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The long lasting effects of pressure injuries and how to prevent them

Monday 6 November 2017

A photo of Lisa Cox in hospital, being hugged by her brother and sister.
Family and friends can help people in hospital prevent pressure injuries by making small movements.

When she was 24, Lisa Cox became very unwell. Having contracted an infection which caused a brain haemorrhage, Lisa was in a coma for three weeks and on life support for two months.

The medication needed to stop the infection resulted in the need to amputate one of her legs, her remaining toes and nine of her fingertips. She spent over a year in hospital recovering and underwent over a dozen operations and procedures – including heart surgery and a total hip replacement, as well as the amputations.

During the time that Lisa was in hospital, she developed three pressure injuries – one on her heel, one on her sacrum and a third on the back of her head. Now, as an advocate for patients, Lisa wants people to know about pressure injuries, and the role patients and their families can play in preventing them.

What are pressure injuries?

Pressure injuries, also known as pressure ulcers, pressure sores or bed sores, are the result of tissue damage caused either by unrelieved pressure or shear force. While anyone can get a pressure injury, those with restricted mobility are more at risk. They can happen anywhere on the body and are extremely painful.

Most often developing on bony parts of the body, pressure injuries can happen very quickly. Just 30 minutes of pressure on one part of the body is enough to cause a pressure injury.

Pressure injuries can range from red and swollen areas to deep, open wounds. Once they’ve developed, they can be hard to heal, especially if the person is still unwell or unable to move.

While Lisa can’t remember the time, her family have told her stories of how they knew she was in incredible pain when her pressure injuries developed, even though she was on the highest dose of painkillers allowed.

“This was before smartphones; they weren’t educated on pressure injuries. They felt absolutely helpless,” Lisa says, “They were extremely motivated to help and were at my bedside for hours every day but they just needed a little basic instruction on what to do.”

“But to be honest, educating my family was not a priority in the first two months. It definitely was during recovery, but when my parents were told they might have to turn off my life support, a pressure injury on my heel was not of upmost importance.”

Importantly, Lisa says that pressure injuries can be deceptive. “My family have photos of my fingers and toes that had turned gangrenous and were quite literally rotting off. As disgusting as they looked I couldn’t feel a thing – it was the tiny little pressure injury on my sacrum that left me screaming in pain on many occasions.”

Just because something ‘looks’ like it shouldn’t hurt doesn’t mean that it won’t so if in doubt, get it checked by a professional.  

While her pressure injuries gradually healed, they still impact her life significantly today. Lisa still experiences pain from the injury sites, because of scar tissue and damage, and wants to make sure people know that the effects of pressure injuries are long term.  

“We don’t think about the long term effects, as well as the short term effects, of pressure injuries on a patient’s wellbeing. Pressure injuries don’t just go away,” Lisa says. But importantly, “they can be prevented or their severity reduced.”

A person with a broken leg lies in a hospital bed.

How to prevent pressure injuries

Pressure injuries often develop on parts of the body touching the surface they lie or sit on, like the shoulders, buttocks, ankles and elbows. Small movements, or ‘wiggles’, that shift pressure from different points of the body, can help prevent pressure injuries from developing.

While nurses will be skilled in shifting patients to prevent pressure injuries, Lisa says it’s important for patients and their families or carers to understand what they can do to help. She advises patients and their families to “open a dialogue with the staff, begin a conversation about pressure injuries, and don’t hesitate to ask them to check you over for injuries.”

Lisa’s injuries weren’t all in places she could easily see, so she relied on family to check for signs of injury, a practice she continues today.

“Involve your significant carers in the process of preventing pressure injuries. Just because they aren’t doctors doesn’t mean they can’t play a role in caring for you.”

When admitted back to hospital for heart surgery a few years ago, Lisa and her family were prepared.

Lisa made sure she would be lying on a pressure relieving mattress and told her family what they should do to help prevent pressure injuries if she was in recovery longer than expected.

When Lisa did spend more time in cardiac ICU than hoped, her family were able to help, shifting her body to relieve pressure on different points. Sometimes, Lisa’s dad would roll up a towel and place it under one hip to help relieve pressure there.

“Small moves make a big difference” she explains. And taking some responsibility for preventing pressure injuries can be beneficial for patients in more ways than one.

“When you’re in hospital it feels like you relinquish all control, all independence, and put your wellbeing in someone else’s hands. But small moves are something that’s really, really doable. If you have trouble doing this yourself, involve your family.”

These days, Lisa still has to be aware of pressure injuries on a day-to-day basis. She has a special, pressure relieving cushion on her wheelchair, covered in fancy green velvet, and a cushion on the desk chair she sits on for work.

Even when lying on the couch relaxing, Lisa keeps in mind the need to ‘wiggle’, shifting her position if things start to get uncomfortable as pressure builds up on one part of her body. She makes sure to not sit for long on hard surfaces, like park benches or on the grandstand seats while watching her husband play footy.

Signs of pressure injuries

Patients, families and carers can look out for signs of developing pressure injuries to help prevent further damage.

Initially, pressure injuries might cause:

  • painful areas
  • red/purple/blue skin
  • blisters
  • swelling
  • dry patches of skin
  • shiny areas of skin
  • warm or cool areas of skin.

A pressure injury might look like a minor issue, but they can hide more damage under the surface of the skin, can become infected and cause scarring. Pressure injuries can delay a patient’s recovery by weeks, or even months.

Pressure injuries can be prevented by small movements of the body, shifting pressure off parts of the body and keeping bedding dry.

Lisa’s story is a reminder that pressure injuries can have lifelong effects. The positive news is that a small move, even a wiggle, can reduce the pressure and prevent pressure injuries.

Last updated: 13 November 2017