Enfermeros del Hospital Dr. Negrín premiados por reducir el porcentaje de oclusión arterial / No disponible

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Arterial disease ulcers, part 2: treatment.

OBJECTIVES: The objectives of this article are to describe the therapeutic options available and develop an appropriate clinical approach suitable to the individual needs of the patient with arterial insufficiency, based on the wound bed preparation paradigm. This information will also assist in the integration of decision making regarding appropriate clinical intervention in an interprofessional team approach, according to the International Inter-professional Wound Caring Model 2012, with inclusion of patient-centered concerns within the patient's circle of care.

[Peripheral arterial occlusive disease and its care in hemodialysis patients].

The prevalence of peripheral arterial occlusive disease (PAOD) in hemodialysis patients is several times higher than among the general population, and is the main reason for amputations in this group. Patients with peripheral arterial occlusive disease face higher hospitalization and mortality rates associated with cardiovascular disease than non-PAOD patients. The ankle brachial index (ABI) is a widely used PAOD screening tool that may under-estimate PAOD prevalence in the hemodialysis population in the presence of extensive vascular calcification. Studies have demonstrated oxygen saturation in the upper and lower limbs and the "Edinburgh Claudication Questionnaire" as simple screening methods that, in combination with ABI, can increase screening test effectiveness. Early PAOD detection, risk factor modification, medical treatment, and exercise rehabilitation therapy can improve walking function and reduce mortality in PAOD patients.

Are toe pressures measured by a portable photophlethysmograph equivalent to standard laboratory tests?

PURPOSE: The purpose of this study was to determine if toe pressures (TPs) obtained by a registered nurse using a portable photophlethysmograph (PPG) were equivalent to TPs obtained by a registered vascular technologist (RVT) using standard laboratory equipment. DESIGN: A within-subjects, comparative design was used for the study. SETTING AND SUBJECTS: Thirty subjects referred to a vascular laboratory for arterial studies were recruited. All tests were performed in the outpatient vascular laboratory of a large, urban medical center. METHODOLOGY: Toe pressures were measured on subjects by the same RN and RVT during the same visit. Data were analyzed using the Bland-Altman method that compares bias (mean difference) and precision (limits of agreement) of measurements to previously determined criterion for clinically important limits of difference (±15 mm Hg) in order to assess equivalence and repeatability of measurements. Kappa statistic was calculated to assess RVT/RN agreement to detect lower extremity arterial disease (LEAD) (ie, TP<50 mm Hg). Sensitivity and specificity of the portable PPG measures were determined. RESULTS: Precision for RVT-RN TPs exceeded the previously determined cutoff criteria (±15 mm Hg), but precision for repeated RN PPG measures fell within the clinically important limits. Kappa statistic calculation (κ=0.76) revealed substantial agreement (90%) between the RVT and RN measures to detect LEAD (<50 mm Hg). The portable PPG technique had good sensitivity (79%) and high specificity (95%) for detection of LEAD. CONCLUSION: Although TPs obtained by the portable PPG were not equivalent to standard laboratory tests, the portable technique agreed sufficiently with the RVT to detect LEAD. The good sensitivity and high specificity of the portable PPG make it suitable for nurses and other primary care providers to use for high-risk patients or patients with wounds, when the ankle brachial index either is elevated above 1.3 or cannot be performed. Photophlethysmograph is also suitable to assess healing potential and the need for referrals to the vascular laboratory, surgeon, or the need for adjunctive therapies.

What's new in lower-extremity arterial disease? WOCN's 2008 clinical practice guideline.

Lower-extremity arterial disease (LEAD) affects 8 to 10 million people in the United States, resulting in pain, tissue loss, infection, limb loss, and an impaired quality of life. LEAD is underdiagnosed, undertreated, and often unrecognized. The purpose of this article is to provide a summary of the recommendations from the 2008 evidence-based, clinical practice guideline, Guideline for the Management of Patients With Lower-Extremity Arterial Disease, recently released from the Wound, Ostomy and Continence Nurses Society. This article presents an overview of the process used to develop the guideline, a discussion of risks for LEAD, and specific recommendations for assessment, interventions, patient education, and risk-reduction strategies.

