Statement of Clinical Problem Pressure ulcers may be an unintended consequence when patients need medical devices to assist with their treatments. It is important for clinicians to recognize that these devices may help and harm simultaneously.

Description of Past Management The following cases demonstrate adverse outcomes from medical devices. The first patient acquired a pressure ulcer from a tracheostomy tie and was treated with wet to dry dressings. Another individual experienced a pressure ulcer from an ostomy appliance and was treating the area with the ostomy wafer. The third patient obtained a pressure ulcer from a diabetic shoe and was using a dry dressing. Lastly a gentleman with a fractured neck developed a pressure ulcer from a halo device. He was treated with wet to dry dressings.

Current Clinical Approach The tracheostomy patient was treated with sharp debridement, a 100% sodium carboxymethylcellulose (Na CMC) fiber dressing with ionic silver and a hydrocolloid. The ostomy patient was fitted with a system that caused no pressure. The ulcer was healed with a protocol of care that included a 100% Na CMC fiber and hydrocolloid dressings. The woman with the foot ulcer was treated with a 100% CMC fiber dressing and a composite dressing containing CMC fibers. The patient with the halo was treated with 100% Na CMC fiber dressing and a composite dressing.

Patient Outcomes All the patients healed. Pressure redistribution interventions and moist wound healing were the common treatment modalities. The ostomy patient did have a wound reoccurrence because she returned to her previous appliance.

Conclusions The patients healed with pressure redistribution interventions and moist wound healing, but it is often a surprise that the use of a medical device may result in harm. Clinicians may be caught off guard with these ulcers that are off the beaten path.