Common presentations and possible causes due to support surfaces
- Pressure injuries on or near the gluteal fold: If the pelvis is posteriorly tilted, the ITs are projected forwards. If the seat cushion has an ischial well check for contact between the ITs and the front of the well. Ensure that the client has good upper limb strength and good skills for self-lift or slide board transfer
- Sacrum and Coccyx: With excessive posterior pelvic tilt, there is more upper body weight distributed through the sacrum or coccyx against the support surface, typically the cushion and mattress. With excessive posterior pelvic tilt, the coccyx projects more and may be subject to greater loading. The commode seat should also be reviewed. Also check also for the clearance against the push wheel of the manual wheelchair during self-lift or sliding board transfers
- Underside of the GTs: check commode seat and cushions with an ischial well that distribute more load to the GTs.
- Lateral side of GT: check side lying in bed, and check if GTs are pressing hard against armrest poles or lateral pads
- Heels: check bed, heel loops on footplates, heel scrapes by front castor wheels
- Lateral border of the foot: external hip rotation, planter flexion and foot inversion may lead to localised pressure or friction on the lateral border of the foot against footplates. Check foot position to allow clearance from flip up hinge of the footplates in wheelchair and commode
- Consider the shape of any scars or wounds. If the wound is elongated when compared to the shape of the bony prominence, there is a possibility of shear component contributing to the injury.
See Pressure Management in Module 8 for more details.