Uso de productos barrera para prevenir complicaciones en la piel periestomal / Use of barrier products in order to prevent complications in the peristomal skin

OBJETIVO: evaluar la eficacia del uso de un aerosol protector barrera para la prevención de la maceración e irritación de la piel periestomal, en el paciente quirúrgico, antes de la colocación de los discos, y valorar la eficacia de la aplicación de dicho aerosol previo a la retirada de los adhesivos. MÉTODO: se llevó a cabo un ensayo clínico aleatorizado con dos grupos de comparación: grupo control (cura habitual) y grupo experimental (cura habitual + aplicación de aerosol como método barrera antes de la colocación del disco y spray quita-adhesivo para su retirada). Se incluyeron a los pacientes ostomizados en el Hospital Universitario Infanta Cristina (Parla, Madrid) en 2019, atendidos en la Consulta de Cirugía General. Se aleatorizaron a dos grupos, 15 por grupo. Se recogieron variables descriptivas el día de la captación y de resultado a los 10 días del seguimiento. Se llevaron a cabo análisis univariante y bivariante. La relación entre las distintas variables se evaluó mediante pruebas estadísticas. RESULTADOS: se aleatorizaron 30 pacientes, 15 en grupo control y 15 en grupo experimental. Se observaron diferencias clínicas en los grupos de comparación al inicio del estudio. Al comparar las variables de resultado a los 10 días de la cirugía en los dos grupos del estudio, se observaron diferencias estadísticamente significativas en la presencia de complicaciones en la piel periestomal (p< 0,001) con un 80% (n= 12) en el grupo control frente al 6,7% (n= 1) en el grupo experimental, y en el tipo de complicaciones entre ambos grupos (0,002), destacando las lesiones de tipo L2 Erosivas. CONCLUSIONES: la utilización tanto de un aerosol protector barrera sobre la piel del paciente antes de la colocación del disco de ostomías como la aplicación para su retirada de un spray quita-adhesivo, parece reducir el riesgo de complicaciones en la piel periestomal en el paciente quirúrgico

OBJECTIVES: to assess the efficacy of using a protective barrier spray for preventing peristomal skin maceration and irritation in surgical patients before disc placement, and to assess the efficacy of the application of said spray before removing the adhesive discs. METHOD: a randomized clinical trial was conducted with two comparison arms: the control group (standard cure) and the experimental arm (standard cure + application of spray as barrier method before disc placement and adhesive remover spray for removing them). The study included ostomized patients from the Hospital Universitario Infanta Cristina (Parla, Madrid) in 2019, seen at the General Surgery Unit. Patients were randomly assigned to two 15-patient arms. Descriptive variables were collected on recruitment day, and for outcomes at 10 days follow-up. Univariate and bivariate analyses were conducted. The relationship between different variables was evaluated through statistical tests. RESULTS: thirty (30) patients were randomized, 15 patients to the control arm and 15 patients to the experimental arm. Clinical differences were observed in the comparison arms at study initiation. When comparing the outcome variables at 10 days after surgery in the two study arms, statistically significant differences were observed regarding the presence of complications in the peristomal skin (p< 0.001) with 80% (n= 12) in the control arm vs. 6.7% (n= 1) in the experimental arm, and in terms of type of complications between both arms (0,002), particularly L2-type erosive lesions. CONCLUSIONS: the use of a protective barrier spray on the skin of the patient before placing the ostomy disc as well as the application of an adhesive remover spray for removal seems to reduce the risk of complications in the peristomal skin of surgical patients

Formación de equimosis y/o hematoma tras la administración profiláctica de enoxaparina subcutánea en abdomen o brazo en pacientes críticos / Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient

Introducción: Los eventos adversos más frecuentes de la administración subcutánea de heparina de bajo peso molecular son la equimosis y/o el hematoma. No existe una fuerte recomendación sobre la zona de punción. Objetivo: Evaluar los eventos adversos, equimosis y/o hematoma, tras administración de enoxaparina subcutánea profiláctica en abdomen vs. brazo, en pacientes críticos. Metodología: Ensayo clínico aleatorizado en dos ramas (inyección abdomen vs. brazo), entre julio de 2014 y enero de 2017, en una unidad de cuidados intensivos polivalente de 18 camas. Incluidos pacientes con enoxaparina profiláctica, ingreso >72h, sin hepatopatías o enfermedades hematológicas, con índice de masa corporal (IMC)>18,5, no embarazadas, mayores de edad y sin lesiones cutáneas que impidan la valoración. Excluidos fallecimientos o traslados de hospital antes de finalizar la valoración. Recogidas variables demográficas, clínicas y aparición de equimosis y/o hematoma en lugar de inyección a las 12, 24, 48 y 72h. Análisis descriptivo, comparación de grupos y regresión logística. Aprobado por la comité de ética, con consentimiento firmado de pacientes/familiares. Resultados: Un total de 301 casos (11 excluidos): 149 en abdomen vs. 141 en brazo. Sin diferencias significativas en variables demográficas, clínicas, IMC, dosis de enoxaparina y administración de antiagregantes. Equimosis en el 48% de los pacientes y hematoma en el 8%, sin diferencias estadísticas abdomen vs. brazo [equimosis, abdomen vs. brazo, n(%): 66(44) vs. 72(51), p=0,25] [hematoma abdomen vs. brazo, n(%):9(6) vs. 14(10), p=0,2]. Se halla significación estadística en el tamaño del hematoma a las 72h: [área de hematoma (mm2) abdomen vs. brazo, mediana (RIC): 2(1-5,25) vs. 20(5,25-156), p=0,027]. Conclusiones: En nuestra cohorte de pacientes, la enoxaparina subcutánea profiláctica administrada en el abdomen produce menos hematomas, a las 72h, que administrada en el brazo. La tasa de incidencia de equimosis y hematomas es menor a la publicada en pacientes críticos, advirtiéndose que pacientes con antiagregantes presentan mayor riesgo de presentar lesiones, no observándose relación de su aparición con el IMC (AU)

Introduction: Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. Objective: To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. Methodology: A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72hours. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families. Results: 301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n(%): 66(44) vs 72(51), P=.25] [haematoma abdomen vs arm, n(%): 9(6) vs 14(10), P=.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm2) abdomen vs arm, median (IQR): 2(1-5.25) vs 20(5.25-156), P=.027]. Conclusions: In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72hours, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving anti-platelet agents present a higher risk of injury. No relationship was observed in relation to BMI (AU)

Recognising and assessing blunt abdominal trauma.

Blunt abdominal trauma is common following major traumatic injury but may not be recognised quickly enough and is therefore a cause of preventable death in trauma patients. Emergency department nurses have a major role to play in reducing the incidence of unrecognised abdominal trauma by enhancing their knowledge and skills. They can do this by attending trauma-related courses, taking on more expanded roles, carrying out full and comprehensive physical assessments, and ensuring that members of the multidisciplinary team use the wide range of diagnostic adjuncts available to them. This article reviews the anatomy and physiology of the abdominal cavity, explains abdominal trauma, gives an overview of advanced abdominal assessment techniques and diagnostic adjuncts, and reviews some management strategies for uncontrolled haemorrhage that have been adopted in the UK.

Oral contrast omission in the computed tomographic evaluation of blunt abdominal trauma: a literature review.

The purpose of this review is to examine existing research on oral contrast administrating as it pertains to the computed tomographic (CT) evaluation of blunt abdominal trauma, as well as to determine the necessity of oral contrast as part of a CT scanning universal protocol. Many hospitals routinely administer both oral and intravenous contrast prior to abdominal CT scan. There have been found to be numerous disadvantages and risks associated with oral contrast administration prior to CT scan. There has been a shift in many hospitals over the years from traditional CT scanners to multidetector row helical scanners, which allow for thinner collimation and higher spatial resolution. With the advances in technology, from single detector row to multidetector row helical CT scanners, the question whether oral contrast is necessary, useful, or dangerous presents itself. There is a significant lack of research on this topic over the past 10 years. All of the studies referenced support no longer administering oral contrast for the initial evaluation of the patient with blunt abdominal trauma. However, the findings of the studies cited in this article are based on small sample sizes and low incidences of solid organ, bowel, or mesenteric injuries. The current level of available research has significant limitations to support a recommendation to eliminate the administration of oral contrast before obtaining the initial CT scanning for blunt abdominal trauma. Further research is necessary before any conclusion or practice change can be made.

