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Heel Presure Ulcers

Discussion in 'Diabetic Foot & Wound Management' started by Tuckersm, Nov 9, 2005.

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  1. Tuckersm

    Tuckersm Well-Known Member


    Members do not see these Ads. Sign Up.
    I am trying to find some evidence on the management of an intact blister over a stage 2+ pressure ulcer on the heel.

    There is a lot of evidence on what to do if the blister has burst (debride necrotic tissue, moist wound healing along with pressure removal)

    But nothing on whether the blister should be burst or not. Ther is some opinion that in general they should be left alone (just protection etc.) other opinion that if the blister is taught it should be partially asperated, but no concensus, from what I have read
     

    Attached Files:

  2. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.
    McElhinny ML, Hooper C.
    J Wound Ostomy Continence Nurs. 2008 Jan-Feb;35(1):79-83.
     
  3. Leigh Shaw

    Leigh Shaw Active Member

    Hi Stephen, Im of the empty the blister school of thought especially if its increasing in size. You also have to concider the patients over all condition and vascular status but I just like to remove that pressure, use a simple dressing and then off load. Follow up in a few days and reassess.
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Decreasing the Incidence of Heel Pressure Ulcers in Long-term Care by Increasing Awareness: Results of a 1-Year Program.
    Frain R.
    Ostomy Wound Manage. 2008 Feb;54(2):62-7.
     
  5. Tuckersm

    Tuckersm Well-Known Member

    Leigh,

    There is now some "expert opinion" that suggests that a stable blister should be left intact and a growing blister aspirated a little with a syringe and resealed with opsite, then once burst, debride. But still no evidence on what promotes faster healing
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Prevention of heel pressure sores with a foam body-support device. A randomized controlled trial in a medical intensive care unit
    Cadue JF, Karolewicz S, Tardy C, Barrault C, Robert R, Pourrat O.
    Presse Med. 2008 Jan;37(1 Pt 1):30-6.
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Reducing hospital-acquired pressure ulcer prevalence through a focused prevention program.
    McInerney JA.
    Adv Skin Wound Care. 2008 Feb;21(2):75-8.
     
  8. Adrian Misseri

    Adrian Misseri Active Member

    G'day Stephen.

    based on the idea that the blister is sterile inside, opening it via aspiration or daianage woudl allow a portal for possible infection, especially in a patinet who is already in a risk situation form having the pressure lesioal already. Possiby some firm, but not tight, general compresion with a crepe bandage to encourage re-absprption of blister may help? Maybe also use with a cot wedge to redece any focal pressure on the area and reduce friction forces?
    Nice picture though... mind if I use it in a seminar?

    Cheers!
     
  9. Tuckersm

    Tuckersm Well-Known Member

    Adrian

    I agree, so the aspiration is completed under sterile conditions only on the big heel blisters, such as this.
     

    Attached Files:

  10. Adrian Misseri

    Adrian Misseri Active Member

    That's such a nice picture, you just like posting it up don't you? :)

    Even though it's performed under sterile conditions, my concers is that it is still a break in the epidermis in what is obviously a compromised patient. Then again, if the blister is superficial enough? Still dont know if i'd drain it though.......

    Cheers Stephen!
     
  11. Asher

    Asher Well-Known Member


    Far out, Newsbot, is there some sort of record in here?

    No disrespect Adrian, I am enjoying your posts, keep it up.

    Rebecca
     
  12. Adrian Misseri

    Adrian Misseri Active Member

    Cheers Rebecca,

    Just learning.. constantly learning.. and prepared to be wrong from time to time :)
     
  13. DTT

    DTT Well-Known Member

    Re: Heel Pressure Ulcers

    Hi Stephen

    A question,

    Is the patient able to WB without pain ?

    I tend to agree with the theory not to break the epidermis for the said reasons

    BUT

    If the blister is such that the patient is experiencing severe difficulties in mobilising because of the pain that can't be remedied by any other means then perhaps a re-think and a drain is advisable??

    Just my thoughts

    Cheers

    Derek;)
     
  14. Erp

    Erp Member

    Re: Heel Pressure Ulcers

    Dear All,

    I have reading this debate with interest and feel the need to add my 2 cents.

    Should we taking into account the vascular status of the patient and whether there are staff/carers available to change dressings if we do create a portal of entry?

    I would also think if the blister is filled with clear, serous fluid it is more superficial than one with haemoserous fluid which would indicate a breakdown into the dermis and may indicate the need for further investigation.

    The height of the blister and it's 'turgidity' may be worth measuring (not sure how) as the higher it is the more likely it is to burst and create a non sterile field anyway. Ie: if it is more than 5mm in height, perhaps its better to drain in a more controlled environment with sterile instruments than wait for it to pop.

    My gut feeling is if it fluctuates, drain it, if not just protect and monitor it.

    Wouldn't more research on this be great?

    Liz.
     
