Úlceras arteriales y venosas. La física de la dinámica de fluidos vasculares como base de la prevención primaria enfermera / Arterial and venous ulcers. The physics of fluid dynamics as a basis for primary nursing prevention

Las úlceras vasculares son lesiones que se producen en las extremidades inferiores provocadas o agravadas por algún problema en el flujo sanguíneo distal, ya sea por el aporte, en el caso de las arteriales, o por el retorno, en el caso de las venosas. El conocimiento del proceso fisiopatológico en la aparición de las mismas ayuda a entender su etiología y proceso de evolución. Además, la comprensión de los mecanismos fisiológicos que las provocan permite escoger entre las diferentes técnicas a llevar a cabo, tanto preventivas como curativas, para establecer las medidas oportunas a poner en marcha. Se consiguen así intervenciones más efectivas dirigidas a la etiología del problema, que evitan que aparezca o se agrave, o, en caso contrario, favorecen una pronta cicatrización y, por lo tanto, una mayor calidad de vida de los pacientes. Enfermería debe conocer el proceso fisiopatológico de dichas lesiones, ya que tiene por objeto fomentar medidas de prevención, así como realizar las curas de manera efectiva, reduciendo las recidivas

Vascular ulcers are wounds in the lower limbs caused or aggravated by a problem in the distal blood flow, either by the supply in the case of arterial ulcers and return in the case of venous ulcers. The knowledge of the physiopathological process behind its etiology helps to understand the cause and evolution of vascular ulcers. In addition, the understanding of the physiological mechanisms that cause them allows to choose the most effective preventive measure or the most appropriate healing treatment. Thus, more effective interventions aimed at the etiology of the problem are achieved. These measures prevent the ulcers from appearing or getting worse, or in the case of presenting them, they promote an early healing, and therefore, a higher quality of life for the patients. The nurses must know the pathophysiological process of such wounds, since it is in charge of promoting preventive measures, as well as performing the cures effectively, reducing recurrences

Peripheral Vascular Disease and Implication of Nursing Practice: A Brief Literature Review.

Nowadays nurse practitioners are working in several acute hospital settings in different specialized departments. For decades, studies have shown the implications of nurse practice in peripheral vascular disease (PVD) and peripheral vascular intervention (PVI) to have several major benefits. However, there are very limited studies and data on this particular aspect. In this literature review, we briefly discuss the implication of nursing practice in PVD/PVI. This review briefly shows that nursing practice has a major contribution and implication in the treatment of patients with PVD or PVI, especially in patients with diabetes mellitus. From available research, we briefly discuss the implication of nursing practice pre- and postoperatively for PVI. Nurses also contribute significantly in catheter-directed thrombolytic therapy, in smoking cessation programs organized for patients with PVD, and in screening patients for PVD. The vascular nurse practitioners are also involved in providing healthcare advice in order to reduce the risk of disease progression. The major lack of research in this particular field should further inspire scientists to develop and carry out research to further investigate and demonstrate the contribution of nurses in the treatment and management of PVD or PVI, which is gradually becoming a major issue.

A prospective study of short-term functional outcome after dysvascular major lower limb amputation.

This study investigates functional status on Day 21 after dysvascular major lower limb amputation compared with one month pre-amputation and evaluates factors potentially influencing outcome. METHODS: A prospective cohort study design was used. Data were collected via in-person interviews using structured instruments and covered functional level (Barthel index 100) one month pre-amputation and on Day 21. Out of a consecutive sample of patients having major lower limb amputation (tibia, knee or femoral) (n = 105), 51 participated on Day 21 follow-up. Clinical, demographic, body function and environmental data were analysed as factors potentially influencing outcome. RESULTS: From pre-amputation to Day 21, participants' functional level decreased significantly in all ten activities of daily living activities as measured by the Barthel Index. Almost 60% of participants were independent in bed-chair transfer on Day 21. Being independent in transfer on Day 21 was positively associated with younger age and attending physiotherapy after discharge. CONCLUSIONS: The findings indicate that short-term functional outcome is modifiable by quality of the postoperative care provided and thus highlights the need for increased focus on postoperative care to maintain basic function as well as establish and provide everyday rehabilitation in the general population of patients who have dysvascular lower limb amputations.

