Pressure Ulcer Care in Children

Pressure sores are generally considered wounds in adults, but they can also occur in children, including newborns. In fact, it is the most common type of complication in the treatment of critically ill children, and the disease will have a significant impact on the treatment of the primary disease and the prognosis of the children. How to care for pressure ulcers requires specific theoretical and skill training for nurses. Although pressure ulcers in children have not received much attention, the incidence of pressure ulcers in children is still high, especially in children with high-risk diseases ( For example, spina bifida and cerebral palsy), studies have found that the incidence of pressure ulcers is 2.4-7.7 per 1000 children discharged from hospital (the entire children's population), and the incidence of pressure ulcers in high-risk groups, such as those with spina bifida, may be as high as 43%.

Children with inadequate nutritional or fluid intake, weak immune systems, or extreme discomfort are at increased risk of developing pressure injuries.

Are the risk factors for neonatal pressure ulcers?

1. External factors :

Pressure factors: The occurrence of pressure ulcers is mainly related to pressure, shear force, and friction, and the primary factor is pressure. When the external pressure is greater than the capillary pressure, the blood flow in the capillaries and lymphatic vessels slows down, resulting in insufficient oxygen and nutrient supply, poor excretion of metabolic waste, short-term high pressure, and long-term low pressure can lead to the occurrence of pressure ulcers. In addition to the pressure of the own body, there are also external forces, such as the pressure of the CPAP nasal plug on the nasal septum during continuous positive pressure oxygen supply, the pressure of the tracheal intubation on the nose during mechanical ventilation, and the pressure of various pipelines on the local skin, etc. . In order to prevent neonatal ventilator-associated pneumonia, raising the upper body of the child will also generate the shearing force on it. The shearing force can cause relative movement of the tissue, cut off the blood supply to a large area, and reduce the tissue oxygen tension: at the same time, the tissue and The fenestrated vessels in between are stretched, and twisted, and torn, leading to deep necrosis. In the NICU, the child is exposed to the incubator, and it is easy to form friction with the wrapping or bed surface when irritable. In addition, dragging, pulling, and pulling when moving the child can cause friction and damage the skin.

Moisture factor: The skin of the newborn is kept in a humid environment for a long time due to fever, sweating, vomiting, urination, drainage, etc. Excessive humidity can cause skin softening and reduced resistance. Humidity will infiltrate the skin tissue, weaken the barrier function of the skin stratum corneum, cause local skin edema, facilitate the passage of harmful substances and facilitate the reproduction of bacteria, making the epithelial tissue more susceptible to damage, thereby causing pressure. Sore. It can also increase the friction of the skin surface, which is easy to produce blisters or ulcers.

2. Internal factors:

Inherent factors: Malnutrition is one of the factors that lead to the occurrence of pressure ulcers, and it is also a factor that directly affects its healing. Nutrition is the material basis for neonatal growth and development, maintenance of normal physiological functions, and tissue repair. The body of critically ill neonates is in a state of stress, the basal metabolic rate increases, and the catabolism of the body is aggravated by disease factors, which reduces the protein in the body. Malnutrition can also lead to the decline of tissue and organ function, and the ability to regulate metabolic changes during the stress period is correspondingly weak.

Where do pressure ulcers occur in NICU children?

Headrest: The headrest is the most common site for pressure ulcers in newborns. Because the head of newborns accounts for 1/4 of the total length of the body, the younger the age, the greater the weight of the head, and the gravity is mainly concentrated on the head, so the risk of pressure ulcers on the headrest is the greatest.

Nasal septum: The respiratory support of critically ill neonates will use mechanical assisted breathing or continuous positive airway pressure (CPAP). LongtermMedical CPAP nasal obstruction and tracheal intubation will cause prolonged pressure on the nasal skin of the child, which is easy to cause the nasal septum. And the skin of the nose is broken, and pressure sores appear. Because the bridge of the nose belongs to the bony prominence that lacks the protection of adipose tissue and the muscle layer is thin, once it is compressed, it will cause blood circulation disorders.

Place where the indwelling needle is fixed: The tail wing of the intravenous indwelling needle and the heparin cap is hard, and the indwelling time can be up to 72 hours. However, the neonatal skin is delicate, and the long-term indwelling and transparent dressings are too tight to cause pressure sores on the local skin. In addition, the child sweats from crying, and the dressing is not breathable, increasing the risk of pressure ulcers. At this time, a self-adhesive bandage can be used to fix it so that it will not irritate the skin.

Compression of each pipeline: There are many indwelling pipelines in critically ill neonates, such as a gastric tube, tracheal intubation, drainage tube, infusion tube, etc. If the tube is not placed properly or the fixing method is incorrect, the pipeline will be pressed under the child, which is very easy and Causes local skin pressure injury. In addition, if the oxygen saturation probe is wrapped too tightly and the position is not changed in time, pressure injuries will be formed on the skin at the wrapping place.

To deal with different factors in neonatal pressure ulcer wounds?

The nature and color of the wound should be assessed daily, and the grade and progression of the wound should be judged.

Treatment of initial pressure ulcers :

Avoid continuous local pressure and increase the number of turns. The new foam dressing covers decompression protection. It has a good fit with the skin and can cushion the pressure to protect the skin.

Treatment of blisters: Small unbroken blisters should reduce local friction, prevent rupture, and allow them to absorb themselves; large blisters should be aseptically punctured with a syringe to aspirate the fluid in the blisters, disinfect the skin, and then cover Longterm Medical Hydrocolloid dressing, hydrocolloid dressing can provide a slightly acid moist environment suitable for wound healing, as well as the characteristics of waterproof and antibacterial.

Management of open wounds :

The dressing should be changed every day, mainly to remove necrotic tissue, clean the wound and prevent infection. Keep the local area clean, and treat the wound with a surgical aseptic dressing. Each time the debridement should be thorough, the necrotic tissue at the edge and bottom of the pressure ulcer should be cut off until a fresh wound with oozing blood appears so as to facilitate the repair and generation of healthy tissue. Rinse with saline during debridement until the wound is completely clean. Then choose alginate dressing to stick to the affected area. Alginate dressing is a natural polysaccharide carbohydrate extracted from seaweed, which can form a soft gel after contact with wound exudate, providing a good moist healing environment for the wound.

Management of infected wounds :

According to the nature of the wound, it is considered that infected patients should be given secretion culture and drug sensitivity tests, and systemic antibiotics should be used in a targeted manner.

NICU children have risk factors for pressure ulcers due to their own physiology, pathology, and treatment intervention. Among them, pressure, friction, moisture, restricted movement, and malnutrition are the top risk factors for pressure ulcers in children. Timely assessment of the risk factors for pressure ulcers in children and taking targeted and effective preventive measures can greatly reduce the incidence of hospital-acquired pressure ulcers and improve the quality of care.

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At Longterm Medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia

Date: July 21, 2022