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It is important that enough time is allowed for skin to build up pressure tolerance over the area that has been previously damaged.
Therefore, to prevent further skin damage, it is recommended that time spent up in a wheelchair is at first limited.
NB it is recommended that all skin marking has completely faded before recommencing mobilising.
The following table is meant as a guide to start re-mobilising. It is recommended that these stages are followed in order.
Do not skip a stage to increase mobilising times – you are at risk of repeated skin damage if you do not adhere to the mobilising regime. In some instances individual regimes may be required for mobilising.
It is important that the cause of any skin marking is established and dealt with, to prevent further skin deterioration.
Please contact the Pressure Clinic or Community Liaison for further advice if skin marking continues after following these guidelines.
Pressure Relief
If you are able to pressure relieve, this should be carried out every 20 minutes for 20 seconds (20/20).
Pressure relief helps to prevent disruption of the blood flow for long periods of time to the seating area.
It allows fresh blood to be “pumped” to the weight bearing areas and allows waste products to be “drained away”- essential needs for healthy skin.
Pressure relief can be achieved by lifting your bottom off the seating area, or by leaning side to side to side or forward, to move your body weight off the bony prominences.
An adequate pressure lift involves full lifting of your ischial tuberosities (the boniest prominence) off the cushion.
Skin
It is essential that skin is checked for signs of dis-colouration or marking (i.e. pressure marks) before getting up into the wheelchair and immediately on return to bed.
When in bed, all pressure should be relieved from any pink or red marks until the mark has faded completely.
For skin marking that has completely faded before 30 mins, please continue mobilising to the next stage.
If a pressure mark does not fade within 30 minutes, relieve all pressure from this area until the mark has completely disappeared and when getting up again, go back to the previous stage e.g. if you marked after 4 hours, go back to the previous stage, 3 hours 30 mins, and if necessary stay at this mobilising time for 3 days before increasing to the next stage.
If skin marking is persistent, take into account factors that may be possible causes of the problem e.g. UTI, weight loss, condition of equipment etc, and seek advice.
If a pressure mark causes at least 3 days of bedrest before it disappears, begin at Day 1 when starting to re-mobilise.
Mobilising guidelines:
| Day | Mobilising time |
|---|---|
| 1 | Up for 30 mins once a day |
| 2 | Up for 45 mins once a day |
| 3 | Up for 1 hour once a day |
| 4 | Up 1 hour 30 mins once a day |
| 5 | Up for 2 hours once a day |
| 6 | Up 2 hours 30 mins once a day |
| 7 | Up 3 hours once a day |
| 8 | Up 3 hours 30 mins once a day |
| 9 | Up 4 hours once a day |
| 10 | Up 5 hours once a day |
| 11 | Up 6 hours once a day |
Continue to increase mobilising by 1 hour each day, until you reach your ideal time spent in your wheelchair with no detrimental effect on your skin.
The mobilising times are intended as a guide only, and may be tailored to your specific needs.
If you require further advice please contact:-
The Pressure Clinic
The Duke of Cornwall Spinal Treatment Centre
01722 429291
