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Pressure Injury Toolkit For Spinal Cord Injury and Spina Bifida

Beyond the wound - Bringing best practice to the bedside

Comprehensive management of nutrition and addressing malnutrition

  • Numerous strategies may be necessary to manage an individual’s nutrition status.
  • Enhance meals and snacks by incorporating liquid or powder supplements and initiating vitamin and mineral.
  • Supplementation and providing enteral or parenteral nutritional support may be required.

Nutritional intake and support:

  • Implement early nutritional support measures if dietary intake is inadequate or if an individual is nutritionally compromised.20

Access to nutrition:

  • Consider the individual’s ability to self feed or the amount and type of assistance needed for eating and drinking. People at greatest risk of malnutrition and dehydration are those who are dependent on others for food and fluid.

Calorie, protein and fluid  intake :

  • For adults with SCI calorie, protein and fluid requirements are (for Stage 2, 3, 4 pressure injuries)51:
    Paraplegia           25.9 ± 1.2 kcal/kg/day                    1.25 – 1.5g/kg/day protein
    Tetraplegia          24.3 ± 1.1 kcal/kg/day                    1.25 – 1.5g/kg/day protein
    Fluid: 1ml/kcal/day + 500ml


Check renal function


Individuals with SCI and PI are at higher risk of developing dehydration


  • Arginine may be considered for individuals with > Stage 2 pressure injury.20
  • Check renal function2


Caution is recommended in individuals at risk of infection


  • Consider supplementing vitamins and minerals in people with known deficiencies to improve PI healing. Use clinical judgement and the results of a thorough nutritional assessment to determine the need for nutrient supplementation in the absence of definitive tests for deficiencies.20
  • Avoid Vitamin E supplementation as it may delay healing20
  • Avoid high levels of zinc2
  • Identify all conditions that may have precautions or contraindications for supplementation, such as renal insufficiency, before implementing micronutrient, protein or fluid supplementation.20

Enteral nutrition:

  • Provide enteral nutrition to support PI healing, if indicated, when the gastro-intestinal tract is intact but dietary intake is inadequate and/or barriers to oral intake exist. Provide total parenteral nutrition, if indicated, to individuals with PI and GI disease or dysfunction.20