Clothing and medical devices

Consider the risk to skin integrity whenever clothing, medical devices, or assistive aids are donned or fitted for a person with spinal cord injury.

Clothing considerations

Natural or wicking fibres: Natural or wicking fibres help to pull moisture away from the skin. This is especially important for materials in direct contact with seated skin surfaces and can help to prevent blemishes and rash development.

Hygiene: Regular washing of clothing and cushion covers reduces the bacterial load on fabrics. This can also assist with preventing urinary complications, such as infections. 

Underwear: Consider firm-fitting long-leg underwear, to reduce friction and improve moisture control. Fitted underwear can also assist with scrotal positioning and reduce the potential risk of sitting on the scrotum. Avoid using continence pads, as they reduce immersion into the cushion or mattress, increase skin temperature and increase friction (from the elastic edges in the inner pad).

Clothing fit: Check clothing isn’t too tight and has some stretch, for better immersion into the cushion. There are clothing manufacturers that sell clothing specifically designed to meet the needs of wheelchair users. For example, wheelchair clothing is often better-fitting, designed to minimise bulk underneath the person and prevent pants from sliding down at the back when sitting.

Clothing texture: Rough textured clothing can cause friction to the skin. Examples of this can be denim or fleece linings, that may pill.

Pressure sources on clothing: Avoid clothes that have thick seams, back pockets, studs and/or buttons. If possible, remove the pockets.

Footwear: Footwear should have a firm sole, to maintain optimal foot positioning on the footplates and protect the toes, if accidentally bumped when in the wheelchair. Shoes should be at least one size bigger, to accommodate any swelling during the day. Avoid tight shoelaces and socks with seams. Make sure the toes are flat inside the shoe.

Metal objects: Metal zippers or studs can hold heat, and caution should be taken near a heater or when exposed to the sun, to avoid burns.

Wrinkles: Try to smooth out big wrinkles in clothing and bed sheets.

Wet clothing: Avoid sitting in wet clothes after swimming. Make sure the skin is rinsed and clothing is changed as soon as possible.

Medical devices

Skin injury can result from prolonged or incorrect use of medical devices, clothing, and aids. Regular checks and proper fitting are essential.

Urinary Catheters, Bags and Straps

When managing a urinary catheter, consider the following:

  • Secure indwelling catheters to prevent tension or pulling.
  • Alternate urine bag placement to each side to reduce the risk of erosion at the urethral meatus or suprapubic stoma site.
  • Check catheter and bag integrity after any repositioning in bed.
  • Avoid overtight leg bag straps; use wider straps or fabric sleeves to reduce skin pressure.
  • Monitor for silicone catheter reactions; silicone materials may cause blistering due to having a textured surface. Consider wrapping with a soft cloth to reduce direct skin contact.

Splints and Braces

  • Regularly check fit and positioning to prevent rubbing, pressure, or skin marking.
  • Hand splints should be elevated on a towel or pillow to avoid skin pressure on surfaces.
  • Cervical collars should be removed twice daily to clean and inspect underlying skin, and to readjust fit.

Abdominal Binders

  • Must be fitted firmly but not tightly to avoid skin marking or compression injury.

Plaster Casts

  • Take extra care when applying to limbs with absent or impaired sensation, as the person may not detect pressure or friction injuries.

Masks and Oxygen Therapy

  • Devices such as CPAP masks or nasal prongs require regular monitoring, especially if the person lacks the dexterity to adjust them.
  • If using humidification, ensure heated tubing or water does not contact the skin to avoid burns.

Tracheostomy Care

  • Replace tracheostomy tapes daily, especially when wet after showering.
  • A foam dressing under the flange can prevent pressure on the skin and manage exudate from the stoma.

Heat Packs

  • Do not use heat packs on areas with absent or impaired sensation due to the risk of burns.

Other Medical Devices

Includes IV lines, feeding tubes, ventilation tubing, and similar items:

  • Ensure tubing is secured to prevent pulling or tension on stomas or insertion sites.
  • Monitor skin under and around tubing for early signs of pressure or irritation.

Carrying items

Educate the person with spinal cord injury to take precautions when carrying items to reduce the risk of skin injury, burns, or pressure damage:

  • Avoid storing items in pockets (e.g. keys, phones, wallets), as they can create pressure points, particularly when seated.
  • Use caution when handling hot food or drinks. Always ensure the hot drink is contained safely and use a tray or towel to protect the skin from heat.
  • Cigarettes can cause burns if dropped on areas with no or reduced sensation, or on flammable surfaces such as bedding, clothing, or wheelchair cushions. Burns can also occur to the fingers when sensation is impaired and a cigarette is held too long.