Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain.

BACKGROUND: AIMS: The aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain. DESIGN: This work was a prospective randomized controlled study. SETTINGS: Study was conducted in the orthopedics clinic of a university hospital. PARTICIPANTS/SUBJECTS: METHODS: The sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded. RESULTS: The patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ˂ .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group. CONCLUSION: Valsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.

The effects of different positions on saturation and vital signs in patients.

BACKGROUND: Patient positioning is an independent nursing intervention and may increase peripheral oxygenation for patients with lung disease. Few studies have been conducted on the effect of body positions on oxygenation in patients with lung disease. AIMS AND OBJECTIVES: To investigate the effects of five different positions on peripheral oxygen saturation (SpO2 ) and vital signs in patients with lung disease. DESIGN: A semi-experimental study was conducted. METHODS: Consecutive samples were recorded from critical care patients followed in the chest clinic of a university hospital. A total of 109 patients with lung disease were recruited. Patients who were able to lie in all positions, and who had unilateral or bilateral lung disease documented by a medical diagnosis by a physician were included in this study. The SpO2 and vital signs were measured at each position three times. RESULTS: For patients with right, left, and bilateral lung disease, lying on the right side of the body at 45 in bed, the SpO2 was higher, but this difference was not statistically significant. There was a significant difference at 40 minutes between the pulse rate in patients with left and bilateral lung disease, but not in patients with right lung disease. No significant differences were found between respiratory rates and body temperature in patients in any of the three groups at 10, 25, and 40 minutes. CONCLUSIONS: Although this difference was not statistically significant, lying on the right side of the body at 45 in bed can be an effective position for improving oxygenation in all patients with lung disease. RELEVANCE TO CLINICAL PRACTICE: As there is insufficient evidence to suggest a specific position, further studies are needed. This study provides evidence that the best oxygenation in patients with unilateral and bilateral lung disease can be obtained by determining the appropriate position for critical care nurses.

The Effect of Cold Vapor and Ice Cube Absorption in the Early Postoperative Period on Sore Throat and Hoarseness Induced by Intubation.

PURPOSE: This study aimed to determine the effect of cold vapor and ice cube absorption in the early postoperative period on sore throat and hoarseness induced by intubation. DESIGN: This is a randomized controlled experimental study. METHODS: Four groups (n = 30) were involved in the study: cold vapor application (group 1), ice cube absorption (group 2), ice cube absorption along with cold vapor application (group 3), and a control group (group 4). The sample consisted of 120 participants. The data were collected using the visual analog scale (VAS) and Stout's hoarseness scale postextubation (zeroth hour) and at the second, sixth, and 24th hours. FINDINGS: After the interventions, the mean VAS scores for sore throat at the sixth postoperative hour were found to be 1.50 ± 1.71, 1.16 ± 1.08, and 1.30 ± 1.62 in group 1, group 2, and group 3, respectively. The mean VAS score for sore throat of group 4 was found to be 3.70 ± 1.89. The decrease in the VAS score for the sixth postoperative hour was ranked from highest to lowest as follows: ice cube absorption group, ice cube absorption along with cold vapor application group, and cold vapor application group. There was no significant difference between application groups in terms of mean VAS scores; however, it was found that mean VAS scores of all application groups were lower than that of control group, and there was a significant difference between them (P < .05). We found that at the sixth postoperative hour after intervention, 33.3% of group 1, 36.7% of group 2, 30% of group 3, and 46.7% of group 4 had hoarseness. No significant difference was found between groups, in terms of hoarseness scores of patients in the sixth postoperative hour after intervention (P > .05). CONCLUSIONS: Cold vapor application, ice cube absorption, and ice cube absorption along with cold vapor application were effective in reducing sore throat but were ineffective as treatment for hoarseness.

Evaluation of oxygen saturation values in different body positions in healthy individuals.

AIMS AND OBJECTIVES: The research was conducted to evaluate oxygen saturation values measured in healthy individuals in different body positions. BACKGROUND: Changes in position affect ventilation-perfusion rates, oxygen transport and lung volume in normal lungs. There have been few studies and not enough information about which positioning of a healthy individual can increase oxygenation. DESIGN: A descriptive study. METHODS: A sample of 103 healthy individuals with no chronic disease, anaemia or pain was included in the research. Individuals were positioned in five different positions: sitting upright, supine position, prone position, lying on the left side and lying on the right side. Oxygen saturation and pulse rates were then measured and recorded after the individuals held each position for ten minutes. RESULTS: It was found that the average oxygen saturation value when measured while sitting in an upright position in a chair was significantly higher than that measured when the individual was lying on the right or left side of the body. Oxygen saturation values measured in the five different body positions were significantly higher in women, in individuals below the age of 35, in those with Body Mass Indexes of below 25 kg/m(2), and in nonsmokers. CONCLUSION: All of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the 'sitting upright' position while the lowest oxygenation was in the supine position. RELEVANCE TO CLINICAL PRACTICE: Based on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant.

