Evaluación de la calidad de la técnica de enfermería "vacuidad del intestino" en Cirugía Pediátrica / Quality assessment for the nursing technique gut irrigation in children surgery

Introducción: el personal de enfermería debe estar bien entrenado en la preparación del paciente que va a ser intervenido por cirugía en afecciones gastrointestinales o con fines investigativos, para lograr una excelente vacuidad del intestino. Objetivo: evaluar la calidad de la técnica de enfermería "vacuidad del intestino" en cirugía pediátrica. Métodos: se realizó un estudio descriptivo retrospectivo en el Servicio de Cirugía Pediátrica del Hospital Provincial General Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en el período 2010-2013. El universo quedó constituido por 74 pacientes que requirieron limpieza del intestino. La calidad de la técnica fue evaluada de excelente, buena, regular y mala. La información se obtuvo de la historia clínica y procesada con la utilización de frecuencias absolutas y porcentajes. Resultados: el 67,56 por ciento de los niños tenía menos de seis años, el 71,62 por ciento eran del sexo masculino, el 32,43 por ciento de los pacientes fueron preparados en la limpieza del colon con fines diagnósticos y el 67,56 por ciento con fines quirúrgicos. Se evaluó de excelente el 100,00 por ciento de los procedimientos "gastroclisis para cierre de colostomía" realizados, y el 98,64 por ciento de los procedimientos "Irrigación total del intestino para otros procederes". Conclusiones: la técnica de enfermería "vacuidad del intestino" en cirugía pediátrica realizada con los procedimientos de gastroclisis y de irrigación total del intestino para otros procederes fue evaluada de calidad. La experiencia del personal de enfermería es notable, evidenciado en los excelentes resultados obtenidos(AU)

Introduction: The nursing staff should be well trained in preparing the patient to undergo surgery for surgery in gastrointestinal diseases, or research purposes for excellent bowel emptiness. Objective: To evaluate the quality of nursing technique "intestine emptiness" in pediatric surgery. Methods: A retrospective study was conducted at the Pediatric Surgery Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola "Ciego de Avila, in the period 2010-2013. The universe was composed of 74 patients who required bowel cleansing. The quality of the data was assessed as excellent, good, fair and poor. The information was obtained from the clinical history and processed using absolute frequencies and percentages. Results: 67,56 percent of children had less than six years, 71,62 percent were male, 32,43 percent of patients were prepared in cleansing the colon for diagnostic purposes and 67,56 percent for surgical purposes. It was evaluated excellent 100,00 percent of procedures "gastroclisis colostomy closure" made, and 98,64 percent of procedures "whole bowel irrigation for other procedures." Conclusions: nursing technique "intestine emptiness" pediatric surgical procedures performed with gastroclisis and whole bowel irrigation for other procedures was assessed quality. The experience of nursing staff is remarkable, as evidenced by the excellent results obtained(AU)

Inclusion of a spasmolytic in bowel cleansing: a prospective randomized study.

The quality of colon cleansing and the tolerance of patients to the procedure are two major determinants of the quality of a colonoscopy. Many bowel-cleansing regimens are known, but there is no ideal regimen. Alverine citrate (Relaxyl, Spasmonal) is a spasmolytic agent that has been shown to affect responses of mechanoreceptors of the intestine to both mechanical and chemical stimuli. Patients who underwent colonoscopies at four centers were randomly assigned two different bowel-cleansing procedures. The bowel-cleansing methods were oral sodium phosphate (NaP) (Group I) and oral NaP plus alverine citrate (Group II). Patients were randomized into one of these regimens. The quality of colon cleansing was assessed by an endoscopist with an empirical, clinically meaningful 3-point scale. Both groups were similar with respect to age, gender, and pre- and postcolonoscopic diagnosis. In Group I, 76 patients (47 women and 29 men; aged 39.53 ± 7.87 years) and in Group II, 71 patients (41 women and 30 men; aged 39.78 ± 8.27 years) were included in the study. In Groups I and II, 37 (48.7%) and 41 (57.7%) patients had perfect bowel cleansing, respectively. The overall colon cleansing in the group with NaP plus alverine citrate was comparable with that in the NaP group. The tolerability of patients to the colonoscopy in the two groups was also similar. Based on the present data, adding oral alverine citrate to NaP does not increase either the quality of bowel cleansing or the tolerance of patients to the procedure.

