Limpieza de úlceras de etiología venosa. Una revisión sistemática / Cleansing venous leg ulcers. A systematic review

Objetivo: Evaluar los efectos de la limpieza, así como las soluciones y técnicas utilizadas, para el tratamiento de las úlceras de etiología venosa. Metodología: Se realizó una revisión sistemática siguiendo las últimas recomendaciones de la declaración PRISMA. La búsqueda se realizó en 3 bases de datos (PubMed, CINAHL, Cochrane), limitándose por idioma (inglés/español) y por año (de enero de 2011 a diciembre de 2021). Siguiendo el diagrama PRISMA, se realizó la depuración y evaluación de calidad de los estudios por pares, utilizando las normas de la Red EQUATOR, y seleccionando únicamente ensayos clínicos aleatorizados y revisiones sistemáticas de calidad media o alta. Resultados: Se identificaron un total de 790 artículos, de los cuales se eliminaron 58 por estar duplicados, 700 tras la revisión por título y resumen, y 25 en el cribado por texto completo. De los 7 artículos restantes, se incluyeron 5 al presentar alta calidad metodológica (cumplieron > 70% de los ítems), 3 con diseño de estudio clínico aleatorizado y 2 revisiones sistemáticas. Conclusiones: Actualmente, no se dispone de evidencias científicas sólidas que den valor a la limpieza dentro del tratamiento integral de las heridas. Se necesitan más estudios que permitan orientar a los profesionales en la toma de decisiones para realizar una práctica segura y una optimización de los recursos existentes, considerando a la persona, sus necesidades y su satisfacción en el proceso del cuidado de las lesiones (AU)

Objectives: To evaluate the effects of cleansing venous ulcers on the healing, as well as wound cleansing solutions available and wound cleansing techniques used. Methodology: A systematic review has been made following the PRISMA statement recommendations. This research used 3 databases (PubMed, CINAHL, Cochrane), filtering by language (English/Spanish) and by date (from January 2011 to December 2021). Diagram PRISMA was the base for filtering and evaluating the peer review quality, using the EQUATOR Network and selecting only the randomised clinical trial (RCT) and high or medium quality systematic reviews (SR). Results: A total of 790 articles were identified, of which 58 were eliminated as duplicates, 700 after reviewing by title and abstract, and 25 after screening by full text. Of the 7 remaining articles, 5 of them were included as they were of high methodological quality (more than 70% of the items were accomplished), 3 with an RCT design and 2 SR. Conclusions: Currently, there is no solid scientific evidence that gives credence that cleansing injuries, adds value, within the comprehensive treatment of wounds. More studies are needed, to give professionals decision-making guidelines for providing safe practices and optimising existing resources, considering the state of the patient, their needs and their comfort during the process of injury care (AU)

Preliminary experience of an expert panel using Triangle Wound Assessment for the evaluation of chronic wounds.

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.

Terapia de presión negativa en el tratamiento de heridas complejas: a propósito de un caso / Negative Pressure Therapy in complex wounds: regarding a case

El tratamiento con fármacos anticoagulantes hace que el paciente que lo toma tenga el riesgo de presentar un hematoma subcutáneo ante un mínimo traumatismo, cuyas consecuencias serán variables en función de la zona donde se produzca, las condiciones del paciente, así como del adecuado tratamiento del mismo. Se expone el caso de un paciente varón de 85 años de edad en tratamiento con acecumarol, que tras sufrir una caída accidental presentó hematoma subcutáneo en extremidad inferior izquierda, siendo derivado al Hospital Comarcal de Alcañiz (Teruel) ante la persistencia y mala evolución del mismo. Se realiza una valoración enfermera según el modelo de Virginia Henderson y se establecen diagnósticos de Enfermería desarrollando el plan de cuidados, para ello se utilizan las clasificaciones de North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) y Nursing Interventions Classification (NIC). Al seguir un plan de cuidados individualizado y con el uso de la terapia de presión negativa (TPN) como eje principal del tratamiento de heridas complejas y de amplia extensión, se consiguió una rápida y satisfactoria resolución de la herida gracias al trabajo de un equipo multidisciplinar

Anticoagulant drug treatment leads patients to be at risk of presenting a subcutaneous hematoma caused even by a minor injury, with consequences that will vary according to the area where it appears and patient status, as well as to the adequate treatment received. We present the case of a male 85-year-old patient on treatment with acecoumarol who, after an accidental fall, presented a subcutaneous hematoma in his lower left limb, and was referred to the Hospital Comarcal de Alcañiz (Teruel) due to its persistence and bad evolution. Nursing assessment was conducted according to Virginia Henderson’s model, and nursing diagnosis was established for developing the plan of care, using the classifications by the North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC) and Nursing Interventions Classification (NIC). By following an individualized plan of care and using Negative Pressure Therapy (NTP) as the cornerstone for the treatment of complex and large wounds, a fast and satisfactory solution was found for the wound, through the work of a multidisciplinary team

Consulta de Enfermería para la valoración de pie diabético. Una oportunidad de mejora / Nurses’ practice for the evaluation of diabetic foot. An opportunity for improvement

El pie diabético constituye una de las complicaciones más relevantes de la diabetes mellitus. En los pacientes diabéticos una atención integral, integrada y multidisciplinar con estrategias encaminadas a la prevención de las posibles complicaciones adquiere gran relevancia. Desde la Consulta de Enfermería de Valoración del Pie Diabético se pretende desarrollar una estrategia de prevención basada en cinco pilares fundamentales: control glucémico y tratamiento de comorbilidades, educación diabetológica del paciente, familiares y cuidadores, exploración del pie, evaluación del riesgo y derivación al especialista. La experiencia y la evidencia demuestran que la prevención es el mejor tratamiento de las úlceras de pie diabético (UPD). Desde la perspectiva de un equipo multidisciplinar y haciendo valer el papel que los profesionales enfermeros juegan dentro del mismo, la creación de consultas de valoración del pie diabético se plantea como una oportunidad de mejora de la calidad asistencial que se brinda a estos pacientes. Por todo ello, el objetivo del presente trabajo es compartir la elaboración y puesta en marcha de un protocolo para la valoración del pie diabético en una consulta de Enfermería de cirugía, así como concienciar sobre la importancia de la prevención de este tipo de lesiones

Diabetic foot represents one of the most relevant complications in diabetes mellitus. A comprehensive, integrated and multidisciplinary care, with strategies targeted to prevention of potential complications, acquires great relevance for diabetic patients. At the Nurse’s Practice for Evaluation of Diabetic Foot, the intention is to develop a prevention strategy based on five essential cornerstones: glycemic control and treatment of comorbidities, education on diabetes for patients, relatives and caregivers, foot examination, risk evaluation, and referral to the specialist. Experience and evidence have demonstrated that prevention is the best treatment for Diabetic Foot Ulcers (DFUs).From the perspective of a multidisciplinary team, and highlighting the role that nursing professionals play within said team, the creation of clinics for diabetic foot evaluation appears as an opportunity for improvement in the quality of care offered to these patients. For all these reasons, the objective of the current paper is to share the implementation and launch of a protocol for diabetic foot evaluation at a Surgical Nursing Practice, as well as to create awareness about the importance of prevention in this type of lesions