Bariatric patients present a special challenge in terms of skin care and prevention of pressure ulcers. Once damage to the skin occurs, bariatric patients heal more slowly due to decreased vascularity of the skin and reduced perfusion of adipose tissue. Bariatric patients are at high risk for acute wounds, pressure ulcers, venous ulcers, non-healing surgical wounds and diabetic wounds of the foot.
Specific Problems in the Bariatric Population
There are several reasons why bariatric patients are more prone to skin problems/wounds:
Inadequate blood supply to adipose tissue- this leads to inadequate oxygenation of the tissues
Poor nutrition- the bariatric patient’s diet often does not include vitamins and nutrients essential for wound healing
Increased diaphoresis- increased sweating leads to moist skin that may be more prone to skin breakdown and the growth of bacteria and fungi
Difficulty in keeping the skin clean- skin folds, in particular, may be difficult for the bariatric patient to clean thoroughly; the abdominal folds and groins may be ignored, leading to an increased risk of skin breakdown in these areas
Immobility- difficulty in changing position/repositioning and movement may increase the risk of pressure ulcers in this population; friction and shear damage can occur in unexpected places, such as under the pannus (abdominal fold)
Tubes and catheters- tubes and catheters can burrow into the skin, causing skin breakdown/ulcer formation
Prevention of Skin Breakdown in the Bariatric Population
Instituting measures to prevent skin breakdown in the bariatric patient may involve staff education, the use of specialized equipment and multidisciplinary care.
Top 5 ways to Prevent Skin Breakdown in the Bariatric
1 - Specialized equipment
Equipment including beds, lifts, turning sheets, mattresses, and chairs should be utilized to offload patient weight frequently. Special commodes that can tolerate additional weight may be used to toilet these patients while providing perinea care at the same time. Staff may need education in the use of specialized equipment. (See #5)
2 - Proper Cleaning
Skin folds should be cleaned and dried several times a day. Alcohol-based lotions and harsh soaps, as well as talcum powders, should be avoided in these areas. If necessary, dry cloths to absorb moisture can be left in skin folds in between washing and drying of the folds.
A dietician should be consulted to provide a meal plan that maximizes healing.
4 - Assessment
Bariatric patients should be assessed for areas of potential breakdown; in addition, any areas that have already broken down should be noted and a plan for wound management should be implemented.
5 - Staff Education
Instituting measures to prevent skin breakdown in bariatric patients may involve additional education of staff. This is critical since no prevention can be obtained without proper training and education.
Preventing and treating skin breakdown in the bariatric population provides special challenges to clinicians caring for this population. Failure to meet nutritional needs, recognize impending breakdown of the skin and adequately treat preexisting skin breakdown and ulcers can have dire consequences for the bariatric patient.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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