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- Pressure Injuries
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Pressure Injury Treatment
When pressure injuries can’t be avoided, it is important to establish a standard of care that treats the whole patient. 3M can help with solutions to support therapy goals established between you and your patients.
Improve pressure injury outcomes with identification, early interventions and treatment
We believe it takes patient-centered science to deliver the highest level of patient care. It also takes highly trained people like you who are committed to evidence-based practices and solutions. By establishing a comprehensive pressure injury (PI) program, you can identify, appropriately stage and treat pressure injuries sooner.
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In an international study of ICUs in 90 countries, 59.2% of pressure injuries were ICU-acquired¹Prolonged positioning and the use of medical devices may put ICU patients at special risk of pressure injuries.
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Patient care cost per pressure injury: $20,900 to $151,700²Eliminating pressure injuries in the U.S. alone could net savings of more than $26 billion.³
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Pressure injuries add 3-7 days to patient stays⁴Facility-acquired pressure injuries lengthen inpatient stays potentially resulting in higher total cost of care.
Staging a pressure injury
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Stage 1Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. At this stage no treatment is necessary, but prevention is crucial. Ensuring pressure reduction is implemented.⁴
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Stage 2Partial thickness skin loss with exposed dermis. These wounds typically are shallow and are found in areas of moisture and shear such as the buttocks and heel. There is NOT necrotic tissue, adipose or muscle tissue visible. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. This requires careful management to help prevent a deteriorating injury.⁴
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Stage 3Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer, and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage, and/or bone are not exposed. Early treatment and intervention are needed to heal the pressure injury along with continued pressure reduction.⁴
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Stage 4Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. Slough and/or eschar may be visible. Epibole, undermining, and/or tunneling often occur. Depth varies by anatomical location. Early treatment and intervention are needed to manage injury and continued pressure reduction is needed.⁴
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Deep Tissue InjuryIntact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, or purple discoloration, or epidermal separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle, or other underlying structures are visible, this indicates a full-thickness pressure injury (Unstageable, Stage 3, or Stage 4). Early identification and intervention are needed to manage injury and continued pressure reduction.⁴
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Unstageable Pressure InjuryFull-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar (i.e., dry, adherent, intact without erythema, or fluctuance) on the heel or ischemic limb should not be softened or removed. Proper staging can be done once the wound is no longer obscured by slough or eschar. Appropriate wound care to precede debridement.⁴
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Medical Device-Related Pressure InjuryMedical device-related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system. This requires careful management to help prevent a deteriorating injury to ensure pressure reduction is implemented.⁴
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Mucosal Membrane Pressure InjuryMucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue, these ulcers cannot be staged. This requires careful management and frequent observation to help prevent a deteriorating injury to ensure pressure reduction is implemented.⁴
Pressure Injury Staging Guide
Download this free guide to help assess suspected pressure injuries.
Assessing and diagnosing a pressure injury
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Use the TIMERS framework for managing hard-to-heal wounds
Setting a clinical goal and choosing appropriate therapies to reach it may help patients and their caregivers adhere to the treatment plan — enabling wounds to heal faster and avoiding potentially adverse outcomes. Throughout the treatment journey, careful observations will guide your treatment recommendations. You can use the TIMERS⁵ mnemonic to help you remember the steps of wound bed preparation:
T: Tissue, I: Inflammation/Infection, M: Moisture Management, E: Edge of Wound or Epibole, R: Regeneration and Repair, and S: Social Factors.
3M offers a variety of treatment options to match your therapy goals. As a result of more than 25 years of patient-centered research and development, 3M™ V.A.C.® Therapy sets the standard for negative pressure wound care. And, our complete line of dressings, drapes, pads and other wound care products complement our therapies in ways that may further help manage a wound over a patient's course of treatment.
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Pressure injury prevention starts with skin protection
- Skin integrity and management of skin conditions is critical in the prevention of pressure injuries. The National Pressure Injury Advisory Panel (NPIAP) recommends a preventative skin care regimen, which includes cleansing and protecting the skin with a barrier product, to aid in prevention of pressure injuries.⁴
- NOTE: Specific indications, contraindications, warnings, precautions, and safety information exist for these products and therapies, some of which may be Rx only. Please consult a clinician and product Instruction for Use prior to application.
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For the routine protection of periwound skin in low risk patients.Protect Skin
3M™ Cavilon™ No Sting Barrier Film
Including Cavilon No Sting Barrier Film in the wound care process helps protect periwound skin from maceration, and can provide protection from adhesive stripping and or tape trauma.⁶ -
For managing moderate to severe skin damage in higher risk patients.Protect At-Risk Skin
3M™ Cavilon™ Advanced Skin Protectant
Unique 3M technology protects skin from stool, urine and other bodily fluids by forming a protective barrier. The waterproof protectant formula in Cavilon Advanced Skin Protectant can help manage friction and shear for up to seven days.⁷,⁸
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Advanced Wound Care
- We deliver solutions that help protect, manage and support skin healing, leading to fewer complications, reducing trauma and improving each patient’s overall well-being.
- NOTE: Specific indications, contraindications, warnings, precautions, and safety information exist for these products and therapies, some of which may be Rx only. Please consult a clinician and product Instructions for Use prior to application.
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Low to High Wound ExudateFoam Dressing
3M™ Tegaderm™ Silicone Foam Dressing
Featuring 3M’s innovative silicone adhesive technology in a 5-layer foam dressing, the Tegaderm Silicone Foam Dressing is suitable for use on fragile skin and with compression therapy. Unique multi-layer design absorbs and evaporate moisture away from the skin’s surface, helping to minimize wound maceration and to maintain moisture balance for optimal wound healing. -
Collagen/Oxidized Regenerated CelluloseManage Inflammation
3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver and 3M™ Promogran™ Collagen Matrix with ORC
In the presence of exudate, 3M™ Promogran™ Collagen Matrix with ORC and 3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver transform into a soft, conformable, biodegradable gel. In a 6 week RCT Comparing the use of Promogran Matrix to moist wound healing in Pus (N=80), the time to complete healing was shorter and more cost effective in the Promogran Matrix group.⁹ -
3M™ Silvercel™ Non-Adherent Antimicrobial Alginate DressingManage Infection
Silvercel Non-Adherent Dressing is a nonwoven pad composed of alginate, carboxymethylcellulose (CMC) and silver-coated nylon fibers, with a non-adherent 3M™ Easylift™ Precision Film Technology designed to allow easy removal along with providing protection to newly formed tissue.¹⁰
Silvercel Dressings kill a broad spectrum of microorganisms associated with bacterial colonization and infection of wounds.¹¹
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Negative pressure wound therapy (NPWT)
- Negative pressure wound therapy has been used as an early adjunct therapy to aid in reducing the size and depth of stage 3 or 4 pressure injuries. 3M has a variety of NPWT solutions to choose from depending on your care setting and patient goals.
- NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for these products and therapies. Please consult a clinician and product Instructions for Use prior to application. Rx only.
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Setting the standard for negative pressure wound therapyTraditional NPWT
3M™ ActiV.A.C.™ Therapy System
The ActiV.A.C. Therapy System is a portable NPWT device for the mobile patient with features to help maintain the programmed pressure at the wound site and detect leaks.3M™ V.A.C.® Ulta Therapy System
This integrated wound management system provides four separate and distinct negative pressure wound therapy options in the convenience of one device for use in a health care facility:
- 3M™ V.A.C.® Therapy
- 3M™ Veraflo™ Therapy
- 3M™ AbThera™ Therapy
- 3M™ Prevena™ Therapy
3M™ Veraflo™ Therapy System
Veraflo Therapy combines the benefits of NPWT with automated instillation and dwell of topical wound solution to provide simultaneous cleansing and granulation tissue formation. -
Designed to help manage wounds in challenging locationsSingle-use NPWT
3M™ Snap™ Therapy System
Snap Therapy System is a disposable NPWT system that combines the simplicity of advanced wound dressings with the proven benefits of negative pressure wound therapy in a discreet design that allows patient mobility.