Effects of Reflexology on Pain in Patients With Fibromyalgia.

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

The Use of ShotBlocker for Reducing the Pain and Anxiety Associated With Intramuscular Injection: A Randomized, Placebo Controlled Study.

There are few studies evaluating the effect of ShotBlocker on pain acquired from intramuscular injection, and these are mostly in children. We hypothesized that the use of ShotBlocker, while administering an intramuscular injection, would reduce the pain and anxiety due to intramuscular injection in adults. A randomized, placebo controlled trial was carried out for more than 20 months in 2010-2011 on 180 adults aged 18 to 80 years who received intramuscular injections of diclofenac sodium (75 mg/3 mL) at the outpatient clinic of a hospital. The patients were grouped into 3 groups: control, placebo control, and experimental. The experimental group was given an intramuscular injection of diclofenac sodium with ShotBlocker. Pain intensity was measured through a visual analog scale after the injection and anxiety was measured using Spielberger's State-Trait Anxiety Inventory. Pulse rate was counted and state and trait anxiety was measured before and after the injection. The Mann-Whitney U test and Wilcoxon and Kruskall-Wallis tests were used to evaluate the data. Patients in the ShotBlocker group had significantly lower pain intensity than those in the placebo and control groups. State anxiety level increased after the injection in the experimental group but did not change in the other 2 groups. ShotBlocker did not affect the pulse rate. Our results suggest that using ShotBlocker during intramuscular injection reduced patients' pain intensity because of injection but did not reduce anxiety levels. Thus, ShotBlocker is recommended as a pain-relieving tool during intramuscular injection in adults.

The effects of music therapy on pain in patients with neuropathic pain.

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity.

Effect on pain intensity of injection sites and speed of injection associated with intramuscular penicillin.

The aim of this one-group, quasi-experimental study was to examine the effect of choice of injection site and injection duration on the intensity of pain associated with intramuscular penicillin injection. Injections containing the same dose of drug were administered 12 hours apart for each patient over 5 s/mL and 10 s/mL durations in the dorsogluteal and ventrogluteal sites. Sixty patients who had a medical order for intramuscular penicillin at least twice in a day and for two successive days at the same dose were included in the study. No difference in pain was perceived by participants between the two injection durations at either the dorsogluteal or the ventrogluteal site. This study showed that intramuscular penicillin can be administered to either site over 5 s/mL or 10 s/mL durations. There is a need for further research with a randomized controlled design in different settings and in a larger sample on the impact of choice of injection site and injection duration on pain intensity.

Reflexology: its effects on physiological anxiety signs and sedation needs.

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting.

OBJECTIVES: To determine the factors affecting a patient's intensive care experience. METHODS: The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. RESULTS: Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. CONCLUSIONS: Interventions are needed to make the experiences of patients in intensive care more positive.

The Effects of Active Warming on Core Body Temperature and Thermal Comfort in Patients After Transurethral Resection of the Prostate: A Randomized Clinical Trial.

Prevention and treatment of hypothermia by active warming in perioperative period care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The purpose of this study was to determine the effects of warmed intravenous fluids (WIVF) on the core body temperature and the patients' thermal comfort. Baseline data of 105 male patients undergoing TUR-P surgery and bladder irrigation were analyzed. The experimental group was warmed using active WIVF, and the control group's routine care was conducted using a cotton blanket. Body temperature was higher in patients in the experimental group than those in the control group. Repeated measures Manova revealed significantly different core temperature changes between groups (F = 34.446, p = .001). The thermal comfort scores were also higher in the experimental group than in the control group (x2 = 203.552, p = .001). The findings indicated that WIVF can enhance body temperature and improve the thermal comfort of patients.

A comparison of the effects of a special gynaecological garment and music in reducing the anxiety related to gynaecological examination.

