? pressure ulcer
Our patient has a foley catheter and developed an ulcer at the meatus – the
nurse has called this a pressure ulcer however it seems like I remember
hearing that pressure ulcers are over boney prominences. (this is a male
patient – who also has a UTI with MRSA).
Can someone verify with me if this really can be considered a pressure
ulcer?
Arlene Poolman, RN
Director of Clinical Services
At Home Rehab
800.880.9715
*The Professional Care YOU Deserve*
nurse has called this a pressure ulcer however it seems like I remember
hearing that pressure ulcers are over boney prominences. (this is a male
patient – who also has a UTI with MRSA).
Can someone verify with me if this really can be considered a pressure
ulcer?
Arlene Poolman, RN
Director of Clinical Services
At Home Rehab
800.880.9715
*The Professional Care YOU Deserve*
Comments
Jayne Hinson, RN, HCS-D
QA, coding and review
Advance Care, LLC
585 Southlake Blvd. Ste B
Richmond, VA 23235
804 897 9056 (office)
804 615 9917 (cell)
804 897 1099 (fax)
No, what you have described is not a pressure (decubitus) ulcer which is defined as occurring due to pressure, or pressure combined with shear and/or friction applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue and occur over a bony prominence.
Foley cath tips at the meatus on males can and do frequently cause irritation and rubbing which add to irritation of the soft tissues and breakdown to an ulceration. A thoughtful HH nurse would have secured the cath to the thigh with a holder to prevent this from occurring which happens with a good deal of movement of an unsecured catheter.
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com
How to stage: Injury from medical device
The new NPUAP guidance clarifies how to distinguish between a mucosal ulcer and a pressure injury when the injury occurs on a mucosal membrane, says J’non Griffin, owner and president of Home Health Solutions in Carbon Hill, Ala.
Consider an ulcer caused by use of a catheter: If the ulceration is connected to a mucosal membrane such as the urethra/meatus, this would be a mucosal ulcer. If the catheter made an ulceration against any skin such as the thigh, this would be a pressure injury and staging would be done. The new guidelines state that injury from a medical device would be staged, Griffin explains.
Previously, no clear guidance existed for determining how to categorize a wound that resulted from a medical device.
The previous designation “unstageable” described the wound as having “full thickness tissue loss in which the base of the ulcer is covered by slough … and/or eschar … in the wound bed.”
But the revised guidelines add additional pressure injury definitions stating that “if the pressure injury generally ‘conforms to the pattern or shape of the device,’ then it should be staged. If the mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury, the guidelines state, then due to the anatomy of the tissue these ulcers cannot be staged.”
Still, confusion may come if the OASIS assessment does not change the verbiage to match the new descriptions, Griffin says. — Kathy Gambrell (kgambrell@decisionhealth.com)
Related links: For the NPUAP new definitions visit http://tinyurl.com/gnvnhvg. View schematic artwork reflecting the changes in stages for pressure injury at http://bit.ly/1p0NMaE.