  15. Tuckersm

    Tuckersm Well-Known Member

    Taken from Queensland Health Pressure Ulcer Prevention and Management Guidelines

     
  16. delpod

    delpod Active Member

    Re: Heel Pressure Ulcers

    I agree with this. If your Ax of the blister indicates that it is likely to burst anyway wouldnt it be more favourable to drain it with a syringe or small scalpel incision at the base of the lesion, leaving the area relatively intact, rather than it bursting in a patient's shoe which is a completely un-controlled environment? God knows what is kicking around in some people's shoes!

    Also, I have always been advised to leave the "roof" of the blister in tact as much as possible rather than "de-roofing" upon drainage. what are people's thoughts on this?

    On another note, the use of lambs wool rugs/mats in bed to lie under the heel in order to offload/cushion the area that is under increased pressure?
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Decreasing the incidence of heel pressure ulcers in long-term care by increasing awareness: results of a 1-year program.
    Frain R
    Ostomy Wound Manage. 2008 Feb;54(2):62-7
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Heel ulcer incidence following orthopedic surgery: a prospective, observational study.
    Campbell KE, Woodbury G, Labate T, LeMesurier A, Houghton PE.
    Ostomy Wound Manage. 2010 Aug;56(8):32-9.
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Pressure-relieving devices for treating heel pressure ulcers.
    McGinnis E, Stubbs N.
    Cochrane Database Syst Rev. 2011 Sep 7;9:CD005485.
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Use of High-Frequency Ultrasound to Detect Heel Pressure Injury in Elders.
    Helvig EI, Nichols LW.
    J Wound Ostomy Continence Nurs. 2012 Aug 2.
     
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    What is the best support surface in prevention and treatment, as of 2012, for a patient at risk and/or suffering from pressure ulcer sore? Developing French guidelines for clinical practice.
    Colin D, Rochet JM, Ribinik P, Barrois B, Passadori Y, Michel JM.
    Ann Phys Rehabil Med. 2012 Sep 7.
     
  22. NewsBot

    NewsBot The Admin that posts the news.

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    A retrospective descriptive study of nursing home residents with heel eschar or blisters.
    Shannon MM.
    Ostomy Wound Manage. 2013 Jan;59(1):20-7.
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Morphological characteristics of the human skin over posterior aspect of heel in the context of pressure ulcer development.
    Arao H, Shimada T, Hagisawa S, Ferguson-Pell M.
    J Tissue Viability. 2013 Apr 2.
     
  24. NewsBot

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    Heel Ulcer and Blood Flow
    The Importance of the Angiosome Concept

    Ezio Faglia, Giacomo Clerici, Maurizio Caminiti, Curci Vincenzo, Francesco Cetta
    International Journal of Lower Extremity Wounds September 16, 2013
     
  25. Admin2

    Admin2 Administrator Staff Member

    Report on a clinical evaluation of the KerraPro Heel silicone heel pad.
    Knowles A, Young S, Collins F, Hampton S.
    J Wound Care. 2013 Nov 14;22(11):599-607.
     
  26. NewsBot

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    Articles:
    1
    A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.
    McGinnis E, Greenwood DC, Nelson EA, Nixon J.
    Age Ageing. 2013 Dec 22.

     
  27. malaligned

    malaligned Member

    I agree there must be an initial careful assessment and the decision should be based on the outcome of the assessment.
    Is the fluid sterile? what if blood is involved ? I have seen blister on heels filled with pus so there must be a point where bacteria multiplies and causes tissue breakdown this needs to be treated and so the blister must be de roofed.

    What is the condition of the surrounding tissue? if it is healthy with no bogginess and the fluid level is not rising then perhaps leave it alone but if there is deep tissue damage or signs of infection and the surrounding tissue appears less than healthy then I think it s best to de roof and clean the wound and apply appropriate dressings.
    This gives a controlled environment rather than have the possibility of the blister bursting in the wrong situation.
    Whatever the decision is there must be careful and regular monitoring of the area.
    good luck
     
  28. NewsBot

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    Articles:
    1
    Morphological characteristics of the human skin over posterior aspect of heel in the context of pressure ulcer development.
    Arao H, Shimada T, Hagisawa S, Ferguson-Pell M.
    J Tissue Viability. 2013 May;22(2):42-51.
     
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    Effects of foot posture and heel padding devices on soft tissue deformations under the heel in supine position in males: MRI studies.
    Tenenbaum S, Shabshin N, Levy A, Herman A, Gefen A.
    J Rehabil Res Dev. 2013 Dec;50(8):1149-56.
     
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    Pressure-relieving devices for treating heel pressure ulcers.
    McGinnis E, Stubbs N.
    Cochrane Database Syst Rev. 2014 Feb 12;2:CD005485
     
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    The use of hemoglobin saturation ratio as a means of measuring tissue perfusion in the development of heel pressure sores.
    Aliano KA, Stavrides S, Davenport T.
    Surg Technol Int. 2013 Sep;23:69-71.
     
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    Influence of the Calcaneus Shape on the Risk of Posterior Heel Ulcer Using 3D Patient-Specific Biomechanical Modeling.
    Luboz V, Perrier A, Bucki M, Diot B, Cannard F, Vuillerme N, Payan Y.
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