This Pressure Ulcer Evidence Based Treatment Pathway is based from documents such as the NPUAP/EPUAP and WOCN guidelines. I have revised them in a time related format that is based on predictive modeling evidence.
Week 1 Pressure Ulcer Evidence Based Treatment Pathway
- Relieve Pressure Support Surfaces / Other Offloading Devices
- Manage Infection Culture / Antimicrobials
- Remove Avascular tissue Debride (Leave heel wounds intact unless infected)
- Optimize Nutrition Pre-albumen / Dietary consultation
- Control Moisture Absorbent dressing
- Reduce Healing Delays Treat Co-morbid Conditions
- Fill Dead Space Fill to volume of wound (Don’t over pack)
- Resolve aggravating conditions Treat friction, shear, moisture, and incontinence
- Sponsor Granulation Consider NPWT
Week 4 Pressure Ulcer Evidence Based Treatment Pathway – If the pressure ulcer heals less than 75% over the first 4 weeks* then consider the following adjunctive therapies or treatments:
- Sponsor Granulation NPWT (Revisit use if not previously ordered)
- Fill volume Apply Dermal substitutes
- Revise tissue Surgical Intervention
- Treat Chronic Conditions Debride and Treat with Collagen
10 Week Benchmark: The median days to healing is 73 days for large (>4cm2) ulcers¹.
* Note: Wounds that did not decrease in area by 77% after 4 weeks were significantly less likely to heal² (a 75% closure rate at 4 weeks was selected due to wound measurement conventions)
- Bergstrom et al., 2008. NPUAP & EPUAP. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Pg 54.
- Van Rijswijk L. Full-thickness pressure ulcers: patient and wound healing characteristics. Decubitus. 1993;6:16–2