater than 4 square cm

The median days to healing is 73 days for large (>4cm2) ulcers

(Bergstrom et al., 2008)

Level of evidence: Level 4 study

NPUAP & EPUAP. Prevention and t6reatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Pg 54.

 

Benchmark for Pressure Ulcers greater than 4 square cm

The healing rate for stage 3 pressures was 31.5% and 23.3% for stage 4 pressure ulcers in the first 3 months (12 weeks).

(Brandeis et al., 1990)

Level of evidence: Level 4 study

NPUAP & EPUAP. Prevention and t6reatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Pg 54.

 

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