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Pressure ulcer treatment

The challenge to manage pressure injuries

We all want to avoid pressure injuries. Considerable progress has been made in this area the past few years. Nevertheless, pressure injuries remain a challenge. B. Braun offers different solutions including products for skin care, wound bed preparation and infection management, as well as exudate management. Taking action right from the start helps you to prevent the aggravation of existing pressure injuries and to support the healing process.

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*examples of barriers = slough, necrotic tissue and/or biofilm

Pressure injury management - a holistic approach

In most cases, pressure injuries have a significant impact on patient morbidity[1] and quality of life[2] and can even impact patient survival.[3] Once a pressure injury has developed, it is important to draw up a coordinated treatment plan to promote healing. The basic prerequisites for wound healing must be met and everything that interrupts this process needs to be avoided. These include pressure ease, a clean wound, circulation functioning, an adapted nutrition[4] in terms of both calories and nutrients along with adequate hydration.[4]

 

Depending on the extent of tissue damage, pressure sores can be categorized into four stages. Every stage requires a specific treatment.

Management of stage 1 pressure ulcers

Description

Non-blanchable erythema of intact skin; superficial

 

Goal

  • Skin repair
  • Restore capillary function
  • Protect against friction and pressure

 

 

Protect, treat and repair: daily skin hygiene and care

Linovera® is a product range made of hyperoxygenated fatty acids (HOFA). Indicated for prevention and treatment of stage 1 pressure ulcers (Linovera®) as well as lower limb ulcers and diabetic foot ulcers (Linovera® Emulsion).

 

The products promote blood microcirculation, reducing the risk of ischemia and facilitating the renewal of epidermal cells. They protect against friction, reduce skin fragility and help to prevent dehydration of the skin.

Askina® Heel is a non adhesive hydrocellular heel dressing that intends to protect the heel area from shear stresses and to reduce pressure from external forces.

Management of stage 2 pressure ulcers

Description

Partial-thickness skin loss with exposed dermis; superficial

 

Treatment goals

  • Remove blisters
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Carbosorb is an activated charcoal super absorbent dressing, suitable for moderate to heavily exuding wounds. 

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. 

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Management of stage 3 pressure ulcers

Description

Full-thickness skin loss; deep

 

Treatment goals

  • Debride
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Carbosorb is an activated charcoal super absorbent dressing, suitable for moderate to heavily exuding wounds. 

 

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. 

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

Management of stage 4 pressure ulcers

Description

Full-thickness skin loss; deep

 

Treatment goals

  • Debride
  • Protect organs
  • Prevent/remove biofilm
  • Manage bacterial load and odor
  • Manage exudate and promote moist healing
  • Protect the periwound skin

Prontosan® Wound Irrigation Solution is indicated for cleansing irrigation and moistening of acute and chronic wounds.

 

The use of Prontosan® Wound Gel X can provide long-lasting cleansing and decontamination of the wound bed between dressing changes.

 

Prontosan® Debridement Pad has been designed to support the wound bed preparation when used in conjunction with Prontosan® Wound Irrigation Solution.

Askina® Carbosorb is an activated charcoal super absorbent dressing, suitable for moderate to heavily exuding wounds. 

 

Askina® DresSil Sacrum, Askina® DresSil Heel, Askina® DresSil, Askina® DresSil Border can help to maintain a moist wound environment conducive to natural healing conditions with a perfored silicone wound contact layer, an absorbent polyurethane foam and a vapor permeable waterproof outer film. Indicated for pressure ulcers (PU), diabetic foot ulcers (DFU), venous leg ulcers (VLU) and 1st/2nd degree burns.


Askina® Foam and Askina® Heel can help to maintain a moist wound environment conducive to natural healing conditions with a polyurethane foam wound contact surface with absorption capacity and a vapor permeable, water and bacteria resistant polyurethane film outer layer. 

Askina® Barrier Cream acts as a protectant and moisture barrier against maceration caused by incontinence or bodily fluids, to protect sensitive, fragile skin and severely dry skin, including peri-wound areas. It is indicated for use on intact skin.

 

Askina® Barrier Film Swab and Askina® Barrier Film Spray are sterile liquid dressings intended to form a uniform, transparent film when applied to the skin. The film can provide oxygen and moisture permeability. Both dressings are indicated for use on intact or damaged skin.

More than 4 out of 10 nursing home patients may have pressure injuries.2

"Back to life" after four months of healing of his pressure injury

In the following video, Miguel Cuevas shares his joy of his recovery. He is happy to be able to do all the things again that most people take for granted.

 

Pressure injuries may develop quickly - between the first hour and 4 to 6 hours after sustained loading. 

