A cura di Alberto Apostoli, Claudia Caula, Angela Libardi
In questo numero:
- Empirical measurement of pressure in negative pressure wound therapy for infected wounds: How long can it really stay under pressure?
- “Let the patient decide”. Person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: Secondary analysis of a randomized controlled trial.
- Medical adhesive-related skin injuries and associated risk factors in a pediatric intensive care unit.
CITAZIONE SECONDO PUBMED
Cozza V, Pascale MM, Pepe G, Panzera R, Magalini S, Gui D. Empirical measurement of pressure in negative pressure wound therapy for infected wounds: How long can it really stay under pressure? Wound Repair Regen. 2019 Mar;27(2):190-195. doi: 10.1111/wrr.12693. Epub 2018 Dec 27. PubMed PMID: 30548524.
Surgical site infections represent one of the most common surgical complications. Negative pressure wound therapy is considered an effective wound management system, based on the principle that a negative pressure inside the wound can suction fluids and approximate wound edges. With the negative pressure wound therapy systems commercially available it is assumed that the pressure inside the wound is stable at the set values. We conducted a prospective experimental study to investigate this. The negative pressure level achieved inside the dressing was investigated at a standard distance from the pad of suction and at specific times in patients with surgical site infections. Pressure measurements were performed in 28 dressings in 14 patients admitted to the Emergency Surgery Department between April 2016 and June 2017. In general, the machine was set at a pressure of -100 mmHg. Negative pressure was measured with a portable pressure reader in the dressing sponge at a distance of 0, 1.5, and 3 cm from the suction pad at the time of dressing change at 24 and 48 hours. The data suggest that there is a significant decrease in negative pressure at both 1.5 and 3 cm from the suction pad at 48 hours from the dressing change (p=0.0001 and p<0.0001, respectively). This preliminary study shows with statistical significance that the pressure inside the sponge of a negative pressure wound therapy system decreases after 48 hours, confirming that the pressure inside the system is not the same as the pressure reported by the machine and, instead of being stable, changes overtime.
Perché leggerlo: è importante farsi delle domande osando mettere in discussione le logiche tecnologiche che ci chiedono cieca fedeltà. La terapia a pressione topica negativa è un dispositivo ampiamente diffuso e utilizzato: senza un serio controllo dell’appropriatezza del suo utilizzo rischierà di diventare un’opportunità persa anche per chi effettivamente potrebbe averne beneficio.
CITAZIONE SECONDO PUBMED
Dahlberg K, Jaensson M, Nilsson U. “Let the patient decide”. Person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: Secondary analysis of a randomized controlled trial. Int J Surg. 2019 Jan;61:33-37. doi: 10.1016/j.ijsu.2018.11.022. Epub 2018 Nov 29. PubMed PMID: 30503602.
AbstractBACKGROUND: Patients undergoing day surgery are expected to manage their recovery on their own. Follow-up routines differ, but many patients have expressed a need for more professional support during recovery. The aim of this study was to describe how many follow-up contacts were initiated, and when and why, via a digital solution. Also, we wanted to compare postoperative recovery and characteristics between patients requesting, and patients not requesting, contact. MATERIALS AND METHODS: This was a secondary analysis of a multicenter, two-group, parallel randomized controlled trial. Participants used a digital solution called “Recovery Assessment by Phone Points (RAPP)” for initiating follow-up contacts after day surgery. The quality of postoperative recovery was measured with the Swedish web-version of Quality of Recovery. RESULTS: Of 494 patients, 84 (17%) initiated contact via RAPP. The most common reasons for initiating contact were related to the surgical wound and pain. Contacts were initiated across the 14-day assessment period, with 62% (62/100) in the first postoperative week. The RAPP contact group had significantly poorer postoperative recovery on days 1-14 compared to those not requesting contact via RAPP (p<0.001). There was a significantly higher proportion of patients who had undergone general anesthesia in the RAPP contact group (85% [71/84]) compared to the non-RAPP contact group (71% [291/410]), p=0.003. CONCLUSION: Letting the patient decide him/herself whether, and when, contact and support is needed during the postoperative period, is possible and does not increase the frequency of contacts. This study investigates a digital solution, RAPP, as one example of a person-centered approach that can be implemented in day surgery follow-up.
Perché leggerlo: Le corsie dei nostri reparti trasudano rassicuranti routine che non prendono in considerazione le tanto decantate “preferenze del paziente” (EBM/EBN). Lasciare decidere al paziente per se stesso si può fare!
CITAZIONE SECONDO PUBMED
Wang D, Xu H, Chen S, Lou X, Tan J, Xu Y. Medical adhesive-related skin injuries and associated risk factors in a pediatric intensive care unit. Adv Skin Wound Care. 2019 Apr;32(4):176-182. doi: 10.1097/01.ASW.0000553601. 05196. PubMed PMID: 30845071.
AbstractOBJECTIVE: To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU). METHODS: A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed. MAIN OUTCOME MEASURES: Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically. MAIN RESULTS: The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings. CONCLUSIONS: Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).
Perché leggerlo: l’utilizzo di adesivi medicali è particolarmente diffuso nelle terapie intensive neonatali per il fissaggio di accessi vascolari, dispositivi di monitoraggio, somministrazione di terapie ecc. Nonostante la loro indubbia utilità, gli adesivi possono causare lesioni cutanee (MARSI), attribuibili agli agenti chimici presenti nel prodotto o alla stimolazione meccanica durante il suo posizionamento o rimozione. La presenza di una MARSI rende più vulnerabile il paziente alle infezioni, determina dolore e implica un ulteriore impegno infermieristico. Per questo motivo, conoscere le complicanze secondarie agli adesivi soprattutto nelle persone a rischio rappresenta un elemento aggiuntivo alla buona pratica infermieristica.