Abdoli Tafti, A.

Rafiei, H.

shahrekord university of medical scinces

International Wound Journal ISSN 1742-4801LETTER TO THE ED ITORPressure ulcer on toe because of attaching patient’s toeto the bolt of ICU bedDear Editors,Patients in intensive care unit (ICU) are at high risk ofdeveloping pressure ulcers (1–3), because they are sedated,ventilated and almost invariably confined to their bed forlong time periods that particularly increase the risk ofdeveloping skin breakdown (4). In this article, we reporta case of pressure ulcer on the toe because of attachingthe patient’s toe to a bolt of ICU bed as a part of skeletaltraction device. The patient was a 35-year-old man withmultiple trauma (head trauma, chest trauma and right femurfracture), admitted to ICU during night shift. The patient’slevel of consciousness was low (according to Glasgow ComaFigure 1 Calcaneal traction pressurizing patient’s toe to bed bolt.Figure 2 Attaching patient’s toe to ICU bed bolt.Figure 3 Pressure ulcer in the patient’s toe.Scale was 8) but his haemodynamic status was stable (BP,130/85; PR, 87; Spo2, 97). The patient’s position was supine,and the head of the bed was elevated by 30 in. (to preventventilator-associated pneumonia). Because of a right femurfracture, a skeletal traction weighing 9 kg was attached to thepatient’s foot. During the morning shift, the nurse who wasassigned to care for this patient reported that in the upper partof right toe, a pressure ulcer was seen. Orthopaedic surgeonsassessed the ulcer and reported that the ulcer was the result ofattaching the patient’s toe to the bolt of the bed (Figures 1–3).The size of the ulcer was 4 cm long and 2 cm wide, and wasin stage II according to National Pressure Ulcer AdvisoryPanel (NPUAP) (5) pressure ulcer staging. Apparently, thepatient’s toe was attached to the bolt while he was lying onthe bed at night. The patient’s oxygenation and circulationreadings were good. Hence, the only cause for pressure ulcerin that part was the pressure caused by attaching the patient’stoe to the bolt. This case showed that deep pressure ulcerscan also develop in different body parts that are not usuallyassessed by nurses for signs of pressure ulcer and given lessconsideration by them. So nurses are recommended to con-tinuously check all instruments in contact with patients’ skinfor any signs of pressure ulcer. Nurses should be aware of theways that prevent pressure ulcer development and facilitate itsimprovement.Abbas Abdoli Tafti1 & Hossein Rafiei21Orthopedic Department, Kashani HospitalShahrekord University of Medical SciencesShahrekord, Iran2Depertment of Intensive and Critical Care,School of Nursing and Midwifery© 2013 The AuthorsInternational Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd 339Letter to the Editor A. A Tafti & H. RafieiShahrekord University of Medical SciencesShahrekord, Iranhosseinrafiei21@yahoo.comdoi: 10.1111/iwj.12037References1. Iranmanesh S, Rafiei H, Sabzevari S. Relationship between Bradenscales score and pressure ulcer development in patients admitted intrauma intensive care unit. Int Wound J 2012;9:248–52.2. Iranmanesh S, Rafiei H, Foroogh AG. Critical care nurses’ knowledgeabout pressure ulcer in southeast of Iran. Int Wound J 2011;8:459–64.3. AhmadiNejad M, Rafiei H. Pressure ulcer incidence in intensive careunit patients in Bahonar Hospital, Kerman. J Iran Soc AnaesthesiolIntensive Care 2011;57:10–6.4. Keller BP, Van Ramsshorst JB, Van Der Verken C. Pressure ulcersin intensive care patients: a review of risks and prevention. IntensiveCare Med 2002;28:1379–88.5. National Pressure Ulcer Advisory Panel (NPUAP). Updated stagingsystem 2007; [WWW document]. URL http://www.npuap.org/pr2.htm[accessed on 20 July 2012].© 2013 The Authors340 International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd

Pressure ulcer on toe because of attaching patient's toe to the bolt of ICU bed

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shahrekord university of medical scinces