Posts Tagged ‘2007 Pressure Ulcer Staging Guidelines’

Cartilage Is Present…Now How Do I Stage It?

Monday, November 17th, 2014

(For the latest information based on the 2016 NPAUP Staging System, visit the 9/16/16 blog, “Pressure Injuries with Cartilage? Stage Away”)

In the human body the cartilage is found in joints, rib cage, ear, nose, bronchial tubes, and between the inter-vertebral discs. Most often we as wound clinicians see Printcartilage just below the bridge of the nose or on the ear in our patients with pressure ulcers.

Many clinicians continually question themselves how to stage a wound with visible or palpable cartilage present. After all cartilage does serves the same function as bone, but the word “cartilage” itself is not found in the stage IV definition from the NPUAP.  So how do you stage the pressure ulcer with visible or palpable cartilage?

Well here is your answer: In August of 2012 the National Pressure Advisory Panel released a statement that stated: “Although the presence of visible or palpable cartilage at the base of a pressure ulcer was not included in the stage IV terminology; it is the opinion of the NPUAP that cartilage serves the same anatomical function as bone. Therefore, pressure ulcers that have exposed cartilage should be classified as a Stage IV.”

What that means is any pressure ulcer where you can see or feel cartilage, it will be classified as a stage IV pressure ulcer. There is your answer, simply put: if you have cartilage present in the wound, you stage it as a stage IV pressure ulcer.

For a FREE Webinar called “Pressure Ulcer Staging and Tissue Types”  Click Here or visit http://www.wcei.net/webinars.   Use Coupon Code: BLOG.

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I Stage, II Stage, III Stage , IV…. Making Pressure Ulcer Staging a Little Easier

Friday, June 6th, 2014

There has to be a way to get everyone on the same page.  You would think that over the last 6-7 years since the National Pressure Ulcer Advisory Panel (NPUAP) had released the updated staging guidelines we would have gotten better at this.  Not necessarily the case. blog
Lets try to make pressure ulcer staging as simple as possible.  We will take out the all the extra verbiage; you can read that later on.  We will break staging down to some user-friendly terms.  Now remember, we are talking about pressure ulcers, so all of these skin injuries pressure had to be present, sure – friction and shearing can contribute, but pressure must be present. They are usually located over a bony prominence but we know they don’t have to be; they will be located anywhere the skin has had unrelieved pressure.  If they are related to a device they will take on the shape of the device that has caused the injury to the skin.

Stage I.  This is an area of non-blanchable area of erythema (redness) of intact skin.  That’s what it is. Period.  Intact red skin.  Non-blanchable is when we push on the skin it stays red; it doesn’t turn white or blanch.  So, intact, non-blanchable area of erythema, a stage I pressure ulcer.

Stage II.  This is a superficial or shallow open area.  We say it is pink, partial and painful.  The damage is into the dermis here so the tissue we see will always be smooth pink/dark pink, not granulation tissue.  Never will we see any necrotic tissue here; your wound won’t have yellow, black brown colors in it.  It also may be an intact serum (clear fluid) blister. So there you have it; a stage II is a superficial open area with NO necrotic tissue or it can be an intact or ruptured serum filled blister.

Stage III. This stage is easy.  Damage is now into the subcutaneous tissue, but not through the subcutaneous layer.  So this is the start of full thickness tissue injury.  Now here is where we can start see slough, eschar, and granulation tissue in the wound bed.  Tunneling and undermining may also be present in the full thickness pressure ulcer.  In the stage III pressure ulcer we may see healthy subcutaneous tissue, necrotic tissue or granulation tissue.  What we WON’T see in the stage III is muscle, tendon, ligament or bone, ever.

Stage IV.  This is full thickness tissue damage where we now see muscle, tendon, ligament, or bone in the wound bed.  The definition also states “palpable” so if we can feel tendon or bone here, we would stage it as a stage IV.   Cartilage in the wound bed would be included in the stage IV pressure ulcer.  We can have granulation tissue or necrotic tissue present in the wound bed as well.  Undermining and tunneling may be present in a stage IV, but what I MUST see or feel are those underlying structures – muscle, tendon, ligament and / or bone present to say it’s a “stage IV”.

Unstageable pressure ulcer is a stage we use to classify the pressure ulcer that has enough necrotic tissue present to make the clinician uncertain whether the pressure ulcer is a stage III or stage IV.  So until enough necrotic tissue can be removed we place it in the “unstageable” category.  Once that necrotic tissue is removed and we can evaluate the actual level of tissue destruction in the wound bed, that is when we will stage it and it will either be a stage III or a stage IV.

Suspected Deep Tissue Injury (SDTI).  To be a SDTI the skin must be intact, it must be purple or maroon in color or an INTACT BLOOD filled blister.  Once this intact SDTI pressure ulcer opens up, we would then reclassify it based on our assessment or tissue type in the wound bed.

We need to use the staging definitions set out by the National Pressure Ulcer Advisory Panel (NPUAP) correctly, and all clinicians who assess skin need to have a good understanding of these definitions in order to properly stage pressure ulcers.  What was discussed about above is just a summary, there is more reading we need to do, but this will give us a good place to start with the staging.  We need to start staging consistently across the healthcare continuum; it really just comes down to good wound assessment skills, knowing the tissue type that lies before your eyes and identifying the level of tissue destruction and applying them to the NPUAP staging definitions. Lets get this right!

Wound Assessment Basics : Parts 1,2, and 3

Wednesday, June 22nd, 2011

Wound Assessment

Wound Assessment Basics : Parts 1,2, and 3 will be presented at this year’s Wild on Wounds National Conference in Las Vegas NV at Caesars Palace by Nancy Morgan RN, BSN, MBA, WOCN, WCC, CWCMS and Co-Founder of WCEI.

The basics are often forgotten. At times, we need a refresher to take us back to the basics. Join us in this 3-part session as we identify wound etiology and discuss tissue types. We’ll revisit the 2007 Pressure Ulcer Staging Guidelines and address pressure ulcer staging. But we won’t stop there, as we look at skin lesions, discuss wound pain-and no assessment is complete without proper documentation. We’ll talk about the requirements for proper documentation.

How are your Wound Assessment and Documentation skills? Need a Refresher?

For More Information on the Wound Care Education Institute and WOW 2011, Check out Wild On Wounds National Conference.