An integrative review of health-related quality of life in patients with critical limb ischaemia.

AIMS AND OBJECTIVES: To examine the domains and the domain-specific characteristics within a peripheral arterial disease health-related quality of life framework for their usefulness in defining critical limb ischaemia health-related quality of life. BACKGROUND: Critical Limb Ischaemia presents a highly individualised set of personal and health circumstances. Treatment options include conservative management, revascularisation or amputation. However, the links between treatment decisions and quality of life require further investigation. DESIGN: The framework for this integrative review was the peripheral arterial disease-specific health-related quality of life domains identified by Treat-Jacobson et al. RESULTS: The literature expanded and refined Treat-Jacobson's framework by modifying the characteristics to better describe health-related quality of life in critical limb ischaemia. CONCLUSIONS: Given that critical limb ischaemia is a highly individualised situation with powerful health-related quality of life implications, further research focusing on patient and family-centred decision-making relating to therapeutic options and advanced care planning is required. RELEVANCE TO CLINICAL PRACTICE: A critical limb ischaemia-specific, health-related quality of life tool is required to capture both the unique characteristics of this disorder, and the outcomes for active or conservative care among this complex group of patients.

Disminución de la aparición de dehiscencia y otras complicaciones en el manejo de vías venosas periféricas en el posoperatorio de cirugía hepatobiliar y vascular mediante el uso de aerosol Nobecutan® / Decrerase of dehiscence and other complications in the use of peripheral venous lines in post-operative hepato-biliary and vascular surgery through the use of Nobecutan® aerosol

La canalización de vías venosas periféricas, su vigilancia y mantenimiento las realizan enfermeras con fines diagnósticos o terapéuticos. En la unidad de cirugía se observó que era frecuente la aparición de flebitis, la extravasación o dehiscencia en el punto de punción. En aras de aumentar la calidad de los cuidados y la seguridad del paciente se buscaron nuevas pautas para prevenir o minimizar complicaciones utilizando el aerosol Nobecutan® como nueva técnica y material de fijación. Fue seleccionado por sus características: película adherente (ayuda a la fijación), elástica, transparente (permite la visualización del punto de inserción), permeable y que sella la zona. Mediante la realización de un estudio descriptivo transversal aleatorizado se pretendió abrir campo para la realización de nuevos estudios y la implementación de nuevos procedimientos. Los objetivos fueron: disminuir el número de cambios de catéter, evitar la dehiscencia, disminuir la flebitis, favorecer la sujeción y determinar la efectividad de Nobecutan® en prevención de complicaciones en la zona de inserción. Una vez obtenidos los datos, se elaboró una base de datos y se analizaron mediante el paquete estadístico SPSS versión 19.0 para Windows. Según los resultados obtenidos, y tras la discusión, se concluyó que la aplicación de Nobecutan® en la cura disminuyó de manera significativa la aparición de dehiscencia en el punto de inserción y el número de cambios de vía necesarios durante el ingreso. No se encontró influencia beneficiosa en la flebitis (AU)

Peripheral venous canalization, its surveillance and maintenance is realized by nurses with a diagnostic or therapeutic purpose. In the surgery unit was observed frequent appearances of phlebitis, extravasations or dehiscence in the point puncture. In order to increase the quality cares and patient safety, it was searched for new guidelines for preventing or minimizing applications using Nobecutan® aerosol as a new technical and material to fix. It was selected by its characteristics: adhesive layer (helps to fix), elastic, transparent (allows to visualize insertion point), permeable and sealing material. It was intended to open up a new field to realize new studies and to implement new procedures by means of a randomized cross-sectorial descriptive study. The objectives were: reduce catheter changes, avoid dehiscence, reduce phlebitis, get a better fixation and determine Nobecutan® effectiveness to prevent complications. With obtained data, a data base was designed and analyzed by statistical software SPSS version 19.0 for Windows. According to obtained results and after discussion, it was concluded to apply Nobecutan® to decrease dehiscence in the insertion point and the numbers of intravenous lines changes during admittance. It wasn't found beneficial influence to phlebitis (AU)

Vascular nursing in Greece: luxury or necessity?