AIM AND OBJECTIVES: To investigate the effect of a special gynaecological garment and music plus the special gynaecological garment on reducing the state anxiety related to gynaecological examination. BACKGROUND: Gynaecological examination is one of the most common anxiety-producing medical procedures and causes embarrassment and discomfort. Few studies have focused on the effect of a gynaecological garment on anxiety associated with gynaecological examinations. DESIGN: The patients were allocated to one of three groups, one control and two experimental. While the patients in the control group were subjected to the normal outpatient procedure, the patients in the first experimental group were dressed in a special gynaecological garment. In the control group, gynaecological examinations were performed with a traditional one-piece drape. In addition to wearing the special gynaecological garment, the women in the garment + music group listened to music during the gynaecological examination. The State Anxiety Inventory Form was applied to the patients in all three groups before and after gynaecological examination. RESULTS: The state anxiety level after gynaecological examination in patients in the control group was found to be higher, but it was found to be lower in patients in both the first experimental group (garment) and the second experimental group (garment + music). The state anxiety level was found to be more reduced in the experimental groups than in the control group. The state anxiety level after gynaecological examination was found to be higher in single patients in the second experimental group. CONCLUSION: The special gynaecological garments are effective in reducing the state anxiety associated with gynaecological examination. RELEVANCE TO CLINICAL PRACTICE: It should be taken into consideration that women perceived state anxiety during the gynaecological examinations. To allay anxiety associated with gynaecological examination in women, a special garment may be considered.

Oral care practices of intensive care nurses: a descriptive study.

The aim of this study was to investigate intensive care unit (ICU) nurses' views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using 'Oral Care Practices Survey' which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x(2) = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x(2) = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications.

Nursing diagnoses in elderly residents of a nursing home: a case in Turkey.

There are limited studies on nursing diagnoses of the elderly living in nursing homes worldwide. This study aimed to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center. Seventy-four elderly individuals were included in the study. Data were collected using the "Elderly Individual's Introduction Form" between April 2007 to August 2007. The content of the form was based on a guide to gerontologic assessment, and Gordon's Functional Health Patterns. The nursing diagnoses (NANDA-I Taxonomy II) were identified by the 2 researchers separately according to the defining characteristics and the risk factors. The consistency between the nursing diagnoses defined by the 2 researchers was evaluated using Cohen's kappa (κ). There was an 84.7% agreement about nursing diagnoses defined by the 2 researchers separately. The weighted kappa consistency analyses showed there was an adequate level of consistency (κ = 0.710), and the findings were significant (p < 0.0001). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), and impaired physical mobility (73%). The diagnosis of ineffective role performance was more frequent in patients with dementia (x(2) =10.993, df = 1, p = 0.001). There was a very significant relationship between dementia and the diagnosis of impaired verbal communication (x(2) = 32.718, df = 1, p = 0.0001). The relationship between mobility disorder and self-care deficit was also significant (x(2) = 19.411, df = 1, p = 0.0001). To improve quality in patient care, nurses should use nursing diagnoses with a systematic assessment and should help the elderly in health promotion or use of the maximum current potential.

Turkish version of the Stroke-Specific Quality of Life Scale.

AIM: To test the reliability and validity of the Turkish version of the Stroke-Specific Quality of Life Scale (SS-QOL). BACKGROUND: Stroke is a leading cause of activity limitation and participation restriction that negatively affect health-related quality of life. The assessment of SS-QOL in stroke patients has not been validated in Turkey. METHODS: Cross-sectional and methodological research design was used. Five hundred stroke survivors who had been diagnosed with stroke at least 6 months previously were included in this cross-sectional study. The reliability of the SS-QOL was based on internal consistency, item correlation. Construct validity was evaluated by Exploratory Factor Analysis. Cronbach's alpha coefficient was calculated for the total score of the SS-QOL to establish the internal consistency of the instrument. Construct validity was assessed by comparing patients' scores on the SS-QOL with those obtained by other test methods: SF-36 Health Survey and Katz Index of Activities of Daily Living. FINDINGS: In the process of adaptation to the Turkish population, the scale was converted to 48 items. The correlation coefficient for the test-retest scores of the SS-QOL was calculated as 0.81. Internal consistency for the scale showed Cronbach's alpha = 0.97. As a result of applying factor analysis to the scale, eight factors were obtained, which accounted for 77.47% of the scale's total variance. CONCLUSION: SS-QOL is a reliable and valid instrument for measuring self-reported health-related quality of life at group level among people with stroke who are diagnosed with stroke at least 6 months previously in the Turkish population.

Does the use of infrared technology (AccuVein AV-500®) for Peripheral Intravenous Cannulation (PIVC) increase the success rate in nursing students? A randomized controlled trial.

