Preventing Pressure Ulcers

Learn about the formation of pressure ulcers and how to prevent them during noninvasive ventilation.

What is a pressure ulcer? 

A pressure ulcer, also known as a pressure sore or injury, is localized damage to the skin and underlying tissues. These ulcers often develop on areas where thin tissue covers bony parts of the body that are in contact with hard surfaces such as beds and medical devices.1

Using medical devices such as masks or breathing tubes for extended periods increases the risk of pressure ulcers. This can cause pain, anxiety and discomfort for patients, which can impact the quality of care provided.1

NIV masks, while essential for respiratory care, can also increase the risk of pressure ulcers.2 Therefore, it is important to identify risk factors and be confident in the steps to take to prevent them.



Signs and Stages of a Pressure Ulcer

Pressure ulcers develop progressively through four distinct stages:

 

Stage 1 of pressure ulcer developing

Stage 1

A localized red area that is warm to the touch. The term pressure injury is used as skin is not yet broken.

Stage 2 of pressure ulcer developing

Stage 2

A pressure ulcer is visible as the skin is broken and partially lost.

Stage 3 of pressure ulcer developing

Stage 3

The pressure ulcer and tissue necrosis extend through all the skin layers. The underlying fat layer is also visible.

Stage 4 of pressure ulcer developing

Stage 4

The pressure ulcer and tissue necrosis extend down to the fat, muscle and bone or cartilage.

Factors affecting the formation of pressure ulcers

Pressure

Excessive pressure from an ill-fitted mask or prolonged lying in one position can collapse vessels and subsequently hinder the blood supply to that area. This can lead to redness and tissue death over time.1

Friction and shear

Continuous skin rubbing can cause irritation and abrasions. Shear forces between thin tissue and a hard surface can stretch and tear delicate vessels, leading to pressure ulcers.3

Stage 3 of pressure ulcer developing

Aging and poor nutrition

Thinner skin and fat layers due to aging or poor nutrition make bones protrude more, increasing the risk of pressure ulcers in older and sicker patients.1

Risk areas for pressure ulcers

To ensure effective NIV, it's crucial to minimize leaks.4 However, tightening the mask too much to achieve this can increase the risk of pressure ulcers as it places excess pressure on the face.5


Most modern ventilators can compensate for minor leaks, making heavy tightening often unnecessary. Check the contact points of the mask and headgear for signs of pressure ulcer formation. 


Noninvasive masks and pressure ulcers

NIV masks are a leading cause of pressure injuries in the ICU, especially for patients with respiratory failure – one of the top conditions requiring critical care. Misalignment of the mask can increase pressure on facial areas, leading to discomfort and a higher risk of ulcers.2

Wrong mask size

A mask that is too big places unnecessary pressure on the face;
a mask that is too small causes unwanted friction.

Shifting without adjusting

Shifting the mask without loosening the straps pulls on the face causing unwanted friction and shear forces.

Poor mask alignment

If the mask is not sitting symmetrically, it may place extra pressure on facial areas.

Medical staff helping patient to reduce chance of pressure ulcers forming

Minimize NIV mask pressure
ulcer risks

These measures help prevent pressure ulcers and ensure patient comfort:


Finger to forehead: Use supportive headgear that is not too restrictive. Place two fingers comfortably between the headgear and the forehead to check that it is well fitted. 


Keep clean: Maintain good skin and mask hygiene to minimize infection risk.6


Try for size: Giving patients a choice of marks to try for size can help. F&P Healthcare has a variety of masks to ensure the mask they wear is best for them.7


Check again: Check and readjust the mask often. Monitor the fitting for swelling, as this can make the mask too tight.7

Minimize risk of pressure ulcers from NIV masks

Interesting facts

  • Effective NIV therapy can help reduce time in the ICU and length of stay in the hospital.8


  • The development of a pressure ulcer associated with an NIV mask occurs in most patients within the first 48 hours of treatment.9


  • Low pressure for longer periods is more likely to cause a pressure ulcer than high pressure for a short period of time.10


  • A common mistake that can cause a pressure ulcer to develop is fitting the mask too tightly.





Take care of the pressure

Our NIV therapy solutions are thoughtfully designed with you and your patient in mind.


Learn about our NIV solutions

Facial-pressure care, comfort care and ease of care are thoughtfully incorporated into all our products. 

Patient wearing Visairo mask

F&P Visairo

Learn more
Patient sitting comfortably in hospital using Optiflow

F&P Optiflow

Learn more
F&P 950 Humidifier being used for NIV patient

F&P 950 Humidifier

Learn more

Fisher & Paykel Healthcare, F&P Healthcare, F&P, F&P 950, Optiflow, and Visairo are trademarks of Fisher & Paykel Healthcare Limited.
For patent information, see www.fphcare.com/ip

View references