Although peripheral arterial disease is prevalent in the primary care setting, insufficient vascular education among nurses and physicians coupled with certain economic constraints undermines treatment efficacy. Moreover, the burden of advanced venous pathology such as posthrombotic syndrome, venous ulcers, and lymphedema remains suboptimally treated. This article advocates the development of a vascular nursing specialty as a means to improving vascular care especially nowadays, when health care providers dictate comprehensive and cost-effective nursing practice and patient management. It also presents the first attempt to organize a Vascular Nursing Educational Session in Greece.

Complicaciones crónicas de la diabetes mellitas. Recomendaciones de la American Diabetes Association (ADA) 2011. Prevención y manejo / Chronic complications of diabetes mellitus. Recommendations from the American Diabetes Association 2011. Prevention and management

La diabetes mellitus (DM) es una de las enfermedades con mayor impacto sociosanitario, no sólo por su elevada prevalencia, sino, sobre todo, por las consecuencias de las complicaciones crónicas que genera. La hiperglucemia ocasiona daño tanto en el ámbito de la microcirculación como en los grandes vasos provocando lesiones macroangiopáticas y microangiopáticas. Las complicaciones macroangiopáticas se originan a partir de alteraciones o lesiones en los grandes vasos arteriales siendo las más importantes, desde el punto de vista clínico, la cardiopatía isquémica, la enfermedad cerebrovascular y la arteriopatía periférica. Las complicaciones microangiopáticas son consecuencia de alteraciones o lesiones de pequeños vasos siendo las más importantes, desde el punto de vista clínico, la nefropatía, la retinopatía y la neuropatía diabéticas(AU)

Diabetes mellitus (DM) is one of the diseases with greater impact public health, not only because of its high prevalence, but, above all, by the consequences of the chronic complications arising from this disease. Hyperglycemia generates damage both in the field of microcirculation and the great vessels causing injury, macroangiopathies and microangiopathies. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy(AU)

Resting Doppler ankle brachial pressure index measurement: a literature review.

Peripheral vascular disease (PVD) is under-diagnosed in primary and acute settings. The use of Doppler ankle brachial pressure index (ABPI) is effective in diagnosing PVD , aid in determining aetiology of leg ulcers and is cost efficient in reducing the effects of atherosclerosis and cardiovascular events. The aim of this literature review was to review practitioners' experience in using Doppler ABPI, different skills used to measure ABPI and to examine practitioners' confidence in ABPI. The findings identified variation in method for Doppler measurement: including position of the artery, arm measurement, resting period and type of equipment for measuring blood pressure, variations in practitioners' training and experience have demonstrated variability in ABPI results. Although limited in number, the studies have demonstrated knowledge gap, and the need for training among health professionals.

Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial.

OBJECTIVE: To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease. DESIGN: Prospective randomised controlled trial. SETTING: Multicentre trial in secondary and tertiary healthcare setting. PARTICIPANTS: 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal. INTERVENTION: Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment. MAIN OUTCOME MEASURES: The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor. RESULTS: Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria). CONCLUSION: An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease. TRIAL REGISTRATION: Clinical trials NCT00785031.

[Patients who undergo cryoplasty. Nursing results (NOC), tolerance to this operation]. / Pacientes sometidos a crioplastia. Resultado de enfermería (NOC) tolerancia a la actividad.

The medical profession has started to use a new treatment for peripheral vascular disease: cryoplasty. The objective of this article is to study the results of nursing treatment "tolerance to this operation" for patients who undergo this technique, cryoplasty. In order to know what indicators are those most adequate to quantify its evolution, the author chose these indicators: Taking a walk, Length of walk, Tolerance to climbing stairs, Ease in carrying out Daily Life Activities, Resistance by the lower body and speaking ability while exercising. The author gave a pre-and post-cryoplasty grade for each of these indicators on a 5 point Likert evaluation scale.

Pacientes sometidos a crioplastia. Resultado de enfermería (NOC) tolerancia a la actividad / Patients who undergo cryoplasty. Nursing results (NOC), tolerance to this operation

Un nuevo tratamiento para la Enfermedad Arterial Periférica se ha comenzado a utilizar: la crioplastia. El objetivo del presente trabajo es estudiar el resultado de enfermería «Tolerancia a la actividad» en los pacientes sometidos a esta técnica, y conocer qué indicadores son los más adecuados para cuantificar su evolución; se escogieron Paso al caminar, Distancia de caminata, Tolerancia a subir escaleras, Facilidad en la realización de las Actividades de la Vida Diaria (AVD), Resistencia de la parte inferior del cuerpo y Habilidad para hablar durante el ejercicio y se les dio una puntuación (escala de valoración tipo Likert de 5 puntos) pre y poscrioplastia(AU)

The medical profession has started to use a new treatment for peripheral vascular disease: cryoplasty. The objective of this article is to study the results of nursing treatment «tolerance to this operation» for patients who undergo this technique, cryoplasty. In order to know what indicators are those most adequate to quantify its evolution, the author chose these indicators: Taking a walk, Length of walk, Tolerance to climbing stairs, Ease in carrying out Daily Life Activities, Resistance by the lower body, and speaking ability while exercising. The author gave a pre-and post-cryoplasty grade for each of these indicators on a 5 point Likert evaluation scale(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.

Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology specialist nurse-led unit.

We describe a prospective evaluation of the safety of peripheral angiography procedures performed on day-case patients in a dedicated radiological nurse-led and administrated unit. Patients referred for peripheral vascular angiography, over a 10-year period, were pre-assessed by a radiology specialist nurse in a nurse-led clinic. Radiologists performed all procedures, whereas radiology specialist nurses were responsible for patient care before, during and after angiography and during the 24 h follow-up. Procedures were divided into diagnostic or interventional; complications were divided into immediate or delayed (24 h follow-up) either requiring hospital admission (major) or day-case unit management (minor). Patient acceptability was assessed using a standard questionnaire. Cost analysis was also performed. 401 day-case peripheral angiography procedures (144 diagnostic and 257 interventional) were performed in 310 patients. 109/401 (27.2%) procedures were performed on patients with diabetes mellitus. In diagnostic studies, 16/144 (11.1%) immediate and 6/144 (4.2%) delayed complications occurred whereas, in interventional studies, 65/257 (25.3%) immediate and 13/257 (5.1%) delayed complications were noted. A major complication occurred in 17/257 (6.6%) of patients in the interventional group and 3/144 (2.1%) in the diagnostic group. Puncture site haematoma was the most common complication. Nurse-led care was acceptable to the patient, with a high level of patient satisfaction seen. In conclusion, day-case diagnostic and interventional peripheral angiography procedures can be performed safely in a specialist nurse-led and administrated unit, with complication rates being within the accepted guidelines.

Day-case peripheral angioplasty using nurse-led admission, discharge, and follow-up procedures: arterial closure devices are not necessary.

