Pressure injuries in palliative care

Pressure injury is localised tissue damage usually over a bony prominence from pressure (causing tissue compression resulting in restricted blood supply), often in combination with shear (causing tissue deformation). For an outline of risk factors and preventative strategies for pressure injuries, see the Ulcer and Wound Management guidelines. In patients with palliative care needs, measures to prevent pressure injuries are essential because they can develop very easily and quickly, and once present are difficult to heal. However, when circulation is failing in a dying patient, it may be difficult to prevent the development of a pressure injury.

Management of established pressure injuries is guided by potential benefits and burdens of treatment, and the patient’s prognosis, goals of care and preferences—see Principles of symptom management in palliative care.

For patients in the early stages of a life-limiting illness, the goal is generally to promote healing and control symptoms; for information on pressure area management, see the Ulcer and Wound Management guidelines.

For patients with an advanced life-limiting illness and short life expectancy, managing pain, odour and bleeding are more important than healing the pressure injury. Opioids (and occasionally other analgesics) may be required for breakthrough and incident pain. Appropriate dressings and control of infection (if present) are important components of pain management.

Good skincare (see General skincare measures in palliative care) and use of pressure-relieving aids, cushions, overlays and mattresses help to prevent further skin breakdown. Wet skin increases the risk of pressure injuries, so continence management is essential. For patients with urinary incontinence, a barrier cream (eg Comfeel Barrier Cream, Sudocrem, zinc and castor oil cream) may be used with care on vulnerable skin. Urinary catheterisation may be necessary. For more information, see Urinary incontinence in palliative care.