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    Pressure Wound Prevention

    Hi Everyone,

    I am a incomplete, t2 -t7, post four years now and, Unfortunately, I ended up with a pressure wound on my butt due to not following through with pressure relief. Long story short, I was forced to have a flap, and I was on bed rest for 3 months. The combination of the 3 months of bed rest and the 6 weeks on a Clinitron bed after my surgery, I lost all of my muscle mass so I had to give up my apartment and surrender myself to a nursing home, and that is where I am now. I have set a goal of living independently again once my upper body strength is built up again and I have made sure I am ready by transferring in and out of bed. I have been here a couple of months now and things were going really well until I asked my CNA to check out my feet and she noticed two blisters on the back of both heels. I figured out that this happened due to lifting myself up and down on the trapeze bar with my pressure boots on and it caused friction lifting myself up and down. I was concerned and pissed off to say the least. So, here I am with a set back to deal with and I need you're help.

    First off, in my opinion, due to the blisters I can no longer wear my boots in bed because I need to do pressure relief. Maybe I am lifting myself too high? I am doind my best to clear my butt. Is this necessary? Here in the nursing home, I am having my CNA float my heels with pillows. If, and when, I am living independently, I don't think I will be able to transfer into bed and at the same time, position the pillows and position my feet so my heels can float. I can't attempt this now because I would need the physical therapy department to begin the procses and, at this early point, I am not ready for that. So, if you were in this scenario, how would you handle it?

    Thank you for you're feedback

    Michael
    Last edited by michael5462; 26 Mar 2011, 6:15 PM.

    #2
    First, get yourself a pair of air boots (they have open heels) to wear until your heels are healed. Once you are able to wear your boots or shoes, do so when doing your pull-ups with the trapeze bar. Also, use a towel so that the friction is between the towel and the sheet not you feet and the sheet. Rubber soled shoes should grip the towel sufficiently and your feet will slide nicely. We do that on the therapy may because sneakers will not slide on the mat but some activities require the grip.--eak
    Elizabeth A. Kephart, PHR
    mom/caregiver to Ryan-age 21
    Incomplete C-2 with TBI since 3/09

    Comment


      #3
      The boots you were using were not properly fit if they allowed you to get heel pressure ulcers. What type are you using? These are most likely pressure, not shear/friction injuries. If you are worried about friction, sheepskin will help (although not eliminate) friction, although it does little to reduce pressure. Bridging your heels with pillows now is the proper thing to do, but be sure that you feet do not spasm off the pillows.

      You should not need a trapeze to turn in bed. They are very hard on your shoulders. What type of bed and mattress are you on now?

      The nursing home should have been inspecting your skin and caught these problems long before you got black heals. In my state, they can be fined for allowing this to happen. Check with your Ombudsman for your facility.

      Do you live alone? Could you use a lift for transfers at home?

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

      Comment


        #4
        The nurse is right in that they should be checking your skin from head to toe every day. I do that for Ryan even though his only skin issues have been very limited. He has the heel blisters at the trauma hospital from the hard boots they put him in because the nurses were not taking them off. The changed to air boots and his heels got better. The other was from the transport from the hospital to rehab-he spent more than six hours in transit and got to rehab with a red spot on his butt. In addition to his SCI, he crushed both his legs in the accident so I can understand the boot issue, his ankles were broken and they needed the support.

        He has full sensation and shifts in his seat as much or more than I do. We have chosen thick socks over pillow propping as he moves his legs and feet through out the night and the pillows get in the way and tweak his back. He does not turn at night on a schedule but shifts himself in his sleep as he always did. His skin is pristine and I still check it every morning when I get him up and every night when I put him to bed. A red spot is easier to manage than a blister or a full blown pressure sore.

        Given your history with pressure sores-that is why you are there, they should be diligent about checking your skin twice a day.--eak
        Elizabeth A. Kephart, PHR
        mom/caregiver to Ryan-age 21
        Incomplete C-2 with TBI since 3/09

        Comment


          #5
          I am so sorry this has happened to you. What a cluster.

          Foot wounds can be very difficult to heal. I have experience in this area. A blackened area can do one of two things .. it can dry up and fall off eventually (hope so!) or it can open up and become a deep wound that's difficult to heal and has the potential for osteomyelitis (infection of the bone) because the bone is so close to the skin - trust me - you don't want that.

          Are you using an air mattress or overlay? You will need to in the future because it's become obvious that you're prone to wounds already (some people are more than others - not your fault).

          What cushion are you using on your chair or are you even up yet?

          I like the multi-podus boots but the nurse here likes .. is it a prevalon boot? I can't remember. (http://www.sageproductsglobal.com/en/prevalon.cfm)

          Diet is extremely important. Take multi-vitamins and get lots of protein and stay hydrated - what kind of meals do you get in the nursing home? Not very good ones I imagine. Can you get access to protein drinks? It's difficult to manage weight and have to be on bed-rest. No way around that, unfortunately.

          There are other things that can be silent but mess up healing - diabetes, thyroid issues, red blood cell counts. Just FYI.

          Therabands are excellent if you have to be on bedrest .. they keep your muscles warm and limber. I wouldn't recommend free weights in bed until both the bum and heel wounds are taken care of, unfortunately.

          Both are high risk pressure areas.

          EDIT TO ADD: If you don't have family or friends that can help, I can see about sending you a theraband to keep limber. Ebay is a good place to find medical equipment (pressure relieving boots, mattresses) if money is a problem. You seriously need to be on vitamins - I can't stress that enough.
          Last edited by lynnifer; 26 Mar 2011, 11:02 PM.
          Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

          T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

          Comment


            #6
            Michael, your heels are blistered right, not blackened. There is HUGE difference in the level of damage done. Blisters heal fairly quickly with proper treatment (good multi vitamin and an extra vitamin C daily will help). The trauma hospital put pink pads (some sort of treatment that the nurse may know the name of but that was it. Black spots, however are altogether different and indicate dead cells, not damaged ones.--eak
            Elizabeth A. Kephart, PHR
            mom/caregiver to Ryan-age 21
            Incomplete C-2 with TBI since 3/09

            Comment


              #7
              Hi Michael!

              I had your same (almost) issues right out of rehab. My place was not ready and had to go to a nursing home and I developed pressure sores there. When I got to my own home, had a big one that required surgery and then a lot of bedrest to heal it. I had no flap surgery cause the odds were 50/50 that it would remain the same. SO, I decided to heal it at home since I had help and the time to do it. Its almost on 3 years now, but doing well. ANYTHING To get OUT of that damn home!! Post your addy and I will send you some goodies in the mail! I feel for ya brother...hope you have lots of visitors and friends that help you out, and if not add me onto the list cause ya sound cool!
              dougie

              Comment


                #8
                Originally posted by SCI-Nurse View Post
                The boots you were using were not properly fit if they allowed you to get heel pressure ulcers. What type are you using? These are most likely pressure, not shear/friction injuries. If you are worried about friction, sheepskin will help (although not eliminate) friction, although it does little to reduce pressure. Bridging your heels with pillows now is the proper thing to do, but be sure that you feet do not spasm off the pillows.

                You should not need a trapeze to turn in bed. They are very hard on your shoulders. What type of bed and mattress are you on now?

                The nursing home should have been inspecting your skin and caught these problems long before you got black heals. In my state, they can be fined for allowing this to happen. Check with your Ombudsman for your facility.

                Do you live alone? Could you use a lift for transfers at home?

                (KLD)

                First off, they aren't pressure wounds, Thank God for that and secondly, the type of boots is provided below. They are skil-care.

                I am not utilizing a trapaeza while turning in bed. I am using the trapeze for pressure relief on my buttocks.

                At this early point, of course, I am not living alone, but if I did, I know in advance, my insurance company wouldn't cover a lift for me, unfortunately.

                http://skil-care.com/cgi-bin/index.c...55&prod=503034

                Comment


                  #9
                  I'm a c7 guy and I can put two pillows at the foot of the bed and arrange my legs and feet. I'm not a super-quad by any means. You should be able to do it. Like you, I just got discharged from a rehab hospital after having surgery on my butt for a wound. 14 weeks of hell. However, fortunately I own my own house so I came home. Get some hand weights and build your strength back up while in bed.

                  Comment


                    #10
                    Originally posted by lynnifer View Post
                    I am so sorry this has happened to you. What a cluster.

                    Foot wounds can be very difficult to heal. I have experience in this area. A blackened area can do one of two things .. it can dry up and fall off eventually (hope so!) or it can open up and become a deep wound that's difficult to heal and has the potential for osteomyelitis (infection of the bone) because the bone is so close to the skin - trust me - you don't want that.

                    Are you using an air mattress or overlay? You will need to in the future because it's become obvious that you're prone to wounds already (some people are more than others - not your fault).

                    What cushion are you using on your chair or are you even up yet?

                    I like the multi-podus boots but the nurse here likes .. is it a prevalon boot? I can't remember. (http://www.sageproductsglobal.com/en/prevalon.cfm)

                    Diet is extremely important. Take multi-vitamins and get lots of protein and stay hydrated - what kind of meals do you get in the nursing home? Not very good ones I imagine. Can you get access to protein drinks? It's difficult to manage weight and have to be on bed-rest. No way around that, unfortunately.

                    There are other things that can be silent but mess up healing - diabetes, thyroid issues, red blood cell counts. Just FYI.

                    Therabands are excellent if you have to be on bedrest .. they keep your muscles warm and limber. I wouldn't recommend free weights in bed until both the bum and heel wounds are taken care of, unfortunately.

                    Both are high risk pressure areas.

                    EDIT TO ADD: If you don't have family or friends that can help, I can see about sending you a theraband to keep limber. Ebay is a good place to find medical equipment (pressure relieving boots, mattresses) if money is a problem. You seriously need to be on vitamins - I can't stress that enough.
                    First off, thanks for you're reply and It was refreshing to hear you say "it can dry up and fall off eventually (hope so!)" because my wound nurse indicated that would happen!

                    I am currently sleeping on a low pressure air mattress and have been since my infarction in July of 07.

                    I am sitting on a ROHO cushion in my wheelchair and I am doing pressure relief like no body's business. If I get another wound there, you can't imagine I would feel about that.

                    The pressure boots that I am using are skil-care. I provided a link when I responded to KLD above.

                    I wish I could say I am on a good diet but, simply put, I'm not. I am taking multi-vitamins though. I am very good with the amount of protein I am consuming, but I am too heavy on my carbs. and lacking in the vegetable department. Uuuggghhhh....

                    I guess I didn't present my condition correctly. I am out of bed most of the day and travel down to the therapy department to do my weight lifting six times a week for thirty minutes.


                    Michael

                    Comment


                      #11
                      Originally posted by ekephart View Post
                      Michael, your heels are blistered right, not blackened. There is HUGE difference in the level of damage done. Blisters heal fairly quickly with proper treatment (good multi vitamin and an extra vitamin C daily will help). The trauma hospital put pink pads (some sort of treatment that the nurse may know the name of but that was it. Black spots, however are altogether different and indicate dead cells, not damaged ones.--eak
                      Yes, ekephart, they are blisters. Thank God for that, just like I said to the nurse, KLD. I am not turning at night either. When I arrived here, I had no wounds at all. When I first became paralyzed in March of 2007, once month after, I had two wounds on my heels. After that, I had wound after wound until January of 2011. First the first time, no wounds until this unecessary drama surfaced. I am confident with the preventative work I am doing on my butt. It is the lower legs and feet/heels, I am worried about and that is why I posted this. I am not going to leave this nursing home until I have gone a fairly good amount of time without any wounds what so ever.

                      Comment


                        #12
                        [QUOTE=smokey;1344665]I'm a c7 guy and I can put two pillows at the foot of the bed and arrange my legs and feet. I'm not a super-quad by any means. You should be able to do it. Like you, I just got discharged from a rehab hospital after having surgery on my butt for a wound. 14 weeks of hell. However, fortunately I own my own house so I came home. Get some hand weights and build your strength back up while in bed.
                        /QUOTE]

                        Thank You Smokey, that gives me something to look forward to! :- >

                        Comment


                          #13
                          Michael, make sure they check all your skin twice a day. Any issues will first present as a red spot that does not blanch immediately. This tell you where you have issues.

                          Will the therapy department allow you to go on your own? I an concerned that 30 minutes a day is not enough and that is why you are using your trapeze to strengthen your upper body. If the equipment is off limits except for your allotted time, get creative when in your chair. Do compression lifts (even if your have to supplement with leaning forward or side to side) for pressure relief. Use anything you an get your hands on for a weight. Water bottles are a good place to start. If you cannot do presses with full bottles, drink as much of the water as necessary. Work your way us to full bottles and then look for something heavier.

                          When you manage to get out of there (hopefully soon), you will continue to need skin checks. If there is no one there willing to show you how to do it yourself (with a mirror), find some one who will. Your skin is your biggest organ and needs tobe taken care of.--eak
                          Elizabeth A. Kephart, PHR
                          mom/caregiver to Ryan-age 21
                          Incomplete C-2 with TBI since 3/09

                          Comment


                            #14
                            If you get a pressure sore in a nursing home or rehab center.....at least in Michigan I would find a lawyer myself. Its there job that you don't get these......

                            Art
                            Art

                            Comment


                              #15
                              20 years ago when I had my flap I was in bed 6 weeks waiting for surgery and 5 weeks in hospital after.
                              I did no exercises and when I got up I had more strength from just the rest.......but that was when i was 38 years old.
                              Hate to see what would happen today if I got one.
                              Why I try as hard as hell not to get another.

                              I will never forget the time in bed as it was pure hell....after the first 2 weeks not as bad but still sucked.

                              Art
                              Art

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