Vascular Nursing and Vascular Surgery.

BACKGROUND: Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities. METHODS: For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. RESULTS: From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. CONCLUSIONS: Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.

Managing vascular compromise of hand and digit replantation following traumatic amputation.

Hands are anatomically complex and have great social, physical and emotional importance. Hand or digit replantation following traumatic partial or complete amputation is a complex injury for nursing staff to understand and manage. The absence of clear guidance, combined with a lack of consensus in the literature gives rise to ambiguity and insufficient understanding of appropriate and effective management. This article aims to outline nursing care of the patient in the first few days following hand or digit reattachment, particularly focusing on the recognition and management of arterial and venous compromise. Complications must be recognised and acted on quickly to give the best chance of survival so it is essential for nurses to have an accurate understanding of the signs, symptoms and management options of vascular compromise. Leech therapy, also discussed, has long been used as a nonsurgical option in the management of venous congestion and is a simple and minimally invasive method of managing congestion.

Acute chest syndrome of sickle cell disease.

As patients with sickle cell anemia (SCA) are living longer, health care practitioners increasingly manage the chronic effects of the disease. Although significant strides in management of children with SCA over the past decade resulted in decreased mortality, less research exists to guide the care of the adult with complications from the disease. This case study reviews the care of a young woman with SCA admitted to the hospital for vaso-occlusive crisis with subsequent acute chest syndrome and acute respiratory distress syndrome. The pathophysiology and management of SCA, vaso-occlusive crisis, and pulmonary and neurologic complications of the disease are discussed.

Compassion satisfaction, burnout, and secondary traumatic stress in heart and vascular nurses.

Objectives for this project were to determine the prevalence of compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in heart and vascular nurses to confirm whether differences exist between intensive care and intermediate care nurses. The Professional Quality of Life Scale Compassion Satisfaction and Compassion Fatigue: Version 5 developed by Stamm (2009) was used. Results showed that nurses who work in the heart and vascular intermediate care unit had average to high scores of CS, low to average levels of burnout, and low to average levels of STS. Nurses who work in the heart and vascular intensive care unit had average to high levels of CS, low to average levels of burnout, and low to average levels of STS. These findings suggest that leadership should be aware of the prevalence of STS and burnout in heart and vascular nurses. Raising awareness of STS and burnout in intensive care and intermediate care nurses can help in targeting more specific strategies that may prevent the onset of developing these symptoms.

Orienting nurses to a vascular nursing specialty.

The complexity of medical and nursing care for our patients has become more specialized, requiring nurses to deliver care with greater understanding of specialty-specific disease processes. Although this paradigm shift has occurred, accredited nursing programs continue to prepare our nursing workforce as generalists. Therefore the responsibility falls onto the shoulders of the employer to prepare the nurse to care for specialty-specific populations soon after accepting a position on a specialty-specific unit. This manuscript will discuss a process-curriculum design through evaluation-used by an educator in a Magnet hospital to provide education and support to newly hired nurses for a vascular medical-surgical unit. Benner's Novice to Expert concept provided the stimulus to recognize the need for in-depth specialty knowledge and skill development for medical-surgical nurses to provide optimum patient care.

Neurovascular assessment.

The ability to carry out a neurovascular assessment on a patient's limb is an important skill for all registered nurses. All nurses, whether working in primary or acute care environments, are exposed to patients who have sustained injury or trauma to a limb or have a cast or restrictive bandages in place. The ability to detect a compromised limb through careful observation enables prompt referral and subsequent treatment, which may otherwise result in a permanent deficit. This article discusses the importance of undertaking neurovascular observations providing a step-by-step guide for the reader.

Caring for the elderly: changing perceptions and attitudes.

The aging population is currently one of the main issues facing international health care systems. It is a recognized fact that with advancing age, the likelihood of developing health problems and chronic disease will increase and the demand for health care resources will escalate. This will impact hospitals and long-term care facilities. Our young nurses of the future will be faced with the challenging task of caring for this elderly population. A review of the literature revealed that nursing students have a negative attitude toward the elderly. This may be affected by personal beliefs, values, culture, experience, or observations. Their perceived attitudes toward the gerontology field will make it difficult to recruit the nurses required in this area. This article will explore these issues and examine the role of all health care professionals to help change their attitudes and develop a more positive relationship to meet the needs of this unique population.

The wearing of compression hosiery for leg problems other than leg ulcers.