The importance of pressure injury prevention

Pressure injuries can be a serious problem. Miguel Cuevas explains how the pressure injury has affected his entire life – whether emotionally, in his family life, or at work. His sufferings were not only an ordeal, but also implied high treatment costs. Such situations should be avoided, and pressure injury prevention needs be taken seriously.

Learn more about his story

Our product portfolio

Wound bed preparation and biofilm management

Prontosan® Wound Irrigation Solution

The solution is designed for cleansing, moistening, and decontamination of acute and chronic wounds, including burn injuries. It is available in 1000 ml bottles, 350 ml bottles, and 40 ml ampoules.

Prontosan® Wound Gel 

Provides long-lasting cleansing, moistening, and decontamination of acute and chronic wounds, including burn injuries. Supports the creation of an optimal moist environment for wound healing and may be preferred for deep or tunnelling wounds. Available in 30 ml pods.

Prontosan® Debridement Pad

Effectively removes coatings, dead cell residue, debris, slough, and exudate. Available in packs of 3 and 10.

Exudate management

Askina® Heel

Askina® Heel is a heel-shaped, two-layered, non-adherent foam dressing designed to cover the heel and the malleolus. The gentle polyurethane foam can reduce pressure on wounds in this area as well as provide a moist wound environment to promote wound healing. The waterproof outer layer protects the wound from dirt and bacteria. The product includes the option to use a foam security strap and two self-adhesive hooks that keep the dressing in place even during movement, avoiding the need to use an additional fixation device.Askina® Heel is indicated for the management of a wide range of moderately to highly exuding wounds, mainly for exudate absorption at the heel site. 

Askina® DresSil

Askina® DresSil is a non-bordered, self-adherent soft silicone wound dressing. It absorbs exudate from the wound through silicone perforations and provides a moist wound healing environment to promote wound healing.  The wound contact layer made of silicone reduces pain and trauma during dressing changes, enhancing patient comfort. The waterproof outer layer protects the wound from dirt and bacteria. The soft polyurethane foam conforms to the natural contours of the body making the dressing comfortable to wear, while the waterproof outer layer protects the wound from dirt and bacteria. Askina® DresSil is designed for a wide range of exuding wounds, such as:  Leg and foot ulcersPressure ulcers  Traumatic wounds, e.g. skin tears  Secondary healing woundsMaterial  Askina® DresSil is composed of three layers:  Layer 1: Outer polyurethane filmLayer 2: Absorbent polyurethane foamLayer 3: Silicone adhesive 

Askina® DresSil Active Sacrum

Askina® DresSil Active Sacrum is a sacrum multilayer silicone dressing with border designed to provide active exudate management. Its multilayer structure improves exudate retention and absorption while maintaining the adequate moisture level in the wound1. This may reduce the frequency of dressing changes, thereby saving nursing time and allowing more time to be dedicated to patients and their care2. Askina® DresSil Active Sacrum is designed for a wide range of exuding wounds such as:Pressure ulcersLeg and foot ulcersTraumatic wounds (e.g. skin tears)Surgical woundsIt can also be used on dry/necrotic wounds in combination with gels. The dressing may also be used as part of a prophylactic therapy to help prevent skin damage, e.g. pressure ulcers. MaterialAskina® DresSil Active Sacrum, thanks to its multilayer structure, is designed to offer effective exudate management of chronic wounds:Layer 1: Semi-transparent film with 1 cm apart dots for the Active Exudate Monitoring SystemLayer 2: Superabsorbent layer to absorb and lock in exudateLayer 3: Exudate distribution layer to facilitate quick exudate movement from the foam to the superabsorbent layerLayer 4: Thin foam layer that enables vertical absorption while maintaining a moist environment conducive to wound healingLayer 5: Silicone layer to provide secure fixation while conforming to body contours

Skin resistance improvement and skin protection

Linovera®

Chronic wounds are a major global medical concern,1 significantly impacting patients’ quality of life,2 while also affecting close family and relatives. Chronic wounds also cause considerable financial burden3 on the healthcare system and society.Topical preventive measures such as Linovera® oil are needed to avoid higher healthcare expenditures and preserve patients’ health. They can be used with the goal of promoting integrity of the skin and providing essential moisturizing.4HOFA-containing topical formulations have become an ideal therapeutic option that is part of the clinical protocols for nursing action in the prevention and treatment of ulcers.5 Linovera® is a skin care oil composed of: Hyperoxygenated fatty acids (HOFA) originated from sunflower oil naturally rich in linoleic acid,6 an essential fatty acid important in the maintenance of epidermal integrity and the natural skin’s water barrier.7 Some of the HOFA properties can increase skin resistance, reduce dehydration, reduce friction and pressure forces8 and improve microcirculation.9Vegetable extracts formulated to provide additional benefits such as skin conditioning, humectant, and tonic, enhancing the activity of the product. Thanks to its content of HOFA and vegetable extracts, Linovera® oil can be useful in the prevention of skin breakdown (e.g. prevention of stage 1 pressure ulcers) or in the management of already impaired skin,8,10 helping to provide the best care for your patients. CompositionHyperoxygenated fatty acids derived from sunflower oil (emollient)Aloe Barbadensis extract (skin conditioning, emollient, humectant)Asian Centella oil extract (skin conditioning, skin tonic, soothing agent)Rosemary essential oil (organoleptic) IndicationsLinovera® oil is indicated: For patients whose skin integrity is at riskFor prevention of pressure ulcers, vascular ulcers and diabetic foot ulcersFor treatment of stage 1 pressure ulcers