Diabetic colon preparation comparison study.

The purpose of the present study was to establish an optimal colon preparation for persons with diabetes who are undergoing colonoscopies. Specifically, the aim was to compare the difference between an experimental and standard preparation. Adequacy of bowel preparation is critical for good bowel visualization. Compared with nondiabetic patients, persons with diabetes have slower gastric emptying, colonic transit, and colon evacuation. Inadequate preparations may lead to suboptimal colonoscopy resulting in overlooked pathology, repeated examinations with associated risks, and organizational inefficiencies. Using a single-blind experimental design, 198 persons with diabetes who were scheduled to receive colonoscopies were randomly assigned to either the experimental (diabetic colon preparation) or the control (standard colon preparation) group. Patients in the diabetic colon preparation group had 70% good colon preparations compared with 54% in the standard group, and this finding was significant (χ = 5.14, p = 0.02). Results indicate that diabetic patients receiving 10 ounces of magnesium citrate 2 days prior to their colonoscopies followed by 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to the procedure had cleaner colons than those receiving standard preparation of 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to procedure. This colon preparation is safe, feasible, well-tolerated, and effective.

Rectal irrigation for patients with functional bowel disorders.

Functional bowel disorders encompass a number of symptoms including abdominal, pelvic and/or anal pain, bloating, nausea, disturbed bowel function, faecal urgency or incontinence, straining to evacuate bowels, incomplete emptying and constipation. This article examines the causes and effects of functional bowel problems on patients' quality of life. It provides an overview of the treatment options and clinical management of these conditions, focusing on biofeedback and rectal irrigation. The author reports results from a small scale audit at her hospital and concludes that rectal irrigation is a valuable treatment option for patients with functional bowel disorders.

A systematic review of wound cleansing for pressure ulcers.

AIM: The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing. BACKGROUND: Pressure ulcers impose a significant financial burden on health care systems and negatively affect the quality of life. Wound cleansing is an important component of pressure ulcer care; however, there is uncertainty regarding best practice. DESIGN: Systematic review. METHODS: The Specialised Trials Register of the Cochrane Wounds Group, the Cochrane Central Register of Controlled Trials and bibliographies of relevant publications were searched. Drug companies and experts in the field were also contacted. Randomized controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion. For dichotomous outcomes, relative risk (RR) plus 95% confidence intervals (CI) were calculated; for continuous outcomes, weighted mean difference plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. RESULTS: No studies compared cleansing with no cleansing. A statistically significant improvement in healing occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (p = 0.025). No statistically significant change in healing was seen when water was compared with saline (RR 3.00, 95% CI 0.21, 41.89). No statistically significant change in healing was seen for ulcers cleansed with, or without, a whirlpool (RR 2.10, 95% CI 0.93-4.76). CONCLUSION: There is little trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. Relevance to clinical practice. No firm recommendations for ways of cleansing pressure ulcers in clinical practice can be made, the lack of RCT evidence should be a concern for health care providers.

Safe and effective ear irrigation.

This article outlines the key skills required to undertake safe and effective ear irrigation in the management of ear wax, a common problem experienced by patients in primary care. Nurses require training and practice to ensure competence and the provision of high quality patient care.

Solutions, techniques and pressure in wound cleansing.

This information on best practice discusses the evidence on the use of solutions, techniques and pressure in wound cleansing. The article has been reproduced with the permission of the Joanna Briggs Institute (JBI). The article (JBI 2006a), which updates and supersedes the 2003 information sheet of the same name, has been derived from a systematic review conducted in 2004 (Fernandez et al 2004). The primary references on which this information sheet is based are available in the systematic review reports to members of the JBI via the website: www.joannabriggs.edu.au

Rectal irrigation in the management of functional bowel disorders: a review.