Case Study Excerpt: Stage 4 sacral pressure injury
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A 64-year-old male presented with a stage 4 pressure injury of the sacrum present for more than four years.
Patient comorbidities included: former tobacco use, poor nutritional status, hypertension, chronic paraplegia (more than 15 years), leukocytosis, multiple previous pressure ulcers, and osteomyelitis of the sacrum.
The wound had been previously treated with NPWT, offloading, silver dressings, air mattress, hydrofiber dressings, alginate dressings, and wound debridement. Sharp debridement was performed but limited by the inability to achieve adequate hemostasis.
NPWT with instillation and 3M™ V.A.C. Veraflo Cleanse Choice™ Dressing was initiated. Saline (22mL) was instilled, followed by 1 minute soak time and 30 min of negative pressure at -150mmHg. On day 7, sharp debridement was done at the bedside, removing the tip of the coccyx and non-viable slough/adipose tissue. Two days after the debridement, the therapy was interrupted due to soiling, and the patient underwent colostomy surgery. Three days post-surgery, Veraflo Therapy using the V.A.C. Veraflo Cleanse Choice Dressing was re-started. A silver alginate dressing was placed over the left buttock partial thickness area. On day 5, the therapy switched to 3M™ V.A.C.® Therapy at -125mmHg for nine days.
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Image shows:
A) Day 0 of Veraflo Therapy: Wounds following bedside sharp debridement
B) Day 3 of Veraflo Therapy: After first V.A.C. Veraflo Cleanse Choice™ Dressing change
C) After 9 days of NPWTRead the full case study (page 14) and 11 other case studies (PDF, 996 KB)
Patient data and photos courtesy of Kimberly D. Hall, DNP, RN, GCNS-BC, CWCN-AP, COCN, and Jessica Patterson, BSN, RN, CWOCN
NOTE: As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.
Cost savings associated with use of V.A.C.® Therapy support early* initiation of Negative Pressure Wound Therapy
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Study looks at effect on length of stay with early vs. late initiation of NPWT
The study looked at length of stay (LOS) in home healthcare with stage 3 or 4 pressure ulcers or surgical wounds. The results indicated that early application of NPWT was related to a reduced overall length of home care services. Additionally, higher costs for wound care treatment could result because for each day that NPWT application was delayed, nearly one day was added to total LOS.¹²
Read more about cost savings (PDF, 281 KB)
* Defined as treatment within the first 7 days for acute wound and 30 days for chronic wounds from the first wound treatment date.
3M™ Promogran™ Collagen Matrix with ORC helps to promote an optimal healing environment for pressure injury
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In a 33-patient prospective and randomized evaluation¹³ of the protease-modulating effect of Promogran Matrix (n=23) treatment of pressure ulcers, both elastase and plasmin activity levels were significantly reduced compared to baseline and control (n=10) treatment (p <0.05) after 5 days.
After 12 weeks, wounds treated with Promogran Matrix showed a significant reduction in wound surface area compared to control, 65% vs 41%.
Training opportunities and educational resources
Deepen your clinical expertise with training opportunities and educational resources designed especially for you.
3M webinars and archived events can help to keep you up to date with the latest product guidelines and scientifically supported standards of care.
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Although significant progress has been made in recent years to prevent pressure ulcer/injury (PU/I), it was still one of only two hospital-acquired conditions that saw an increase according to a 2018 Agency for Healthcare Research and Quality (AHRQ) report. Join Jessica Pehrson, RN, MSN, CWS, as she outlines common areas where PU/I diagnosis, treatment and prevention often come up short despite the latest global efforts to determine root causes and expand clinical recommendations for assessment and management.
