Ask AI

Search

Loading...

Table of contents

Pressure ulcer

What's new

Updated 2024 WHS guidelines for the prevention and management of pressure ulcers.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of pressure ulcer are prepared by our editorial team based on guidelines from the Wound Healing Society (WHS 2024), the American Academy of Family Physicians (AAFP 2023), the European Pressure Ulcer Advisory Panel (EPUAP/PPPIA/NPIAP 2019), and the American College of Physicians (ACP 2015). ...
Show more

Classification and risk stratification

Risk assessment: as per WHS 2024 guidelines, assess all patients for their risk of developing PUs.
A
Show 2 more
Create free account

Diagnostic investigations

History and physical examination: as per WHS 2024 guidelines, review medications,
A
, assess nutritional status,
B
perfusion and oxygenation,
A
and evaluate for systemic diseases in patients with PUs.
A
Show 3 more

More topics in this section

  • Evaluation for wound infection

Diagnostic procedures

Bone biopsy: as per WHS 2024 guidelines, perform bone biopsy for culture and histology in patients with suspected osteomyelitis associated with a PU.
A

Medical management

Topical antimicrobials: as per WHS 2024 guidelines, recognize that topical antimicrobials (silver-containing cream, antimicrobial-containing foam dressing, cadexomer iodine) have been shown to decrease the bacterial load in ulcers.
A

More topics in this section

  • Systemic antibiotics

  • Management of osteomyelitis

  • Management of distant infections

  • Growth factor therapy

  • Management of pain

  • Management of odor

Nonpharmacologic interventions

Offloading: as per EPUAP/NPIAP/PPPIA 2019 guidelines, elevate the heels using a specifically designed heel suspension device in patients with stages 1-2
B
and stage ≥ 3 PUs,
B
or a pillow/foam cushion in patients with stages 1-2 PUs, offloading the heel completely to distribute the weight of the leg along the calf without placing pressure on the Achilles tendon and the popliteal vein.
B

More topics in this section

  • Pressure-relieving surfaces

  • Nutritional support

Therapeutic procedures

Electrical stimulation: as per WHS 2024 guidelines, consider offering electrical stimulation in conjunction with conventional therapy in patients with chronic stage 2-4 PUs.
B

More topics in this section

  • Negative pressure wound therapy

  • Therapeutic ultrasound

  • Laser therapy

Perioperative care

Perioperative management: as per WHS 2024 guidelines, address modifiable risk factors, including optimizing glucose control, before flap reconstruction.
A
Show 2 more

Surgical interventions

Debridement: as per WHS 2024 guidelines, perform initial debridement (sharp, mechanical, enzymatic, ultrasonic, or autolytic; more than one method may be appropriate) to remove the obvious necrotic or devitalized tissue, excessive bacterial burden, and cellular burden of dead and senescent cells. Perform maintenance debridement to maintain the appearance and readiness of the wound bed for healing.
A
Show 4 more

More topics in this section

  • Wound cleansing

  • Wound dressings

  • Surgical closure

  • Fecal and urinary diversion

  • Amputation

Specific circumstances

Pediatric patients: as per EPUAP/NPIAP/PPPIA 2019 guidelines, obtain an age-appropriate nutritional screening and assessment in neonates and pediatric patients at risk of pressure injuries.
B
Show 2 more

More topics in this section

  • Seated patients

  • Patients with medical devices

Preventative measures

Skin care: as per WHS 2024 guidelines, apply prophylactic dressings over bony prominences for PU prevention in patients in the ICU.
A

More topics in this section

  • Offloading

  • Pressure-relieving surfaces

  • Repositioning

Follow-up and surveillance

Clinical follow-up: as per EPUAP/NPIAP/PPPIA 2019 guidelines, reassess the pressure injury at least weekly to monitor progress toward healing.
B
Show 4 more

More topics in this section

  • Management of chronic ulcers