When a loved one becomes bedbound, the bed–which should be a place of rest–can quickly become a source of risk. As an in-home Nurse Practitioner, I see many families who are doing their absolute best but aren’t aware of the small, specific techniques that prevent skin breakdown.
Pressure injuries, specifically Stage 1 injuries (where the skin is still intact but not damaged), can develop in as little as two hours! The good news? With a proactive routine, many of these are entirely preventable. Here is how you can protect your loved one’s skin at home.
The Power of the “Turn”
The most effective way to prevent pressure injuries is to move the body. In the hospital, we use a “Two-Hour Turn” schedule, and I recommend the same for home care.
When we say “turning,” we don’t mean flipping someone completely over. It’s about shifting the weight off the bony prominenes–the tailbone (sacrum), hips, and shoulder blades.
- The 30-degree Tilt: Instead of laying someone flat on their side (which puts all of the pressure on the hip bone), tilt them to about 30 degrees and support their back with a long body pillow or wedge.
- The Clock Method: Many families find it helpful to keep a “turning log” or set a phone timer. Even a slight shift in position can restore blood flow to compressed skin.
“Floating” The Heels: A Non-Negotiable
The skin on our heels is surprisingly thin, and the heel bone is quite sharp. If a patient lies on their back with their heels resting on the mattress, the weight of the entire leg is concentrated on that tiny point.
To “float” the heels:
- Place a pillow lengthwise under the calves.
- Ensure the pillow ends just before the ankle, allowing the heels to hang freely in the air (like they are “floating”).
- Pro-Tip: Never place a pillow directly under the heels or the backs of the knees, as this can increase pressure or even cause blood clots.
Identifying Stage 1 Early
A Stage 1 pressure injury is your “final warning.” At this stage, the skin is not yet broken, but the tissue underneath is stressed.
- In light skin: Look for a red spot that stays red even after you remove the pressure for 30 minutes.
- In dark skin: Look for a spot that appears purple, bluish, or “shiny,” or has some of the texture changes discussed in the last blog post.
- The touch test: The area may feel warmer than the surrounding skin or feel “boggy” (squishy) like a bruised plum.
Practical Tips for Caregivers
- Check the Sheets: Wrinkles in bedsheets can act like tiny saw blades against fragile skin. Ensure the bottom sheet is pulled tight and smooth.
- Watch the Head of the Bed: If the head of the bed is raised higher than 30 degrees, the body tends to slide down. This creates “shear,” which tears deep layers of skin. Keep the bed as flat as the patient can safely tolerate.
- Skin Hygiene: Use moisture barrier creams if the patient struggles with incontinence, but avoid vigorous rubbing. Friction from massage can actually cause more damage to stressed skin.
Preventing pressure injuries is a marathon, not a sprint. By implementing a turning schedule (while YOU are awake) and floating the heels today, you are preventing a painful and complex wound tomorrow. Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.