Documentation of Traumatic Blisters
Distinguishing Traumatic Blisters from Pressure Injuries
- Traumatic blisters should be documented based on their causal mechanism (friction, thermal injury, fracture-related) rather than as pressure injuries 1
- The British Association of Dermatologists recommends documenting the appearance of the blister, including size and dimensions, and condition of surrounding skin 1
Proper Documentation Guidelines
- The British Association of Dermatologists guidelines recommend gentle cleansing with antimicrobial solution, piercing the blister at its base with a sterile needle, leaving the blister roof intact as a biological dressing, and application of bland emollient to support barrier function 1, 2
- Record the number and location of blisters on a daily blister chart to track progression, as recommended by the British Association of Dermatologists 1, 2
Avoiding Common Documentation Pitfalls
- The British Journal of Dermatology advises against documenting as "pressure injury" unless there is clear evidence of prolonged pressure as the primary cause 1
- Avoid using pressure injury terminology such as "stage 2 pressure injury" or "pressure-related blister", as recommended by the British Association of Dermatologists 1
Monitoring and Follow-up Documentation
- Document signs of potential infection requiring intervention, including changes in fluid characteristics, surrounding erythema progression, and increased pain or warmth, as recommended by the British Association of Dermatologists 1