El cribaje de arteriopatía periférica en Atención Primaria mediante doppler / Doppler screening of peripheral arteriopathy in Primary Care

La arteriopatía periférica es causa de numerosas complicaciones responsables de una morbi-mortalidad elevada. El cribaje de esta enfermedad mediante técnica doppler está siendo realizado por enfermeras en centros de Atención Primaria.Objetivos: conocer la relación entre los factores de riesgo cardiovascular y el resultado de la prueba de cribaje de arteriopatía periférica realizada con doppler e identificar la relevancia de la prueba.Método: estudio observacional descriptivo. Sujetos del estudio (n = 119): pacientes con diabetes mellitus II remitidos al programa de cribaje de arteriopatía periférica, mediante doppler, del Centro de Atención Primaria Florida Sur durante el año 2007, seleccionados por muestreo de conveniencia.Resultados: no se observan asociaciones estadísticamentesignificativas entre el resultado obtenido con doppler y los diferentes factores de riesgo cardiovascular que presentan los sujetos. Sólo se observan diferencias estadísticamente significativas con la varia-ble “revisión de pulsos previa”. No se registró ninguna actuación tras obtener un resultado patológicoen el 66,67% de la muestra.Conclusión: aunque no hay asociación entre el resultado positivo del ITB y la presencia de factores de riesgo cardiovascular, la técnica de cribaje con doppler es útil para la detección de arteriopatía periférica. Hay que mejorar la relevancia de su utilización en lo referente a las actuaciones posteriores al resultado positivo, especialmente, la educación sanitaria

Peripheral arteriopathy causes numerous complicationsthat lead to a high morbidity and mortality. Doppler screening of this disease is performed by nurses in Primary Care centres.Objectives: to learn about the relationship between cardiovascular risk factors and the peripheral arteriopathy screening test results performed with doppler and identify the relevance of this test.Method: descriptive observational study. Study subjects(n=119): patients with diabetes mellitus II, selected by convenience sampling referred to the peripheral arteriopathy doppler screening program in the Florida Sur Primary Care Centre during 2007.Results: no statistically significant associations were found between the results obtained by doppler and the subjects’ different cardiovascular risk factors. There were only statistically significant differences in the variable “previous pulse examination”. No measures were taken after obtaining a pathological result in 66,67% of the sample.Conclusion: even though there is no association betweenthe positive result of AAI and the presence of cardiovascular risk factors, the Doppler screening technique is useful for the detection of peripheral arteriopathy. The relevance of its use must be improved in regards to subsequent measures to be taken based on positive results, especially in healthcare education (AU)

Evaluation of lower extremity arterial circulation and implications for nursing practice.

Lower extremity arterial disease (LEAD) affects millions of Americans, causing impaired function and a high risk of nonhealing wounds, infection, and limb loss. This chronic, progressive condition is often silent until a life- or limb-threatening complication occurs and impacts the quality of life of individuals and their families and results in high healthcare costs. Assessment forms the cornerstone of effective nursing care, yet despite several national guidelines, LEAD remains unrecognized in half of persons with the condition. This article presents an overview of assessment of LEAD, including descriptions of the risks, pathogenesis, and common characteristics of arterial disease.

Recommendations for leg ulcer care in acute trusts.

Lucy Aldeen describes recommendations that aim to assist tissue viability nurses and managers in acute trusts to implement guidelines on leg ulcer management. The goal is to improve and sustain standards of care for this patient group.

Leg ulcers.

This article aims to explain the difference between venous and arterial leg ulcers, methods of treatment and prevention for each kind of ulcer, and the social and emotional impact of venous ulcers.