Journal of Wound Ostomy and Continence Nursing最新文献

In clinical practice, a large variety of medical devices adhere to skin to perform their function. The repeated application and removal of these devices can lead to skin damage or medical adhesive-related skin injury. Awareness of this problem has increased in the past decade, and this adverse event can be prevented with appropriate selection of adhesive products and the appropriate techniques for application and removal. A wide variety of adhesives and backing systems have been developed to create medical devices with an array of attributes, so they can accomplish many different indications in the clinical setting and meet various needs, including doing the clinical job without damaging the skin and causing further patient complications. The selection of an adhesive product should take into consideration a patient's skin assessment and history of medical adhesive-related skin injury, and using only the minimal adhesive strength needed to perform the function while protecting the skin from damage.

Peripheral artery disease is a complex health condition. It is associated with atherosclerotic occlusive lesions in the arteries limiting normal blood flow, mostly involving the lower extremities, leading to chronic limb-threatening ischemia (CLTI). Chronic unrelenting ischemic leg pain can be debilitating and distressing, contributing to poor health-related quality of life. Comprehensive management of pain associated with CLTI requires multimodal approaches that draw on a range of strategies and specialist treatments delivered by an interdisciplinary team across various health care settings. We recognized a significant gap in evidence-based strategies that are accessible, appropriate, acceptable, effective, and safe for the elderly with CLTI-associated pain. We therefore conducted an umbrella review or overview of multiple existing reviews that employ a rigorous and transparent method to comprehensively identify and synthesize relevant literature including systematic, scoping, and narrative reviews. The purpose of this umbrella review was to aggregate and compare various management options to inform best practices and quality indicators for the management of ischemic pain in older patients with peripheral artery disease.

Purpose: The purpose of this study was to describe nurses' experiences of caring for patients with colorectal cancer who underwent surgery to create a spontaneously closed defunctioning tube ileostomy after low anterior resection.

Design: Exploratory, descriptive study.

Subjects and settings: Data were collected from 6 registered nurses specialized in Wound, Ostomy and Continence Care (WOC nurses). The patient cohort comprised 247 hospitalized patients with histologically confirmed colorectal cancer who underwent low anterior resection of the rectum and creation of a closed defunctioning tube ileostomy. The study setting was the First Affiliated Hospital, Zhejiang University School of Medicine.

Methods: Semi-structured interviews and content analysis were used to collect and analyze data. The Wound, Ostomy and Continence Care nurses visited patient participants 1 week after hospital discharge and 1 to 2 times per week until the cannula was removed and the ostomy wound closed. Data were collected over a 6-month span after the surgery from January 2016 to December 2018.

Results: Content analysis identified 7 management strategies unique to caring for patients with a closed defunctioning tube ileostomy. They are: (1) cannula fixation (securement); (2) maintaining inflation of the cannular balloon to prevent fecal flow into the distal bowel, (3) cannular patency, (4) dietary advice for prevention of cannular blockage, (5) selecting an ostomy pouching system, (6) patient education, and (7) care during and following cannula removal (extubation).

Conclusions: We identified 7 areas of nursing care unique to the closed defunctioning tube ileostomy that provide a basis for creating clinical guidelines for patients undergoing this procedure.

Awareness of medical adhesive-related skin injury (MARSI) has increased in the decade since a foundational consensus report was published in 2013. Additional research has provided greater knowledge of the epidemiology of MARSI, along with its assessment, prevention, and management. To summarize knowledge generated in the past decade and review our current understanding of MARSI, a panel of nine clinical experts from four countries (United States of America, United Kingdom, Canada, and Brazil) convened to discuss the literature published since the initial 2013 document and develop updated recommendations for clinical practice. The group formulated 20 updated consensus statements covering the assessment, prevention, and management of skin injuries related to adhesive medical devices and proposed next steps to address remaining gaps in research and knowledge of this complex and clinically relevant condition.

This article is an executive summary of the Wound, Ostomy, and Continence Nurses Society's (WOCN) 2024 Guideline for Management of Wounds in Patients With Lower Extremity Arterial Disease. It is part of the Society's Clinical Practice Guideline Series. This article presents an overview of the systematic process used to update and develop the guideline. It also lists specific recommendations from the guideline for screening and diagnosis, assessment, management, and education of patients with wounds due to lower extremity arterial disease (LEAD). Suggestions for implementing recommendations from the guideline are also summarized. The guideline is a resource for WOC nurse specialists, other nurses, and health care professionals who work with adults who have/or are at risk of wounds due to LEAD. The complete guideline includes the evidence and references supporting the recommendations, and it is available from the WOCN Society's Bookstore (www.wocn.org). Refer to the Supplemental Digital Content Appendix (available at: http://links.lww.com/JWOCN/A123) associated with this article for a complete reference list for the guideline.

Purpose: The purpose of this study was to determine the incidence and identify potential risk factors for medical device-related pressure injury (MDRPI) in critically ill and hemodynamically unstable adults (patients classified class III or IV on the Therapeutic Intervention Scoring System-28; TISS-28).

Design: Prospective cohort study.

Subjects and setting: The target population was critically ill adults who were using one or more medical devices and categorized as class III or IV on the TISS-28. The study sample comprised 77 participants followed daily until discharge, death, transfer, or lesion development. Data were collected from January to March 2020. The study setting was an intensive care unit with 40 beds in a large hospital in a municipality in the state of Minas Gerais, Brazil.

Methods: Sociodemographic and pertinent clinical data, pressure injury (PI) risk assessed using the Braden Scale for Pressure Sore Risk, and head-to-toe skin inspections were completed. The incidence rate of MDRPIs was calculated, and survival analyses were completed via the Kaplan-Meier method and Cox regression model.

Results: Forty-nine of 77 participants developed an MDRPI, reflecting an incidence rate of 63.6%. Collectively, 71 MDRPIs occurred in these 49 participants. Univariate analysis indicated significant associations between MDRPI occurrences and level of consciousness ( P = < .001), use of tube holder for ventilation devices ( P = .013), nasal cannula ( P = .034), nasogastric cannula ( P = .034), presence of edema ( P = .001), infection ( P = .007), higher TISS score ( P = .047), and greater number of medical devices ( P = .022). Survival analysis indicated that a high or very high-risk score on the Braden Scale for Pressure Sore Risk ( P = .043) and edema ( P = .030) are risk factors for MDRPI occurrences in this vulnerable population.

Conclusions: The incidence rate of MDRPIs was 63.6%. The categories with the highest high or very high risk scores on the Braden Scale for Risk of Pressure Pain and Edema emerged as risk factors for MDRPI in this critically ill and vulnerable population.