Note: The presenter is an employee of 3M.
Viewing on desktop? Register/Login to view the course
Get the iOS app or the Android app to view the course on mobile
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Correct pressure injury identification
Correct pressure injury identification and staging is key to treatment. This requires careful and frequent patient monitoring as well as special consideration for ICU patients and those with comorbidities like diabetes, obesity, incontinence, peripheral vascular disease and orthopedic conditions.
Watch our short video (4:49) to learn more about pressure injuries.
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Increase your knowledge of the latest techniques and training with the wide range of courses available on 3M Health Care Academy. Discover online learning that's right for you.
Viewing on desktop? Register/Login to view all courses
Get the iOS app or the Android app to view all courses on mobile
Ready to try 3M Solutions?
See how our combination of products and technology helps you manage wound care the smart way.
Connect with one of our 1,800+ 3M Account Representatives providing support for OR, hospital, patient transitions and post-acute care settings.
Explore solutions for different conditions
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Help your patients stay fully engaged in daily activities and enjoy their quality of life with science-based compression therapy and skin integrity solutions.
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Your patients count on you to help them stay out of the hospital and reduce the pain and discomfort caused by DFUs. We offer NPWT, advanced wound dressings, and skin integrity solutions to help your patients on their journey to healing.
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Optimal outcomes start with early treatment and consistent management of traumatic wounds. Together, we can strive to reduce preventable complications, drive toward better outcomes and, ultimately, aspire to restore patients’ lives.
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People living with chronic edema and VLUs want to engage fully in everyday activities - without feeling uncomfortable or self-conscious about what’s on their legs and feet. 3M can help manage challenges related to VLUs.
Looking for more information?
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3M is committed to providing customer service, including product reimbursement education and resources, to clinical providers and healthcare facilities that use qualified 3M products.
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We are here to help! Get in touch with our customer support team for advice about our products and how to use them.
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View our advanced wounds and NPWT portfolios and browse our product catalog.
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Find Instructions for Use to easily access documents for specific 3M Health Care products.
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NOTE: Specific indications, contraindications, warnings, precautions, and safety information exist for these products and therapies. Please consult a clinician and product instructions for use prior to application. This material is intended for healthcare professionals.
References
1. Labeau SO, et al. 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.
2. Pressure Injury Fact Sheet. National Pressure Injury Advisory Panel. https://npiap.com/page/. Accessed January 27, 2023
3. Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019 Jun;16(3):634-640.
4. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA; 2019
5. Atkin L, Bućko Z, Conde Montero E, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 28(3 Suppl 3):S1–S49.
6. Bianchi, J. A. N. I. C. E. (2012). Protecting the integrity of the periwound skin. Wound Essentials, 7(1), 58-64.
7. Brennan, Mary R.; Milne, Catherine T.; Agrell-Kann, Marie; Ekholm, Bruce P. Clinical Evaluation of a Skin Protectant for the Management of Incontinence Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J of Wound, Ostomy & Continence Nursing. 2017. 44(2):172-180.
8. 3M Data on File. EM-05-013924.
9. Nisi, G et al. Use of protease modulating matrix in the treatment of pressure sores. Chir. It. 2005; 57(4):465-8.
10. Clark, R. and Bradbury, S. Silvercel™ Non-Adherent Made Easy. Wounds International Vol. 1(5) 2010.
11. Teot L et al. The management of wounds using SILVERCEL™ Hydro-Alginate. Wounds UK Supplement. 2005.1(2).
12. Baharestani MM, Houliston-Otto DB, Barnes S. Early versus late initiation of negative pressure wound therapy: examining the impact on home care length of stay. Ostomy Wound Manage 2008;54:48-53.
13. Kloeters O, et al. Prospective and randomised evaluation of the protease-modulating effect of oxidised regenerated cellulose/collagen matrix treatment in pressure sore ulcers. International Wound Journal. 2016 Dec;13(6):1231-1236.