Many people have leg problems other than ulceration. Practitioners from one primary care trust in Suffolk considered nursing assessment of these patients and the fitting of prescribed compression hosiery where appropriate as a health promotion initiative. However, ongoing assessment adds to heavy clinical demands on community practitioners. Engaging with people to take greater responsibility for their health, and recognition that practice should be underpinned by credible evidence, provided the backdrop to a two-staged retrospective audit. Results are based on the nursing records of 101 patients wearing prescribed compression hosiery other than for previous venous ulceration. It was concluded that following an initial detailed holistic assessment, including ankle brachial pressure index, those patients who meet identified characteristics can be empowered to return for reassessment only if there is a change in their health status, or skin changes to their legs. An information leaflet is considered critical to this strategy.

Efficacy of home health care in patients with peripheral vascular disease.

This investigation was designed to study the effects of home health care (HHC) on patients who have been hospitalized with peripheral vascular disease. For a patient to have HHC, the patient had to have a defined wound, educational needs, or both. Sixty patients, 30 with HHC and 30 without, were contacted approximately 30 days after their last hospital discharge. The 30 patients with HHC were deemed to be at increased risk because of multisystem disease with multiple medications, infirmity, early senility, and often complex wounds. In a prospective fashion, each patient was interviewed by either a registered nurse or medical student using a standardized data collection form. The following issues were assessed: incidence of postoperative complications, knowledge of the patient of his or her disease, compliance with medication (knowledge of, regular use), incidence of readmission, and unscheduled clinic or emergency department visits. Upon statistical analysis using the two-sample t-test and Pearson chi-square test, no significant differences were found between the two groups in terms of complications, compliance, or patient education. HHC, therefore, was found to be helpful to patients with peripheral vascular disease. In our study, the use of HHC made the risk of complications in a group of patients with defined teaching needs and wound care needs equal to that in a group with no such defined needs on discharge from the hospital.

Vascular complications of coronary interventions.

Vascular complications such as hematoma, pseudoaneurysm, and arteriovenous fistula that occur after intracoronary or intracardiac procedures are responsible for considerable morbidity and some mortality. In addition, many of these complications result in considerable increases in hospital stays and in the costs associated with the procedures. A number of risk factors for vascular complications after coronary interventions have been identified. They include excessive anticoagulation, use of femoral sheaths for extended lengths of time, multiple interventions during the same hospitalization, catheter insertion in the superficial or deep femoral artery larger catheter size, and complex interventions such as stent deployment or atherectomy. Specific interventions have been identified that help to decrease procedural risk, improve early detection and prompt treatment of the vascular injury, and prevent long-term disability.

Laser angioplasty in peripheral vascular disease.

The use of laser energy to recanalize peripheral arterial vessels is a new and challenging alternative to more extensive surgical intervention. This exciting technique allows the critical care nurse to respond creatively to changing protocols and patient situations, establishing standards of nursing care for this patient population.

Noninvasive testing in the evaluation of peripheral vascular disease.

Noninvasive testing for peripheral vascular disease is a simple and painless method to detect and localize arterial and venous pathology. It is recommended for clients experiencing symptoms of muscle or tissue ischemia and for clients who have a history of atherosclerosis prior to any operative procedure of the lower extremity where the potential for healing is in question. Postoperatively, noninvasive testing is used to assess graft patency after lower extremity revascularization. Venous evaluation for deep vein thrombosis is also performed. This article discusses techniques involved in noninvasive testing.

Wound healing and peripheral vascular disease.

Patients who are hospitalized in the intensive care unit with peripheral vascular disease are at a higher risk for developing complications. The impaired wound healing of this patient population compounds the initial presenting pathology. It is the prudent critical care nurse that realizes this and incorporates this into a plan of care for the patient. Postoperative interventions should be aimed at preserving blood flow and tissue oxygen perfusion and maintaining nutritional requirements to achieve adequate collagen synthesis, angiogenesis, and the prevention of infection.

Trends in endovascular surgery.

Endovascular surgery is currently in its infancy. Much work is necessary before its full potential can be realized. Initial enthusiasm has appropriately turned into more sober, realistic cautiousness. This review summarizes experiences with angioscopy, IU, PTA, laser angioplasty, atherectomy, and stent placement. Solving the restenosis problem following endovascular interventions could significantly broaden the applications of endovascular surgery. The nursing challenges brought by this new field are not different from those of traditional vascular surgery and catheterization. Keeping up with the new technology as it quickly evolves and documenting clinical effectiveness probably require an endovascular nurse specialist in a center planning to do a great deal of procedures.

Vascular complications of the patient undergoing intra-aortic balloon pumping.

Despite advances in intra-aortic balloon catheters and consoles, the vascular complication rate of IABP has not decreased. Predisposing complication factors identified through research include gender, diabetes, peripheral vascular disease, catheter size, prolonged pumping, ankle-arm index less than 1.0, and insertion method. Signs and symptoms of leg ischemia due to thromboembolus or compartment syndrome may occur in as high as 40 per cent of patients. Assessment, documentation, and teaching remain important aspects of the nurse's role in the prevention and detection of vascular complications.