Bed sores, also known as pressure ulcers, are areas of damaged skin and underlying tissue caused by constant pressure that restricts blood flow to vulnerable spots on the body. These injuries typically form over bony areas like the sacrum, hips, and heels when an individual is bed-bound or has limited mobility. A wedge pillow is a specialized, non-invasive tool designed to redistribute body weight and relieve this harmful pressure on those high-risk areas. By strategically altering a person’s position, the wedge helps prevent the formation of new pressure ulcers and promotes the healing of existing, early-stage injuries.
Choosing the Right Pillow Angle and Material
The most widely recommended angle for safe lateral positioning is 30 degrees, often referred to as the “Rule of 30.” This specific incline is crucial because it shifts weight away from the hip bone, or greater trochanter, allowing the body’s mass to be supported by the large muscles of the buttocks instead. Wedges that force a person into a steeper 90-degree side-lying position can concentrate pressure directly onto the hip and shoulder, which can increase the risk of skin breakdown.
The pillow’s composition is important for its effectiveness and comfort. High-density foam is preferred for the main structure of the wedge, as it provides the firm, stable support necessary to maintain the exact 30-degree angle without collapsing under a person’s weight. Some wedges incorporate a layer of memory foam on the surface to contour to the body, further distributing pressure while maintaining the foundational support. Additionally, look for covers made of low-shear or moisture-resistant fabric, which help reduce friction against the skin and maintain hygiene.
Essential Positioning for Pressure Relief
To achieve the 30-degree lateral incline, gently turn the person toward one side of the bed, ensuring they are positioned close to the edge before placing the wedge. The wedge must be placed behind the person’s back and shoulder, tucking it securely under the sheet or draw sheet for stability. The pillow should extend from the person’s shoulder down to below the hip, cradling the back and ensuring that both the sacrum and the hip bone are suspended off the mattress surface.
Once the wedge is securely in place, the person is gently rolled back onto it until they are resting comfortably at the 30-degree tilt. It is important to confirm that the spine is aligned and the weight is distributed across the back and large muscle mass, not directly on the hip bone. A quick check involves sliding a hand between the person’s sacrum and the mattress; if the hand can move freely, the pressure has been successfully offloaded.
Smaller wedges or pillows are used to offload other bony prominences. For the lower body, a pillow or specialized heel suspension device must be placed under the calves to “float” the heels completely off the mattress surface. A smaller pillow should be positioned between the person’s knees and ankles to prevent bone-on-bone pressure and reduce friction between the legs.
Integrating Repositioning Frequency
A stringent repositioning schedule remains the primary method for preventing pressure injuries. For individuals who are bed-bound and cannot shift their own weight, the established protocol is to reposition them at least every two hours. This regular rotation ensures that no single area of the body is subjected to prolonged pressure, which is the root cause of tissue damage.
Rotation commonly moves from the right side, to the back, to the left side. The wedge pillow facilitates this by supporting the 30-degree side-lying position on both the right and left, with a supine (on the back) position in between. The head of the bed should not be elevated more than 30 degrees to minimize shear forces. For individuals who are chair-bound, the frequency of weight shifting must be increased to at least once every hour.
The repositioning time is also the opportunity for a thorough skin check, which is an integrated part of the process. During each turn, the caregiver should inspect the skin over all bony areas for signs of redness that do not disappear when pressed, known as non-blanchable erythema, which is the first sign of a Stage 1 pressure injury. Documenting the time of each turn and the condition of the skin helps maintain consistency and allows for early detection of any skin changes.
When Wedge Pillows Are Not Enough
Wedge pillows are a positioning tool and have limitations when a pressure injury progresses beyond simple skin changes. They cannot reverse significant tissue damage. Their use should be immediately coupled with professional medical consultation if the skin injury worsens or if the injury advances past Stage 1.
Clear signs indicate the need for immediate escalation of care to a doctor or wound care specialist. If the pressure sore has developed into an open wound, shows a break in the skin, or presents as a deep crater, specialized treatment is required. Other signs of a serious or infected wound include a foul odor, discharge such as pus, or systemic symptoms like fever.