Skin Care

By: CVH Team

Anyone who remains lying or sitting in one position for more than a couple of hours is at risk for skin breakdown. This can lead to pressure sores, which are also known as pressure ulcers or bedsores. These skin problems can be painful and decrease a person’s quality of life.

Someone who cannot change position in bed or is limited to sitting in a chair needs to be helped to change position every hour or two. Repositioning, pressure reduction, and good skin care are all necessary to prevent skin problems and to keep small problems from getting worse.

 

Preventative skin care

• Look at the person’s skin daily. Tell the health care team about any changes you notice, such as red areas. These are the first signs of skin breakdown, and will lead to sores if left untreated.
   
• Clean skin daily.
   
• If the person uses an adult incontinence brief, clean the skin under the brief each time it is changed. Protect skin with a moisture barrier cream. These products often contain zinc or silicone.
   
• Use mild cleansing products.
   
• Avoid using hot water to clean the skin.
   
• Use moisturizers for dry skin.
   
• Check to make sure clothing and bed linens are clean, dry and free of wrinkles. Wrinkles increase friction and may lead to skin discomfort or pain.
   

Pressure reduction

• Relieve any constant pressure on areas at greatest risk for skin breakdown. These include the site of existing pressure sores, the site of previously healed sores, scars, and bony areas.
   
• If the person is in bed, remind, or help, the person to change position every two hours.
   
• If the person is in a chair or wheelchair, remind, or help, the person to change position every hour. If possible, help the person stand briefly, or alternate between sitting and lying. It is best if the person avoids sitting for long periods.
   
• Use pillows between legs, under arms or elsewhere. This separates bony areas, prevents direct skin-on-skin contact, and may make swollen legs and ankles feel better.
   
• Have the person avoid lying directly on the side, that is, with the front of the body facing sideways, at right angles to the mattress. A better position is to lie slightly sideways, that is, using supporting pillows to help the front of the body tilt about thirty degrees to the mattress.
   
• Avoid using air rings or other donut-shaped cushioning devices.
   
• Ask your local home care or palliative care program if they have a loan program for pressure-reducing mattresses.
   

Moving someone in bed

Some people may find it uncomfortable to be moved, but staying in the same position for more than a couple of hours may lead to even greater pain or discomfort. Changing positions is important, except in cases when someone may not live more than a few hours. These are some general tips for moving someone in bed.

• If possible, watch a member of the care team do a move, so you can see how it is done.
   
• If the person finds it painful to be moved, talk to the health care team about giving the person pain medication beforehand. They can tell you the best type of medication to use for this purpose, and explain how and when to give it.
   
• Moving someone from one position to another is easier with two people, with each standing on opposite sides of the bed.
   
• Take care to keep your knees slightly bent (not locked) when you do any sort of lifting. This gives your back proper support.
   
• When moving a person, lift the person off the surface below, rather than dragging the person in direct contact with the surface.
   
• Moving someone is much easier if the person is lying on a turning sheet or a cloth absorbent pad. Turning sheets are small sheets that run from the person’s head to buttocks. Any sheet can be made into a turning sheet by folding it in half and laying it over the full sheet. The sheet or pad allows two people to grab onto the corners to lift or move the person on the bed.
   
• After the move, pull on the sheet or pad from top to bottom, to smooth out wrinkles.
   
• Before starting a move, lower the bed to a flat position, or recline the bed as far as the person’s condition allows. Lower the bed slowly, as rapid movements can cause discomfort.
   

Moving someone from their back onto their side

• Place a pillow under the person’s head before starting the turn and have pillows ready to place under legs, arms, and behind the back.
   
• If the person is going to be turned onto the right side, take the left arm, bend it gently at the elbow, and place it over the stomach.
   
• Bend the left leg at the knee, and place a pillow between the person's legs.
   
• Place one hand behind the person’s buttocks and the other underneath the shoulder.
   
• Roll the person in the direction of your helper, and have the helper hold the person in place.
   
• Once the helper is holding the person, place your hands under the person’s buttocks to move the body back toward the centre of the bed.
   
• You may need to pull the right (bottom) shoulder forward if it looks uncomfortable. This places the person in more of a fetal position rather than lying completely straight.
   
• Arrange the pillows comfortably between the person’s shoulder and head, and also between the legs. When you return the person onto their back later, place a pillow under the head and one under each shoulder, positioned to make the person as comfortable as possible.
   

Raising someone in bed with a turning sheet

People who are sitting up in bed will naturally slide down over time. Before you raise the person, lower the bed until it is flat, or as flat as the person’s condition allows.

• If possible, ask the person to tuck their chin into their neck during the move, so their head is protected.
   
• Take hold of a bottom and top of the turning sheet on your side, and have your helper do the same on the other side.
   
• On a signal, such as the count of three, gently lift the person toward the head of in bed.
   
• Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.
   

Raising someone in bed without a turning sheet

• Stand near the person’s shoulder, with your helper on the opposite side.
   
• Look toward the head of the bed, and place one of your arms under the person’s shoulder closest to you.
   
• Use your free arm to support yourself by leaning into the bed.
   
• On a signal, such as the count of three, lift the person toward the head of bed.
   
• If possible, ask the person to bend their knees and dig into the bed with their heels to help with the move.
   
• Once the bed is raised again to a comfortable position, you can place a pillow under the person’s knees to prevent slipping.