Preventing & Treating Pressure Ulcers

Living with locked-in syndrome means someone can’t shift themselves, roll over, or signal when something feels wrong. That makes skin care a constant, daily job for caregivers, not an occasional task. Pressure ulcers can form quickly and heal slowly, so prevention comes first. This guide covers repositioning, mattresses, wound basics, and warning signs to watch for in any care setting.

What Is a Pressure Ulcer?

A pressure ulcer, also called a bedsore, forms when skin and the tissue underneath stay squeezed between a bone and a surface, such as a mattress or wheelchair seat, for too long. That squeezing cuts off blood flow, and without blood flow, skin starts to break down. Bodily fluids can also break down skin, resulting in bedsores.

They tend to show up over bony areas: the heels, hips, tailbone, and back of the head are the most common spots.

People with locked-in syndrome face a much higher risk than most. Since the body can’t move on its own, weight stays on the same few points for hours unless someone else shifts it. There’s also no way to feel or signal that a spot has gone numb or sore, so early warning signs can pass unnoticed.

These wounds range from mild skin redness to deep, open injuries that reach muscle or bone. They can lead to dangerous infections and, in some cases, become life-threatening. This is exactly why prevention has to come first, and why daily attention to skin matters so much.

Repositioning: Building a Schedule with the Care Team

Repositioning matters because pressure, left in one place too long, is really the whole problem behind bedsores. When blood flow to an area gets cut off long enough, the tissue starts to break down. For someone with locked-in syndrome, nothing shifts that weight except a caregiver stepping in. Without regular repositioning, a small patch of red skin can turn into a deep wound in a matter of hours, not days. Getting this right is one of the most protective things a caregiver can do.

However, the information out there about how often to shift someone who is bedbound is confusing. One doctor may tell you to shift your loved one every two hours while another may suggest every four hours. A major review of the evidence published by Cochrane found no proof that any single schedule works better than another at preventing bedsores.

Comparisons between two-hour, three-hour, and four-hour turning intervals all came back unclear. That means the right schedule isn’t a fixed rule; it depends on the person. These factors should guide the plan:

• Skin condition and how it’s responding
• Overall comfort
• General health status

This is a conversation to have directly with the care team, not a number to look up.

Some approaches show early promise. Small, frequent shifts in position — even tiny movements, rather than a full turn — may help reduce pressure buildup between larger repositioning sessions. Devices that track a person’s position and remind caregivers when it’s time to turn them have also shown some benefit in helping staff stay consistent.

Keep the head of the bed as low as possible, within whatever limits the person’s medical condition allows. A higher incline increases sliding and friction against the sheets, adding risk on top of pressure alone.

The bottom line: treat repositioning as an ongoing, adjustable plan built with input from nurses or therapists, not a fixed schedule borrowed from somewhere else.

Daily Skin Checks

Repositioning and skin checks go hand in hand; one relieves pressure and prevents issues, while the other catches problems early. Every time a caregiver repositions someone, it’s a natural moment to look closely at the skin, especially over the heels, hips, tailbone, and back of the head.

What to look for:

• Redness or discoloration that doesn’t fade after a few minutes
• Skin that feels warmer or cooler than the area around it
• Any breaks, cracks, or blisters in the skin

If any of these show up, it’s time to alert the medical team rather than wait and see. Catching a change on day one, instead of day three, can be the difference between a spot that heals on its own and a wound that needs weeks of care.

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Wound Care Basics (When a Bedsore Has Already Formed)

Once a pressure ulcer develops, care shifts from prevention to healing. This isn’t something a caregiver should manage alone—it calls for guidance from nurses or wound care specialists—but knowing what to expect helps families ask the right questions and spot problems early.

• Keeping the wound clean. Wounds are typically cleaned at each dressing change using a gentle solution like saline or clean water. Harsh antiseptics are generally avoided since they can damage the skin.
• Removing damaged tissue. Dead or damaged tissue can block healing and often needs to be removed by a trained professional, a process called debridement. Debridement is not always required. There are several methods of debridement, and the choice depends on the wound and the person’s overall condition.
• Choosing the right dressing. Dressings are selected to keep the wound moist, but not overly wet, which helps new tissue form. The type of dressing may change as the wound heals or if it starts to look different.
• Watching for infection. Warning signs include increasing pain, a bad smell, redness spreading outward, or a wound that isn’t getting any smaller after about two weeks of consistent care. Any of these should be reported to the medical team right away.
• Supporting healing through nutrition. Getting enough protein and calories plays a real role in how well a wound heals. This is worth discussing with the care team rather than adjusting on your own.

Wound care is a team effort. The caregiver’s job is to watch closely and communicate quickly; the technical work belongs to trained professionals.

Red Flags in a Nursing or Care Facility

Choosing or monitoring a care facility means knowing what warning signs to watch for. Some issues seem unrelated to skin care at first, but they often point to the same root problem: not enough attention to each resident.

• Slow response to call lights. If call lights go unanswered for long stretches, residents may be waiting too long for help repositioning.
• Visible bedsores, bruising, or skin tears. These are signs that repositioning and skin checks may not be happening consistently.
• Staff not washing hands between residents. This raises infection risk for anyone with an open wound.
• Soiled linens or unclean rooms. Poor sanitation can slow healing and increase infection risk for existing sores.
• Strong cleaning smells masking odors. This can be a sign that something, like an infected wound, is being covered up rather than treated.
• No clear repositioning routine. If staff can’t describe how often residents are turned or checked, that’s worth asking more about directly.

Families can also request a facility’s most recent state inspection report to check for a documented history of concerns.

Preventing and treating pressure sores can seem daunting, but with practice, it will become just another routine part of caregiving.

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Rich Newsome

Catastrophic Injury Locked-In Syndrome Attorney

Rich Newsome is a dedicated attorney specializing in catastrophic injury and medical malpractice cases. With over 25 years of experience, she is committed to advocating for victims and their families, ensuring they receive the justice and compensation they deserve.