Faecal incontinence and constipation are examples of functional bowel disorders that can lead to distressing psychological and physical symptoms which seriously impact upon quality of life. Rectal irrigation has been introduced as a treatment option for such patients. This article critically reviews and evaluates the current evidence on the effectiveness of rectal irrigation as a management option for functional bowel disorders. The review was conducted using BIOSIS, AHMED, CINAHL, MEDLINE, and Web of Knowledge. From 1051 articles identified through the literacy search, only nine were specifically concerned with the evaluation of rectal irrigation as a treatment option for functional bowel disorders. The results of the literature review do indicate that rectal irrigation could be a successful treatment option for some people, however, variations between studies and methodological limitations mean evidence of the effectiveness of rectal irrigation is lacking.

Antiseptics, iodine, povidone iodine and traumatic wound cleansing.

Wound cleansing is an integral part of the management of acute traumatic wounds. There is consensus that it reduces infection rates. However, the choice of cleansing agent remains controversial, especially the use of antiseptics has been questioned. This article reviews the current literature on the use of antiseptics particularly povidine iodine in traumatic wound cleansing and discusses the beneficial and harmful effects of such practice.

Ostomy care and rehabilitation in colorectal cancer.

OBJECTIVES: To review ostomy care in colorectal cancer, current trends in assessment, management, and treatment, and the role of the enterostomal therapy (ET) nurse in cancer care. DATA SOURCES: Published literature and the author's clinical experiences in ostomy wound care. CONCLUSION: Care of the patient with colorectal cancer requiring an ostomy involves both physical and psychological rehabilitation. The education and skills of an ET/wound, ostomy, and continence (WOC) nurse can provide a valuable service to the patient/family, surgeon, oncology nurse, and other health care providers. IMPLICATIONS FOR ONCOLOGY NURSES: An ostomy is not a handicapping procedure. Living well with a colostomy can be achieved through proper patient preparation, education, and planning. Provision of individualized comprehensive care facilitates physical and psychological rehabilitation.

Prontosan wound irrigation and gel: management of chronic wounds.

Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.

Tap water or normal saline for cleansing traumatic wounds?

The aim of this review was to identify whether cleansing with tap water results in higher rates of wound infection or delayed healing compared with other cleansing solutions in adults or children with acute uncomplicated traumatic soft tissue wounds. The review utilized a systematic search of key databases (Cochrane Library, Medline, Embase, Cinahl, British Nursing Index and PubMed), bibliographies, and internet resources. Three controlled trials were found which studied 1281 people. One further study reported outcomes but could not be fully examined as only an abstract was available. Based on the studies reviewed, results suggest no clinically significant increase in the risk of wound infection in wounds irrigated with tap water when compared to sterile normal saline in uncomplicated soft tissue injury. However, the available evidence lacks strength because of the relatively low power and poor quality of studies.

Flushing an i.v. line: a simple but potentially costly procedure for both patient and health unit.

This observational study investigated the intravenous (i.v.) medication administration technique of Registered Nurses (n = 47) using the injection port of a concurrent intravenous infusion. Study findings showed that the majority of nurses adhered to the most common although debatable recommended guideline in stopping the concurrent infusion and slowly administering the medication in the syringe over 3-5 minutes, prior to flushing the line quickly. Nurses failed to account for the dead space in the i.v. line when calculating the administration rate for pre and post medication flush. Similarly, the benefits of continuing the concurrent infusion when administering intravenous medication were not taken into consideration. Based upon these study findings, we recommend changes to procedural guidelines for i.v. medication.

Assessment and intervention knowledge of nurses in managing catheter patency in continuous bladder irrigation following TURP.

Continuous bladder irrigation (CBI) is an established procedure designed to prevent the formation and retention of blood clots following transurethral prostatectomy (TURP). The purpose of this study was to evaluate a tool designed to determine what steps the nurse should follow to assess whether a catheter is blocked and the actions to be taken to restore catheter patency for CBI.

Is tap water a safe alternative to normal saline for wound irrigation in the community setting?

OBJECTIVE: This double-blind randomised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds. METHOD: The trial was conducted in two metropolitan community health centres in New South Wales, Australia. Thirty-five patients with 49 acute or chronic wounds were randomised to receive wound irrigation with either normal saline or tap water. RESULTS: Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water. CONCLUSION: Although the small sample size is a limitation of this study, the researchers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients.