Read the latest blog from Joanna Swann, Lead Tissue Viability Nurse at University Hospitals Birmingham NHS Foundation Trust, on the challenges of Pressure ulcers (PU) in the proned Intensive Care patient

“I won’t be the first to say we are in challenging times. Our work places are experiencing unprecedented changes that are testing all of us and we can’t do the things we would normally do to de-stress; meet with family and friends, go to the gym, enjoy a holiday. However, there are many opportunities to learn new skills and make changes to practice to improve outcomes for patients suffering with COVID-19.

Pressure ulcers (PU) in the proned Intensive Care patient

One of the biggest challenges has been PU in the COVID +ve patient requiring proning in the intensive care unit. It became clear very quickly that there was a very different pattern of injury in these patients. Facial injuries mainly related to the endotracheal (ET) tubes and ET tapes have been prevalent along with injuries to the nose, forehead, cheeks and chin. The patients experiencing these wounds have tended to be obese, heamodynamically unstable, oedematous, with low albumin levels, requiring multiple episodes of proning with intropes in progress. Often even head movement from side to side has been difficult due to the physical build of the patient and haemodynamic and/or respiratory problems making any repositioning of ET tubes, changes of ET tapes and skin inspection a challenge, if not impossible. Trying to address these issues has led to collaborative working both within organisations and nationally. People have pulled together, suggested innovative approaches to prevention of these wounds and are learning from each other.

In recovery

The number of COVID +ve patients in ITU is thankfully falling but patients that are now in recovery are having to come to terms with what they have been through, and some of these are also having to deal with healing PU to their faces. These wounds are leaving scars. Clearly these will fade over time but some will remain very visible which may have psychological implications around body image, and the scars serving as a reminder of a time they would more than likely prefer to forget.

So, it is time to look forward.

As we are still learning about this virus it is a time to ask what can we do to prevent these PU in the first place given the severity of illness this COVID 19 causes? What devices can be developed to help reduce risk and what can we do to reduce the impact of scarring for these patients?

All questions that as a community we can help to answer to improve outcomes for the future.