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Pressure ulcer treatment

The challenge to manage pressure ulcers

We all want to avoid pressure ulcers. Considerable progress has been made in this area the past few years. Nevertheless, pressure ulcers remain a challenge. B. Braun offers different solutions including products for skin care, wound bed preparation and infection management, as well as exudate management. Taking action right from the start helps you to prevent the aggravation of existing pressure ulcers and to support the healing process.

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Join us in the EPUAP 2022 meeting

22nd annual meeting of the EPUAP, Sept. 14-16

B. Braun will participate in the 22nd annual meeting of the European Pressure Ulcer Advisory Panel  in Prague, CZ. Visit us at booth 7 to learn about our pressure ulcer product solutions.
More information about the meeting on the EPUAP 2022 webpage

Pressure ulcer management - a holistic approach

In most cases, pressure ulcers have a significant impact on patient morbidity(1) and quality of life(2) and can even impact patient survival.(3) Once a pressure ulcer has developed, it is important to draw up a coordinated treatment plan to promote healing. The basic prerequisites for wound healing must be met and everything that interrupts this process needs to be avoided. These include pressure ease, a clean wound, circulation functioning, an adapted nutrition(4) in terms of both calories and nutrients along with adequate hydration.(4)

 

Depending on the extent of tissue damage, pressure sores are categorized into four stages. Every stage requires a specific treatment.

Management of stage 1 pressure ulcers

Description

Non-blanchable erythema of intact skin; superficial

 

Goal

  • Skin repair
  • Restore capillary function
  • Protect against friction and pressure

 

 

Protect, treat and repair: daily skin hygiene and care

Linovera® is a product range made of hyperoxygenated fatty acids (HOFA). Indicated for prevention and treatment of stage 1 pressure ulcers (Linovera® Oil) as well as lower limb ulcers and diabetic foot ulcers (Linovera® Emulsion).

 

The products promote blood microcirculation, reducing the risk of ischemia and facilitating the renewal of epidermal cells. They protect against friction,(5) reduce skin fragility and help to prevent dehydration of the skin.(6,7)

Askina® Heel is a non adhesive hydrocellular heel dressing that protects the heel area from shear stresses and reduces pressure from external forces.

Management of stage 2 pressure ulcers

Description

Partial-thickness skin loss with exposed dermis; superficial

 

Treatment goals

  • Remove blisters
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

Helps to prevent secondary infection(8) and biofilm formation(9)

Reduces healing time(10)

 

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.(11)

 

Prontosan® Gel X proper wound cleansing can be essential. The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® is a range of primary dressings consisting of an ionic silver alginate matrix, which provides a broad antimicrobial effectiveness(12) and helps to prevent contamination from external bacteria. In the presence of wound exudate, the silver alginate matrix helps to maintain a moist wound environment conducive to natural healing conditions.
 

  • Askina® Calgitrol® Paste is a dressing with an ionic silver alginate matrix in a paste form.
  • Askina® Calgitrol® Thin is a conformable ionic silver alginate matrix used as a wound bed interface.
  • Askina® Calgitrol® Ag integrates an ionic silver alginate matrix on an absorbent polyurethane foam dressing.

Askina® Carbosorb is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Management of stage 3 pressure ulcers

Description

Full-thickness skin loss; deep

 

Treatment goals

  • Debride
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

Helps to prevent secondary infection(8) and biofilm formation(9)

Reduces healing time(10)

 

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.(11)

 

Prontosan® Gel X proper wound cleansing can be essential. The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® is a range of primary dressings consisting of an ionic silver alginate matrix, which provides a broad antimicrobial effectiveness(12) and helps to prevent contamination from external bacteria. In the presence of wound exudate, the silver alginate matrix helps to maintain a moist wound environment conducive to natural healing conditions.
 

  • Askina® Calgitrol® Paste is a dressing with an ionic silver alginate matrix in a paste form.
  • Askina® Calgitrol® Thin is a conformable ionic silver alginate matrix used as a wound bed interface.
  • Askina® Calgitrol® Ag integrates an ionic silver alginate matrix on an absorbent polyurethane foam dressing.

Askina® Carbosorb is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Sorb Rope is an absorbing alginate dressing suited for the management of moderate to heavily exuding cavity wounds.(9)

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Management of stage 4 pressure ulcers

Description

Full-thickness skin loss; deep

 

Treatment goals

  • Debride
  • Protect organs
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

Helps to prevent secondary infection(8) and biofilm formation(9)

Reduces healing time(10)

 

It moistens wound dressings and dissolves encrusted bandages or wound dressings during dressing changes.(11)

 

Prontosan® Gel X proper wound cleansing can be essential. The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Calgitrol® is a range of primary dressings consisting of an ionic silver alginate matrix, which provides a broad antimicrobial effectiveness(12) and helps to prevent contamination from external bacteria. In the presence of wound exudate, the silver alginate matrix helps to maintain a moist wound environment conducive to natural healing conditions.
 

  • Askina® Calgitrol® Paste is a dressing with an ionic silver alginate matrix in a paste form.
  • Askina® Calgitrol® Thin is a conformable ionic silver alginate matrix used as a wound bed interface.
  • Askina® Calgitrol® Ag integrates an ionic silver alginate matrix on an absorbent polyurethane foam dressing.