AIM: To audit the safety of day-case peripheral arterial intervention without the use of arterial-closure devices using nurse-led admission, discharge, and follow-up procedures. MATERIALS AND METHODS: Patients referred for elective, peripheral vascular intervention were selected for day-case care according to pre-determined criteria using telephone triage. Post-procedure haemostasis was achieved using manual compression. After 3h bed-rest, patients were mobilized and discharged at 5h. Patients were contacted by telephone next working day to audit complications. RESULTS: One hundred and eighty-three elective day-case peripheral interventions were performed over 2 years, predominantly using 6 F sheaths. No closure devices were used. Five patients (2%) returned to the department because of persistent groin symptoms the next day. One of these had a false aneurysm. Four required no further treatment. A single patient returned at day 6 with a delayed false aneurysm. CONCLUSION: Day-case peripheral vascular intervention can be safely performed in appropriately selected patients without the use of arterial closure devices. Specialist radiology nurses have a major role in the counselling, care, and follow-up of these patients.

Organising a nurse-driven PAD rehabilitation clinic within the vascular surgical department: what is required and are treatment goals reached--a prospective study?

OBJECTIVES: Patients with PAD may have severe symptoms from their lower extremities as well as a 3-4 fold increased risk of death due to systemic atherosclerosis. The purpose of this study was to identify whether treatment goals of a nurse led rehabilitation clinic were achieved. DESIGN: Prospective cohort study over 4 year period to May 2004. METHODS: All patients with symptomatic PAD were offered enrollment in a nurse-led rehabilitation clinic and given advice on diet and exercise. All smokers were offered smoking cessation advice and treatment. Anti-platelet therapy was prescribed to all patients and statin therapy was prescribed to those with dyslipidemia. RESULTS: 693 patients with symptomatic PAD were prospectively entered into the clinic (total 2563 clinic visits). Average age was 67 years and 53% were males. Some (167, 24%) were included for non-surgical treatment and most (526, 76%) were included as part of their postoperative follow-up. After 6 months, the proportion of patients taking platelet inhibitors and statins had increased from 63% and 27% to 87% and 84% respectively. Mean total cholesterol was reduced from 6.2 mmol/l to 4.9 mmol/l and mean LDL cholesterol from 3.9 mmol/l to 2.6 mmol/l. After 1 year the proportion of smokers was reduced from 59% to 51.5% (12.5% relative reduction). CONCLUSION: This nurse-driven rehabilitation clinic has proven effective in reaching medication targets for secondary prevention. Smoking cessation was less successful.

Health-related quality of life after revascularization for peripheral arterial occlusive disease: long-term follow-up.

AIM: This paper reports a study to measure quality of life, before and after revascularization, in patients with intermittent claudication and critical limb ischaemia from a long-term perspective. BACKGROUND: Patients with peripheral arterial occlusive disease have a number of problems which affect their quality of life and a successful revascularization results in immediate improvements in quality of life. However, knowledge of the durability of the improvements is sparse. Therefore, research on the outcomes of treatment and nursing care should investigate the long-term effects on quality of life and daily activities. METHODS: A quasi-experimental longitudinal follow-up study was conducted with 80 patients with intermittent claudication and 62 with critical ischaemia. Assessment with the Nottingham Health Profile was made before revascularization and 6 months, 12 months and up to 4 years afterwards. The data were collected between 1995 and 2000. RESULTS: Quality of life was improved 6 and 12 months after revascularization in patients with intermittent claudication in energy, pain, emotional reactions and physical mobility, while those with critical limb ischaemia also had improvements in pain and sleep. The improvement in pain was particularly evident for both groups and remained significantly improved up to 4 years after revascularization. Patients with critical limb ischaemia, however, deteriorated significantly with regard to physical mobility between 12 months and 4 years. Being a woman and belonging to the critical ischaemia group was significantly associated with high total Nottingham Health Profile score. Thus, patients with intermittent claudication had more durable benefits from revascularization than those with critical limb ischaemia. However, both groups had less pain than at baseline after 4 years. CONCLUSION: The degree to which quality of life was durable over time seems to depend on the severity of the disease and gender. Patients with critical limb ischaemia were older, had more other diseases and a lower quality of life than patients with intermittent claudication, which confirmed that patients with critical limb ischaemia need more ongoing nursing support to maintain independence in daily life a long time after revascularization.