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Deep Tissue Pressure Injury

A Clinical Review

Preston, Ave, MSN, RN, ACNS-BC, CWOCN; Rao, Aditi, PhD, RN; Strauss, Robyn, MSN, RN, ACNS-BC, WCC; Stamm, Rebecca, MSN, RN, CCRN, CCNS, WCC; Zalman, Demetra, MSN, RN, CRNP, CSC, WCC

AJN The American Journal of Nursing: May 2017 - Volume 117 - Issue 5 - p 50–57
doi: 10.1097/01.NAJ.0000516273.66604.c7
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A deep tissue pressure injury (DTPI) is a serious type of pressure injury that begins in the muscle closest to the bone and may not be visible in its early stages. Its hallmark is rapid deterioration despite the use of appropriate preventive interventions. In 2007, the National Pressure Ulcer Advisory Panel added suspected deep tissue injuries to the traditional classification system, and by 2010 DTPIs had accounted for about 9% of all pressure injuries and were for the first time more prevalent than stage 3 or 4 pressure injuries. On average, patients who develop these injuries are older and have a lower body mass index than patients who develop other pressure injuries. Most commonly, DTPIs appear on the skin over the coccyx or sacrum, the buttocks, and the heels. This article discusses the pathophysiology; risk factors; and assessment, prevention, and treatment of DTPIs, using a composite case to illustrate the progression of this serious type of pressure injury.

Using a composite case study for illustration, the authors describe the development, progression, and management of these serious, complex pressure injuries.

Ave Preston is a clinical nurse specialist at the Hospital of the University of Pennsylvania, Philadelphia, where Aditi Rao is director of nursing practice and Magnet program director, Robyn Strauss is a clinical nurse specialist, Rebecca Stamm is associate director of clinical implementation, and Demetra Zalman is an NP. Contact author: Ave Preston, ave.preston@uphs.upenn.edu. The authors have disclosed no potential conflicts of interest, financial or otherwise.

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