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Pressure Ulcer/Injury Treatment
When pressure ulcers/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 ulcer/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 ulcer/injury (PU/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 ulcers/injuries were ICU-acquired1
Prolonged positioning and the use of medical devices may put ICU patients at special risk of pressure ulcers/injuries.
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Each pressure injury generates significant costs
Cost of pressure ulcer prevention per patient at risk varied between €2.65 and €87.57 per day. Cost of pressure ulcer treatment ranged from €1.73 to €812.92 per patient per day.3
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Pressure ulcer/injuries add 3-7 days to patient stays4
Facility-acquired pressure ulcers/injuries lengthen inpatient stays potentially resulting in higher total cost of care.
Staging a pressure ulcer/injury
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Stage 1
Intact skin with a localised 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. Colour 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 2
Partial 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 3
Full-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 ulcer/injury along with continued pressure reduction.4
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Stage 4
Full-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 along with continued pressure reduction is needed.4
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Deep Tissue Ulcer/Injury
IIntact or non-intact skin with localised 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 colour 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 along with continued pressure reduction.4
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Unstageable Pressure Ulcer/Injury
Full-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 Ulcer/Injury
Medical device-related pressure ulcers/injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure ulcer/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, ensuring pressure reduction is implemented.4
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Mucosal Membrane Pressure Ulcer/Injury
Mucosal membrane pressure ulcer/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, ensuring pressure reduction is implemented.4
Pressure Ulcer/Injury Staging Guide
Download this free guide to help assess suspected pressure ulcers/injuries.
Download pressure ulcer/injury staging guide (PDF 1.5 MB) Arrow Hollow Right Icon
Assessing and diagnosing a pressure ulcer/injury
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 ulcer/injury prevention starts with skin protection
Skin integrity and management of skin conditions is critical in the prevention of pressure ulcers/injuries. The EPUAP recommends a preventative skin care regimen, which includes cleansing and protecting the skin with a barrier product, to aid in prevention of PUs/PIs.4
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For the routine protection of skin in low risk patients.3M™ Cavilon™ No Sting Barrier Film
This unique terpolymer based non-stinging barrier film is ideal for routine skin protection from moisture and friction. Consider use of this breathable, fast-drying barrier on heels, elbows and tops of ears. -
For managing moderate to severe skin damage in higher risk patients.3M™ Cavilon™ Advanced Skin Protectant
Unique 3M technology protects skin from faeces, urine and other bodily fluids, a leading factor in pressure ulcer/injury development. Cavilon Advanced Skin Protectant also can be used to protect intact skin in areas exposed to friction and shear from bedding, clothing, shoes or any other material.6,7
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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.
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Low to High Wound Exudate3M™ 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. -
Tegaderm HP Foams3M™ Tegaderm™ High Performance Foam Adhesive Dressing
3M™ Tegaderm™ High Performance Foam Adhesive Dressing is formulated to adapt to changing wound environments through the unique construction of its four layers.This dressing is indicated for use as a primary dressing for partial and full thickness dermal wounds. -
Collagen/Oxidized Regenerated Cellulose3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver
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.8 -
3M™ Silvercel™ Non-Adherent Hydro-Alginate Antimicrobial DressingSilvercel 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.9
Silvercel Dressings kill a broad spectrum of microorganisms associated with bacterial colonisation and infection of wounds.10
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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.
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Setting the standard for negative pressure wound therapy3M™ 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 locations3M™ 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.
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Case Study Excerpt: Stage 4 sacral pressure ulcer/injury
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A 64-year-old male presented with a stage 4 pressure ulcer 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 NPWTPatient 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.11
Read more about cost savings (PDF 562 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 ulcers
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In a 33-patient prospective and randomized evaluation12 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 keep you up to date with the latest product guidelines and scientifically supported standards of care.
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Correct pressure elcer/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
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 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 oedema 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.
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Looking for more information?
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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 wound care and Negative Pressure Wound Therapy and I.V. dressings portfolios and browse our product catalogue.
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Find Instructions for Use (IFU) to easily access documents for specific 3M Health Care products.
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Find answers to the most frequently asked questions regarding 3M Health Care.
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
- Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, Calvino-Gunther S, Chaboyer W, Coyer F, Deschepper M, François G, Honore PM, Jankovic R, Khanna AK, Llaurado-Serra M, Lin F, Rose L, Rubulotta F, Saager L, Williams G, Blot SI; DecubICUs Study Team; European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators.
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. doi: 10.1007/s00134-020-06234-9. Epub 2020 Oct 9. Erratum in: Intensive Care Med. 2021 Apr;47(4):503-520. PMID: 33034686; PMCID: PMC7880913. Pressure Injury Fact Sheet . National Pressure Injury Advisory Panel. https://npiap.com/page/. Accessed January 27, 2023- Demarré L, Van Lancker A, Van Hecke A, et al. The cost of prevention and treatment of pressure ulcers: A systematic review. Int J Nurs Stud. 2015;52(11):1754-1774. doi:10.1016/j.ijnurstu.2015.06.006
- 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 - 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. - 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. - 3M Data on File. EM-05-013924.
- Nisi G, Brandi C, Grimaldi L, Calabrò M, D'Aniello C.
Use of protease modulating matrix in the treatment of pressure sores . Chir Ital. 2005 Jul-Aug;57(4):465-8. PMID: 16060184. - Clark, R. and Bradbury, S. Silvercel™ Non-Adherent Made Easy.
Wounds International Vol. 1(5) 2010. - Téot L, Maggio G, Barrett S (2005).
The management of wounds using SILVERCEL™ Hydro-Alginate . Wounds UK Supplement. 2005.1(2) - 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. - 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.