BACKGROUND: PIVC is one of the essential procedures of modern medicine, and is one of the most widely used and important treatments in the clinical setting. Nevertheless, it is one of the most difficult skills to teach in nursing education, and it is the skill which causes the most anxiety in nursing students. OBJECTIVES: The aim of the study was to examine the effect of the teaching method using infrared technology on PIVC success, duration, and the level of psychomotor skills and knowledge in the acquisition of PIVC skills in nursing students. METHODS: This was a pre-test post-test randomized experimental study with a control group. The research was conducted in the Skills and Simulation Laboratory of a Nursing Faculty of a university between December 2019 and February 2020 to examine the effects of teaching PIVC measurement via infrared light on students' success rate. A theory lesson on PIVC followed 15 days later by laboratory practical was carried out with all of the students included in the study. The PIVC Knowledge Evaluation Form as a pre-test. The researchers completed the PIVC Skills Performance Test from observation during the application of the checklist. Immediately after the procedure, the PIVC Knowledge Evaluation Form was applied as a post-test. RESULTS: The procedure success rate of the experimental group was 90%, and that of the control group was 46%. Comparing PIVC skill scores between the groups, the difference was found to be statistically significant (Z = -2.741; p < 0.05). The groups' PIVC knowledge levels increased in a similar way. CONCLUSION: Teaching with infrared technology contributes more to students' success in PIVC skills than does standard teaching. Both methods were effective in developing knowledge of PIVC.

The effect of music therapy on physiological signs of anxiety in patients receiving mechanical ventilatory support.

AIMS: The aim of this study was to investigate if relaxing music is an effective method of reducing the physiological signs of anxiety in patients receiving mechanical ventilatory support. BACKGROUND: Few studies have focused on the effect of music on physiological signs of anxiety in patients receiving mechanical ventilatory support. DESIGN: A study-case-control, experimental repeated measures design was used. METHOD: Sixty patients aged 18-70 years, receiving mechanical ventilatory support and hospitalised in the intensive care unit, were taken as a convenience sample. Participants were randomised to a control group or intervention group, who received 60 minutes of music therapy. Classical music was played to patients using media player (MP3) and headphones. Subjects had physiological signs taken immediately before the intervention and at the 30th, 60th and 90th minutes of the intervention. Physiological signs of anxiety assessed in this study were mean systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation in blood measured by pulse oxymetry. Data were collected over eight months in 2006-2007. RESULTS: The music group had significantly lower respiratory rates, and systolic and diastolic blood pressure, than the control group. This decrease improved progressively in the 30th, 60th and 90th minutes of the intervention, indicating a cumulative dose effect. CONCLUSION: Music can provide an effective method of reducing potentially harmful physiological responses arising from anxiety. RELEVANCE TO CLINICAL PRACTICE: As indicated by the results of this study, music therapy can be supplied to allay anxiety in patients receiving mechanical ventilation. Nurses may include music therapy in the routine care of patients receiving mechanical ventilation.

Nursing diagnoses in patients having mechanical ventilation support in a respiratory intensive care unit in Turkey.

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08).

Comparison of oxygen saturation values and measurement times by pulse oximetry in various parts of the body.

The aim of this study, which included 40 patients, was to compare the values pulse oximetry and the measurement times in various regions of the body. Data were analyzed using intraclass correlation coefficient test and paired-sample test. The confidence power value was found to be .81 for the comparison of oxygen saturation values by arterial blood gas analysis and measurement by the forehead probe. It was found that the time for oxygen saturation measurement using the forehead probe was shorter than those using the finger and toe probes.

The effect of 2 different care products on incontinence-associated dermatitis in patients with fecal incontinence.

PURPOSE: We compared the effects of 2 devices used to contain fecal incontinence--a perianal pouch and adult containment brief--on the incidence of incontinence-associated dermatitis (IAD). DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The sample was drawn from patients hospitalized in the neurology and neurosurgery wards of a large university hospital in Turkey. Thirty bedridden subjects with fecal incontinence and indwelling urinary catheters participated in the study. Subjects were randomly allocated to treatment with a perianal pouch (n = 15) or adult containment brief (n = 15). METHODS: Routine hygiene was completed once daily and repeated whenever the perineal area was found to be soiled.Perineal skin integrity was evaluated daily during skin care. Data were collected using a Patient Identification Form, a Patient Observation Form, and a Perineal Skin Integrity Assessment Form. RESULTS: The mean number of products used on a daily basis by patients with a perianal pouch was 5.80, as compared to 5.46 by patients with adult incontinence briefs. IAD occurred in 66.7%of patients in the perianal pouch group and in 100% of subjects managed by containment briefs, a statistically significant difference (χ² = 6.0, P = 0.04). The onset of IAD occurred later in subjects allocated to management with a perianal pouch than inpatients using adult containment briefs (U = 30.500, P = 0.011). IAD involved an average of 1.8 areas among patients managed with a perianal pouch, as compared to 2.3 areas in patients managed with adult containment briefs (P = NS). CONCLUSION: Management of bedridden patients with fecal incontinence with a perianal pouch reduced the incidence of IAD and delayed to time to onset when compared to management with adult containment briefs. We recommend use of perianal pouches for prevention of IAD in bedridden patients with fecal incontinence.