Trauma: when there's no time to count.

Trauma is the leading cause of death for people younger than age 45 in the United States. To help prevent death or disability, critically injured trauma patients must reach definitive care within the "golden hour."Often, the perioperative team has no more than 10 minutes to prepare the room before a patient who has suffered multiple, critical, traumatic injuries is rushed into the OR. For the trauma patient's safety, the perioperative team must be diligent and use creative measures to efficiently ensure that all surgical counts are completed. Foregoing surgical counts places the trauma patient at an increased risk for unintentionally retained foreign objects.

Cuidados a pacientes que sufren traumatismos / Care patients with trauma

La autora describe la etiología y tratamientos que reciben los pacientes que sufren algún tipo de trauma. Se detallan los cuidados de enfermería brindados a este tipo de pacientes (AU)

Management of a dehisced abdominal wound with VAC therapy.

The management of large cavity wounds has always posed particular challenges for nurses and clinicians. The National Institute for Clinical Excellence (NICE, 2001) suggests that the number of difficult-to-heal surgical wounds may increase in the future and that increased knowledge and expertise should be available across primary and secondary care. Recent research into wound healing has tended to focus on the biology of wound healing and manipulation of the healing processes with new dressings technology and other clinical and cost-effective treatments. Vacuum-assisted closure (VAC) is an innovation that is being given increasing attention. In Northampton, one patient nursed in the community setting has recently benefited from the technology to accelerate healing of a deep abdominal cavity. This article considers the historical management of cavity wounds and presents a case study. The feelings of the patient and the experiences of the district nurses in overcoming management problems are discussed. The case has proved to be the catalyst for a collaborative initiative across primary and secondary care services to ensure that all patients requiring the treatment are able to receive it in the community setting as well as in the hospital, when they are ready for discharge. It is recognized in Northampton that there are several applications for VAC in wound management and that the treatment has many benefits for patients and for those managing finite NHS resources.

Temporary abdominal closure using an i.v. bag silo for severe trauma.

Patients with severe abdominal trauma injuries can have improved outcomes if a priority-oriented approach is taken to surgical intervention. This includes temporary abdominal closure and planned reoperation to complete complex, lengthy procedures when the patient is stabilized. Temporary abdominal closure can be achieved safely and cost-effectively by using a presterilized 3-liter cystoscopy fluid i.v. bag. This article discusses the rationale for temporary abdominal closure and planned reoperation, physiologic considerations in abdominal compartment syndrome (ACS), abdominal injuries or conditions leading to ACS, and manifestations of ACS. It compares and contrasts various materials used for temporary abdominal closure, illustrates bag preparation and silo application and removal, and analyzes complex intraoperative and postoperative nursing activities.

Ultrasound evaluation of abdominal trauma in the emergency department.

To review the use of ultrasound for assessment of abdominal trauma during the secondary assessment. Three current methods for evaluation of abdominal trauma will be outlined. The use of ultrasound in evaluation of patients with blunt abdominal trauma will be highlighted, including performance of test, time to test completion, strengths, and limitations. The use of serial examination utilizing focused abdominal sonography for blunt trauma (FAST) to evaluate hemoperitoneum will be presented.

Abdominal compartment syndrome.

TOPIC: Abdominal compartment syndrome (ACS) in blunt and penetrating abdominal trauma. PURPOSE: To review the clinical manifestations, pathophysiology, and nursing management of patients with ACS. SOURCES: Published literature, case study. CONCLUSIONS: Trauma nurses play a key role in early identification and management of ACS. Priorities include knowledge of signs and symptoms, methods of measurement of ACS; specifics of wound care, psychosocial interventions, and key factors in discharge planning.

Laparoscopic applications for abdominal trauma injuries.

Laparoscopy has been shown to be an effective diagnostic and therapeutic modality for trauma patients. The benefits of laparoscopic intervention include the avoidance of negative laparotomy procedures, decreased patient morbidity rates, shorter hospital stays, and lower costs. Laparoscopic limitations are discussed in this article as well as the perioperative nursing considerations in all phases of trauma patients' care. Five case studies in which patients' care was enhanced by the use of laparoscopy are presented.