Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial.

Hip fractures in the elderly are a serious problem for the health service due to the high rate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area. The present randomised controlled trial tests whether applying a new innovative multi-layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset of pressure ulcers in the sacral area. From March to December 2016, 359 fragility hip fracture patients were randomly divided into 2 groups: 182 in the control group and 177 in the experimental group. Pressure ulcers occurred overall in 36 patients (10%): 8 patients (4.5%) in the experimental group compared to 28 (15.4%) in the control group: P = 0.001, relative risk 0.29 (95% CI 0.14-0.61) with NNT of 9 (95% CI 6-21). In the experimental group the onset of pressure ulcers occurred on average on the 6th day compared to the 4th day in the control group (HR 4.4). Using polyurethane foam is effective at reducing the rate of pressure ulcers in the sacrum in elderly patients with hip fracture. The adhesiveness of this device also enables costs to be kept down.

SHARP VERSUS BLUNT DIALYSIS NEEDLE USE WITH BUTTONHOLE METHOD: OPEN RANDOMISED TRIAL.

BACKGROUND: Current protocols recommend the use of a blunt needle to access the arteriovenous fistula via a buttonhole. This study aims to demonstrate whether a sharp needle can be used at the same buttonhole site without causing complications. GOAL: To measure and compare fistula cannulation failures between the use of blunt and sharp needles. PLAN: Open-crossover randomised controlled trial. PARTICIPANTS: Adult out-patients who had provided consent and were on dialysis with a mature arteriovenous fistula and buttonhole cannulation. OUTCOME MEASURES: Failed cannulation-difficulty in inserting the needle and the trampoline effect; incidence of complications, such as infection and haematomas; times to haemostasis; patients' pain; and patients' preferences. RESULTS: Based on analysis of the data from the 35 patients enrolled, no significant differences were detected in failed cannulation of the fistulae between the use of a blunt needle and a sharp needle for the 335 venous accesses (p = 0.071). However, a significant difference was detected for the 335 arterial accesses (p = 0.001), in which the sharp needle was more effective. Significant differences were also detected in the difficulty of insertion and in the trampoline effect for both venous and arterial access (p < 0.05); the use of a sharp needle was more favourable. CONCLUSION: This study demonstrates an increased incidence of failed cannulation using a blunt needle compared with using a sharp needle, although this was not significant. In addition, the use of a sharp needle did not result in any increase in complications.