How to Prevent Pressure Sores and Other Skin Injuries

When you are in bed

1. If you cannot change your own position, you need to schedule times when someone else can help you turn.  Be sure that you are turned at least every two to three hours.  This will help to prevent skin problems.

2. Give extra attention to protecting your heels, elbows, shoulders, and hip bones.  Small pillows and foam padding may help.

3. Never smoke in bed or rest an ashtray on any part of your body.  Be careful of ashes, matches and burning cigarettes.

When you are sitting

1. In order to prevent pressure sores, relieve pressure every 15 minutes.  This may be hard at first, but it must become part of your daily routine.  Your physical therapist will teach you ways to shift your weight and will remind you to do these weight shifts until you start doing them automatically.

2. Cushions are a must for anyone restricted to a wheelchair.  Use your cushion if you are going to sit in a chair or a car for more than 15 minutes.  Cushions will delay tissue damage but will not prevent it.

3. Your physical therapist will help you choose the best cushion for you.  A good quality foam cushion may work as well for you as a more expensive one.  Replace your cushion when it loses it firmness or gets dry and flaky.

4. Never use rubber air rings or rubber doughnuts as cushions.  They increase pressure and cut off blood flow to the skin inside the ring.

5. Adjust the foot pedals on your wheelchair to improve your sitting position.  Your thighs should be parallel to the floor.  This will spread the weight of your upper body more evenly.  Pressure on your lower thighs will increase if the foot pedals are too low. If your knees are too high, there will be more pressure on your hip joints and tailbone. If your knees are too low, you will be off-balance.

6. Sit up straight in your chair.  Slouching will sooner or later cause pressure sores on your tailbone.  Over time, poor posture may cause spine damage, which could lead to breathing problems.

When you are transferring

1. Before transferring into a bathtub, fill the tub with water that is not too warm or too cold.  This will prevent burns and provide a softer landing.  Place a two-inch foam cushion at the bottom of the tub and a soft cloth on the tub’s edge to make the transfer easier.  Getting out of a tub will be easier after you drain out the water.

2. Lift your body as much as possible when transferring.

3. It will be easier and safer to transfer to and from your wheelchair if your bed and toilet are the same height.

4. Do not "bump" up and down stairs on your bottom unless it is an emergency.

When you are traveling

1. Secure your wheelchair to the floor when travelling in a van.  This protects you against injuries if there is a sudden stop.  Use at least one safety belt when travelling in any vehicle.  It is best to use both a shoulder harness and a lap belt.

2. Remember to do weight shifts every 15 minutes while riding in a car.  It is a good idea to completely change positions every 100 miles.  The best way to do this is to stretch out or lie down. A trip or vacation can be very expensive if it ends with a pressure sore.

When you deal with heat or cold

1. Wear warm clothing and shoes in the winter.  Frostbite is possible, and it can be as severe as a burn.

2. Check the water temperature before bathing.  Be careful around faucets that may be hot after running the water.  Also watch for hot pipes under sinks in public places.  Do not use electric heating pads or electric blankets.  They can cause burns even in people with normal feeling.

3. Always know where your legs and feet are.  Car heaters and air conditioners can cause serious burns or frostbite on legs with no sense of feeling and poor circulation.  Beware of sun-warmed cars.  Be careful not to touch chrome on door frames and windows while transferring.  Also, don’t use wire “seat covers” while traveling.

4. Do not sit too close to radiators, stoves, or space heaters.  Stay at least six feet from a space heater.

5. Be careful when cooking from your wheelchair.  Do not lift boiling pots from the stove or leave them where you could knock them onto yourself.  NEVER carry hot liquids, chemicals, or acids on your lap.  It may be best for someone else to do the cooking and/or carrying if you cannot do it safely.

6. REMEMBER!  Be extremely careful with ashes, matches, and burning cigarettes.  Never rest an ashtray on any part of your body.

General Health Care for You to Remember

1. Inspect your feet often.  Cut your toenails straight across.  Cuts and calluses are a potential source of infection.  To soften and remove hard excess skin:    

   Soak feet in warm, soapy water (not hot). Gently rub each foot with a washcloth. Remove calluses and hard skin. Rinse feet and dry with a towel. Gently rub on Nivea Cream or other skin oil.

2. Make sure your shoes are soft and fit right.  This helps prevent foot problems.  When you buy new shoes, check them for tissue paper in the toes.

3. Wear clothes that fit right.  Tight clothing can pinch your skin.  Be sure the surface is smooth and does not scrape your bottom on objects during transfers.  Don’t sit on surfaces that have small objects, such as clips or pencils on them, since they can cause sores.

4. You will need to change your schedule for weight shifts as your body changes.  If you have no muscle function in your hips and legs, you will lose weight and bulk in these areas.  As you lose weight and bulk, your tailbone will become more exposed and the risk of pressure sores will increase.  This is a major reason that weight shifts are so important.

5. Eat a well-balanced diet high in protein.  Tissues that are exposed to pressure need good nutrition.

6. It is important to check your skin both morning and evening.  This will help you detect trouble spots as soon as they develop.  Use a mirror to check hard-to-see spots.  If you are quadriplegic, mirrors can be adapted but you may need to have someone help you inspect your skin.  You will learn how to check your skin at the hospital.