1.2 Identify pressure sites of the body

This guide will help you answer 1.2 Identify pressure sites of the body.

Pressure sores, also known as pressure ulcers, often develop on areas of the body where the skin and soft tissue are compressed between a bone and an external surface for extended periods. These are referred to as “pressure sites.” Identifying these sites is essential for preventing pressure ulcers, especially in individuals with limited mobility. People who are bedridden, use a wheelchair, or have difficulty repositioning themselves are particularly at risk.

Body Areas at Risk

Pressure sites differ depending on whether an individual is lying down, sitting, or changing positions. Common areas prone to pressure ulcers can be divided into two main categories based on whether the person is lying or seated.

Common Pressure Sites When Lying Down

People who are confined to a bed are most at risk of developing pressure sores while lying down. Key pressure areas include:

• Occiput (back of the head): This can experience prolonged pressure when lying flat on the back, particularly in individuals with little hair or elderly people whose skin is more fragile.
• Shoulders: Specifically, the scapula (shoulder blades) may become vulnerable when lying flat on the back.
• Elbows: Constant pressure from resting arms against the mattress may cause sores here.
• Sacrum (lower back/tailbone): This is one of the most common areas for pressure ulcers, especially in people who recline for long periods. It bears significant weight and pressure.
• Buttocks and Ischial Tuberosities: The bony prominences at the base of the pelvis are common sites for pressure when a person lies or leans slightly on their side or back.
• Hips (Greater Trochanters): When lying on the side, the hips are commonly affected.
• Heels: The heel bears significant weight while lying flat, especially if the legs are resting in one position for too long.
• Ankles (Malleolus): Lying on the side puts the outer ankle at risk of pressure damage.

Common Pressure Sites When Sitting

Individuals who spend long hours sitting or using a wheelchair are prone to pressure ulcers in different areas due to pressure distribution when seated. Key sites include:

• Coccyx (Tailbone): Sitting causes pressure on the lower back and tailbone. Limited movement increases the vulnerability of this area.
• Ischial Tuberosities: These are the weight-bearing bones at the bottom of the pelvis when sitting. They are highly at risk of pressure sores in individuals who sit for long periods.
• Thighs: Prolonged sitting can cause compression on the backs of the thighs where they rest against a chair.
• Shoulder Blades: Sitting against a firm or poorly cushioned chair can create pressure on the back, particularly the shoulder blades.
• Feet: The heels and balls of the feet can develop pressure damage when resting on footrests for prolonged durations.

Other Pressure-Prone Areas

In addition to the areas described above, other potential pressure points include parts of the body affected by specific equipment, such as medical devices, splints, or braces. These can press against the skin and create pressure ulcers in unexpected areas, including:

• Behind the Ears: When oxygen tubes or similar equipment press on soft skin for extended periods.
• Between the Knees: Lack of padding between legs while lying on one’s side can cause friction and pressure sores to develop on inner knees.
• Toes: Tight bedding or footwear that presses against the toes for prolonged periods can create sores.

Risk Factors and Pressure Points

The prominence of bone, lack of muscle or fat padding, and reduced blood supply increase the risk for skin breakdown at these pressure sites. Certain factors make individuals even more vulnerable, including:

• Thin or Fragile Skin: Elderly individuals or those with malnutrition have less skin elasticity and fat padding, increasing susceptibility.
• Impaired Mobility: People who are bedridden, wheelchair-bound, or unable to reposition themselves frequently experience prolonged pressure on specific areas.
• Medical Devices or Plaster Casts: These may place constant pressure on atypical body sites.
• Paralysis or Loss of Sensation: Those who cannot feel discomfort in pressure areas may fail to move and relieve strain.

Visualising Pressure Site Locations

To better identify these areas, think of parts of the body where bone is closest to the skin without significant fat or muscle cushioning. These bony areas, such as the tailbone or the heels, are the most common pressure sites.

Preventative Measures for Pressure Sites

Once you know which areas are vulnerable, you can take proactive steps to protect the skin and reduce the risk of breakdown:

• Regular Repositioning: Change the position of the individual every two hours (or as necessary).
• Specialised Cushions and Padding: Use pressure-relieving devices like foam, gel, or air cushions to reduce stress on high-risk areas.
• Good Hygiene and Moisturisation: Keep skin clean and hydrated to improve elasticity and resilience.
• Monitor Redness or Damage: Early signs of pressure damage, such as non-blanching redness, should prompt immediate action to adjust the individual’s position or pressure-relief strategy.

Final Thoughts

By identifying these common pressure sites, care workers can focus on monitoring and protecting vulnerable areas to reduce the chances of pressure sores developing. Regular checks and proactive interventions make a significant difference in maintaining comfort and skin integrity.