Linovera® Emulsion

Chronic wounds are a major global medical concern,1 significantly impacting patients’ quality of life,2 while also affecting close family and relatives. Chronic wounds also cause considerable financial burden3 on the healthcare system and society.Topical preventive measures such as Linovera® Emulsion are needed to avoid higher healthcare expenditures and preserve patients’ health. They can be used with the goal of promoting integrity of the skin and providing essential moisturizing.4HOFA-containing topical formulations have become an ideal therapeutic option that is part of the clinical protocols for nursing action in the prevention and treatment of ulcers.5Linovera® Emulsion is a light emulsion moisturizing cream composed of:Hyperoxygenated fatty acids (HOFA) originated from sunflower oil naturally rich in linoleic acid,6 an essential fatty acid important in the maintenance of epidermal integrity and the natural skin’s water barrier.7 Some of the HOFA properties can increase skin resistance, reduce dehydration, reduce friction and pressure forces8 and improve microcirculation.9  Vegetable extracts formulated to provide additional benefits such as skin conditioning, humectant and tonic, enhancing the activity of the product.How Linovera® Emulsion can be usedThanks to its content of HOFA and vegetable extracts, Linovera® Emulsion can be useful in the prevention of skin breakdown (e.g. pressure ulcers, vascular ulcers, and diabetic foot ulcers) or in the management of already impaired skin8,10 helping to provide the best care for your patients.With its creamy consistency, Linovera® Emulsion is easy to apply on large body areas, such as limbs and feet11.CompositionHyperoxygenated fatty acids derived from sunflower oil (emollient)Aloe Barbadensis extract (skin conditioning, emollient, humectant)Asian Centella oil extract (skin conditioning, skin tonic, soothing agent)Rosemary essential oil (organoleptic)Ginkgo biloba (skin conditioning)IndicationsLinovera® Emulsion is indicated: For patients whose skin integrity is at riskFor prevention of pressure ulcers, vascular ulcers and diabetic foot ulcersFor treatment of stage 1  pressure ulcersFor large skin surfaces, such as whole lower limbs

Askina® Barrier Cream

Askina® Barrier Cream is a white concentrated cream that provides protection to skin from body fluids. It protects dry, chafed, red, or irritated skin by moisturizing the skin and providing a long-lasting barrier.(1)

Ally® Barrier Film Spray

Ally® Barrier Film Spray is intended to prevent skin breakdown caused by moisture/stoma effluents, to protect peristomal skin at risk from maceration and excoriation and to maintain the integrity of newly healed skin to stop secondary skin breakdown. Ally® Barrier Film Spray is especially recommended for people with irritated or sensitive peristomal skin.

Askina® Barrier Film Swabs

Askina® Barrier Film Swabs are sterile foam applicators with a polymeric solution which offer between 48-72h of protection to intact or damaged skin. The non-stinging solvent forms a uniform film when applied to the skin. It is a multiple use device that is intended for single patient use.(1) 

[1] Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol. 2005 Mar;26(3):293-7. doi: 10.1086/502542. PMID: 15796283.

[2] Sebba Tosta de Souza DM, Veiga DF, Santos ID, Abla LE, Juliano Y, Ferreira LM. Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings. J Wound Ostomy Continence Nurs. 2015 Jul-Aug;42(4):352-9. doi: 10.1097/WON.0000000000000142. PMID: 26135820.

[3] Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, Calvino-Gunther S, Chaboyer W, Coyer F, Deschepper M, François G, Honore PM, Jankovic R, Khanna AK, Llaurado-Serra M, Lin F, Rose L, Rubulotta F, Saager L, Williams G, Blot SI; DecubICUs Study Team; European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021 Feb;47(2):160-169. doi: 10.1007/s00134-020-06234-9. Epub 2020 Oct 9. Erratum in: Intensive Care Med. 2021 Apr;47(4):503-520. PMID: 33034686; PMCID: PMC7880913.

[4] Munoz N, Posthauer ME, Cereda E, Schols JMGA, Haesler E. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations. Adv Skin Wound Care. 2020 Mar;33(3):123-136. doi: 10.1097/01.ASW.0000653144.90739.ad. PMID: 32058438.