Askina® Carbosorb is a conformable, sterile wound dressing combining two layers: an absorbent layer and an activated charcoal layer for the absorption of bacterial malodor.

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.

Askina® Sorb Rope is an absorbing alginate dressing suited for the management of moderate to heavily exuding cavity wounds.(9)

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

“One to four out of 10 hospitalized patients may develop pressure ulcers.”

Defloor T, De Bacquer D, Grypdonck MH 'The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers.' (13)

Clinical case presentation: pressure ulcer managment

Thorough wound assessments and sensible product selections are essential to help prevent and treat wound infections, manage exudate and finally restore skin integrity.This is the clinical case presentation of Fernanda Cortes from Chile who explains step by step how she treated the stage 3 pressure ulcer of a 60-year-old family father. Through her commitment and the effective combination of Prontosan®, Askina® and Linovera® the patient eventually recovered.

Please note that the pictures in the video may be disturbing to sensitive persons.

Back to life after four months of healing of his pressure ulcer

In the following video, Miguel Cuevas shares his joy of his recovery. He is happy to be able to do all the things again that most people take for granted.

 

“Pressure ulcers can occur quickly – between the first hour and 4 to 6 hours after sustained loading.”

Gefen A. 'How much time does it take to get a pressure ulcer?' (14)

Our product portfolio

Wound bed preparation and biofilm management

Wound infection and odor management

Exudate management

Skin resistance improvement and skin protection

1) Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol. 2005 Mar;26(3):293-7. doi: 10.1086/502542. PMID: 15796283.

2) Sebba Tosta de Souza DM, Veiga DF, Santos ID, Abla LE, Juliano Y, Ferreira LM. Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings. J Wound Ostomy Continence Nurs. 2015 Jul-Aug;42(4):352-9. doi: 10.1097/WON.0000000000000142. PMID: 26135820.

3) Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, Calvino-Gunther S, Chaboyer W, Coyer F, Deschepper M, François G, Honore PM, Jankovic R, Khanna AK, Llaurado-Serra M, Lin F, Rose L, Rubulotta F, Saager L, Williams G, Blot SI; DecubICUs Study Team; European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021 Feb;47(2):160-169. doi: 10.1007/s00134-020-06234-9. Epub 2020 Oct 9. Erratum in: Intensive Care Med. 2021 Apr;47(4):503-520.PMID: 33034686.

4) Munoz N, Posthauer ME, Cereda E, Schols JMGA, Haesler E. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations. Adv Skin Wound Care.

2020 Mar;33(3):123-136. doi: 10.1097/01.ASW.0000653144.90739.ad. PMID: 32058438.

5) Jimenez Torres J. Acidos Grasos Hiperoxigenados (AGHO) en el tratamiento y prevencion de las ulceras por presion, ulceras vasculares y pie diabetico. Panorama actual del medicamento 2010; 34(336):695-701

6) Declair V. The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers. Ostomy Wound Manage1997; 43(5):48-52, 54.

7) Colin D, Chomard D, Bois C, Saumet JL, Desvaux B, Marie M. An evaluation of hyper-oxygenated fatty acid esters in pressure sore management. J Wound Care1998; 7(2):71-2.

8) Andriessen AE, Eberlein T. Assessment of a wound cleansing solution in the treatment of problem wounds. Wounds. 2008 Jun;20(6):171-5. PMID: 25942522.

9) Ortega-Peña S, Hidalgo-González C, Robson MC, Krötzsch E. In vitro microbicidal, anti-biofilm and cytotoxic effects of different commercial antiseptics. Int Wound J. 2017 Jun;14(3):470-479. doi: 10.1111/iwj.12625. Epub 2016 Jun 10. PMID: 27282307; PMCID: PMC7949997.

10) Bellingeri A, Falciani F, Traspedini P, Moscatelli A, Russo A, Tino G, Chiari P, Peghetti A. Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. J Wound Care. 2016 Mar;25(3); 160: 162-6, 168. doi: 10.12968/jowc.2016.25.3.160. PMID: 26947697.

11) Ciprandi G, Ramsay S, Budkevich L, Strack A, van Capellen P, Marathovouniotis N. A retrospective systematic data review on the use of a polihexanide-containing product on burns in children. J Tissue Viability.2018 Nov;27(4):244-248. doi: 10.1016/j.jtv.2018.08.001. Epub 2018 Aug 9. PMID: 30170891.

12) Dissemond J, Steinmann J, Münter KC, Brill H, Böttrich JG, Braunwarth H, Schümmelfeder F, Wilken P. Risk and clinical impact of bacterial resistance/susceptibility to silver-based wound dressings: a systematic review. J Wound Care. 2020 Apr 2;29(4):221-234. doi: 10.12968/jowc.2020.29.4.221. PMID: 32281507.

13) Defloor T, De Bacquer D, Grypdonck MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud. 2005 Jan;42(1):37-46. doi: 10.1016/j.ijnurstu.2004.05.013. PMID: 15582638.

14) Gefen A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage. 2008 Oct;54(10):26-8, 30-5. PMID:18927481.

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