What are the 6 Main Classifications Stages of Pressure Injuries?
Pressure injuries, also known as bedsores or pressure ulcers, are a common and serious problem for people who are bedridden or have limited mobility. These injuries occur when there is prolonged pressure on one area of the skin, cutting off blood flow and leading to damage to the skin and underlying tissue. As a participant, it is important for you to understand the different stages of pressure injuries in order to recognise them early and prevent them from getting worse. In this blog article, we will be discussing the six stages of pressure injuries according to the National Pressure Injury Advisory Panel (NPIAP) staging system.
Stage 1:
At this stage, the skin may appear red, but does not turn white when pressed. There is no damage to the skin or underlying tissue. It is important for you to be aware of the preventive measures that can be taken to avoid the development of pressure injuries, such as being turned and repositioned regularly, keeping the skin clean and moisturised, and using specialised equipment when necessary (National Pressure Injury Advisory Panel, 2014).
In dark-skinned individuals, the redness may appear as a purple or blue discoloration. Blanching may be difficult to observe, so other parameters such as bogginess, heat, pain, firmness, and blue discolouration of the skin may be used to identify the presence of a pressure injury (National Pressure Injury Advisory Panel, 2014).
Stage 2:
This type of wound is often shallow and open, with a red or pink colour on the inside. It may also look like a blister that is filled with clear fluid. The wound may be dry or shiny. It is important to note that this type of wound is considered clean and relatively superficial.
To help the wound heal, it is important to protect it from further pressure. This can be done by using a special dressing that can also absorb the fluid from the wound as the skin is broken. Adhesive foams are commonly used for this purpose, but if the wound is located close to the anus, a thick barrier cream may be used instead.
Stage 3:
A stage 3 pressure injury involve damage through to the subcutaneous tissue and might contain dead tissue such as slough and soft, tenacious necrotic tissue. To help the wound heal, dead tissue may need to be removed, this process is called debridement. This can be done using special dressings that help the body remove the dead tissue or by using pads to gently rub the area and remove debris. As the dead tissue is removed, the wound may produce more fluid, so super absorbent pads will be needed to collect it.
Stage 4:
A stage 4 pressure injury is a severe form of pressure injury that occurs when there is full-thickness tissue loss, meaning that the skin and underlying tissue have been completely destroyed leaving the bone, tendon, or muscle exposed. It may also produce slough or eschar, which is dead or dying tissue.
Managing the odour associated with stage 4 pressure injuries is a priority, as well as the wound cleaning process, known as autolytic debridement. If the person is in otherwise good health, surgery and topical negative pressure devices may be used to treat the injury. These devices use suction to remove excess fluid and promote healing.
Unstageable Pressure Injury (Depth unknown):
When you have an unstageable pressure injury, it means that the wound is covered by necrotic tissue, slough, or eschar, making it difficult to determine the depth of the wound and accurately stage it. Unstageable pressure injuries can be found in areas of the body that are difficult to access, such as the sacrum or heels, and are more likely to occur in people who are immobile or have a decreased level of consciousness.
The primary goal of treating an unstageable pressure injury is to remove the necrotic tissue, slough, or eschar covering the wound, so that it can be accurately staged and treated. This process is known as debridement. There are several methods of debridement such as surgical debridement, mechanical debridement or autolytic debridement. Your healthcare provider will decide the best method of debridement for your wound.
After the wound is debrided and accurately staged, appropriate wound care can be initiated. This may include wound dressings, topical treatments, and negative pressure wound therapy (NPWT). Your healthcare provider will decide the best wound care plan for you.
An unstageable (depth unknown) pressure injury is a type of pressure injury that cannot be accurately staged because the wound is covered by necrotic tissue, slough, or eschar. This means that the full extent of the tissue damage is not visible and it is difficult to determine the depth of the wound.
Unstageable pressure injuries are typically found in areas of the body that are difficult to access, such as the sacrum or heels. They are also more likely to occur in people who are immobile or have a decreased level of consciousness.
The primary goal of treating an unstageable pressure injury is to remove the necrotic tissue, slough, or eschar so that the wound can be accurately staged and treated. This process is known as debridement.
Once the wound is debrided and accurately staged, appropriate wound care can be initiated. This may include wound dressings, topical treatments, and negative pressure wound therapy.
It is important to note that unstageable pressure injuries are severe and require prompt medical attention. They are also more likely to become infected, so regular wound care and monitoring are essential to prevent complications and promote healing (National Pressure Injury Advisory Panel, 2014).
Suspected deep tissue injury (depth unknown):
A suspected deep tissue injury (SDTI) is a type of wound that occurs when there is damage to the underlying tissue beneath the skin, such as muscle, tendons, and ligaments. The depth of the injury is not immediately known and it may take several days or even weeks to fully manifest.
Symptoms of a suspected deep tissue injury may include:
Pain
Swelling
Bruising
Discoloration of the skin (such as a purple or maroon localized area)
Tenderness to the touch
Heat or warmth in the affected area
Loss of function or mobility in the affected area
A thin blister or eschar over a dark wound bed
The discoloration of the skin in a suspected deep tissue injury is caused by bleeding in the underlying tissue. This can lead to the formation of a blood-filled blister, which can further damage the tissue if ruptured.
The aim of treating a suspected deep tissue injury is to preserve the tissue intact for as long as possible, and to await what the body can do if the pressure is removed (National Pressure Injury Advisory Panel, 2014).
Conclusion
In conclusion, pressure injuries are a serious problem for people who are bedridden or have limited mobility and it is important for you as a participant to understand the different stages of pressure injuries. By recognising the signs and symptoms of pressure injuries early and taking appropriate preventive measures, you can prevent the injuries from getting worse. If you suspect that you have a pressure injury, it is important to seek medical help as soon as possible and to follow the appropriate treatment plan. Remember, early identification and intervention can prevent progression to deeper and more severe stages of skin damage.
References
National Pressure Injury Advisory Panel. (2014). Pressure injury stages. Retrieved from https://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-stages/
National Pressure Injury Advisory Panel. (2014). Pressure injury stages. Retrieved from https://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-stages/
European Pressure Ulcer Advisory Panel. (2019). Quick Reference Guide: Prevention and Treatment of Pressure Ulcers. Retrieved from https://www.epuap.org/globalassets/guidelines/2019-quick-reference-guide-prevention-and-treatment-of-pressure-ulcers.pdf
Agency for Healthcare Research and Quality. (2019). Pressure Ulcers in Adults: Prevention and Treatment. Retrieved from https://www.guideline.gov/summaries/summary/48196
