Which nursing action during negative-pressure wound therapy on the forearm contributed to the elbow pressure ulcers?

• A. The nurse removed the transparent film by stretching it horizontally.
• B. The nurse placed the tubing over the elbow.
• C. The nurse kept the system in ‘de vac’ mode for 30 minutes before changing the dressing.
• D. The nurse raised the tubing connectors above the level of the NWPT unit.

Answer: (B)

Negative-pressure wound therapy can cause skin injury when forces are transmitted to fragile areas. Placing the tubing over the elbow subjects that prominent joint to direct pressure and rubbing each time the arm moves. The elbow has thin soft tissue over a bony surface, so continuous pressure and shear from the tubing and the suction can reduce blood flow to the skin and underlying tissues, leading to a pressure ulcer. The key preventive step is to route tubing away from joints, secure it to prevent shifting or pulling, and protect the skin with padding or a different path for the tubing. Regularly inspect the skin around the tubing and dressing for signs of pressure or irritation.

Other actions don’t directly create that point of sustained pressure on a vulnerable area; they affect other aspects of therapy or dressing management but not the mechanism that caused the ulcer in this scenario.