Deidre D. Wipke-Tevis

Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions

OBJECTIVE To describe the frequency, manifestations, and correlates of impaired healing of saphenous vein (SV) harvest incisions in hospitalized patients who had undergone coronary artery bypass grafting (CABG). DESIGN Prospective, descriptive, correlational. SETTING West Coast university-affiliated medical center. PATIENTS Thirty-two English-speaking adults who had undergone CABG. OUTCOME MEASURES Impaired wound healing of SV-harvest incisions. RESULTS The overall incidence of impaired healing was 43.8%. The most frequent manifestations of impaired wound healing at discharge were prolonged erythema (8/32), prolonged drainage (8/32), and both prolonged erythema and drainage (2/32). Correlates of impaired healing of SV-harvest incisions were body mass index (product-moment correlation = 0.39, p = 0.026) and preoperative use of diuretics (point biserial correlation = 0.42, p = 0.016). CONCLUSIONS Impaired healing of SV-harvest incisions in this sample occurred more frequently than previously indicated in the literature. Although severe wound infections were infrequent, a high degree of impaired healing occurred (43.8% of patients who had undergone CABG). Future studies need to explore the long-term effects of impaired healing and test interventions to mitigate impaired healing in this population.

Nutrition, tissue oxygenation, and healing of venous leg ulcers

The purpose of the prospective study described in this article was to explore nutrition, tissue oxygenation, and healing in venous ulcer patients. Nutritional risk, anthropometric measures, biochemical indices, two 3-day dietary records, and transcutaneous tissue oxygen levels were obtained. Wound surface area was evaluated 2 times, 4 weeks apart. A convenience sample of 25 English-speaking persons with 1 or more venous ulcers participated (mean age 59.8 years, 60% men, 48% white). Moderate or high nutritional risk existed in 84% of the persons in the sample. Based on body mass index, more than 50% of the persons in the sample were obese. Nonetheless, 17 of 25 persons in the sample had 1 or more abnormal biochemical nutritional indices. In addition, caloric intake (17 of 20), protein intake (15 of 20), and zinc intake (17 of 20) were inadequate to meet the needs for healing. No statistically significant relationships were found between biochemical nutritional indices, tissue oxygenation, and healing. The women in the sample were more likely to heal than were the men (P < 0.05). This study begins to document the problems of overnutrition and undernutrition in the venous ulcer population. Future studies need to explore the effects of obesity and inadequate intake on the healing of venous ulcers. Additional examination of the differences between men and women also is warranted to identify predictors of venous ulcer healing.

Tissue oxygenation, perfusion, and position in patients with venous leg ulcers.

OBJECTIVES The purpose of this study was to compare the partial pressure of transcutaneous tissue oxygen (TcPO2) in persons with venous ulcers in four positions with and without inspired oxygen. METHODS TcPO2 was evaluated two times, 4 weeks apart at a chest reference and three lower extremity sites. RESULTS Lower extremity resting TcPO2 levels were lower in patients with venous ulcers than in healthy adults. Minimal changes in TcPO2 occurred with position changes when subjects breathed room air. When arterial oxygen saturation was increased using inspired oxygen, TcPO2, used as an indicator of perfusion, was lower during leg elevation, sitting, and standing compared to lying supine (p < 0.05). CONCLUSIONS Control of peripheral circulation and tissue oxygenation may be impaired in persons with venous ulcers. Leg elevation, sitting, and standing decreased wound perfusion and may not be beneficial to individuals with venous insufficiency and ulceration. Research is needed to explore relationships among tissue oxygenation, blood perfusion, compression, positioning, and venous ulcer healing.

Nutritional risk, status, and intake of individuals with venous ulcers: A pilot sutdy

Chronic leg ulcers occur in at least 1% of the adult population. The healing of these ulcers remains a clinical challenge. The purpose of this pilot study was to explore the nutritional risk, status, and intake of seven patients with venous ulcers. The Public Awareness Checklist categorized two subjects as being at low risk, two as moderate risk, and three subjects as high nutritional risk. Biochemical indicators of nutritional status identified abnormalities in hemoglobin and/or hematocrit, albumin, transferrin, zinc, and total lymphocyte count. Mean daily intake was inadequate to meet caloric needs in five of six subjects. By conservative estimates (RDA), two subjects had an inadequate protein intake. Data suggest that at least some individuals with venous ulcers are at nutritional risk, have abnormalities in their nutritional status, and/or have an inadequate intake to support healing. Future research is needed to explore the relationship between nutrition and rate of healing in individuals with venous ulcers.

Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: A pilot study

Purpose This study was completed to determine whether there were differences between sterile versus clean dressing change technique for open surgical wounds in the postoperative period with respect to (1) rate of wound healing and (2) cost of supplies. Methods A two-group design was used for this pilot study. Of a sample of 30 patients undergoing elective gastrointestinal operations with wounds healing by secondary intention, 15 were men and 15 were women. Mean age was 40.6 years (SD 13.0 years). Patients were randomly assigned to receive clean or sterile dressings, and the intervention was begun on the first postoperative day and repeated three times a day until discharge from the hospital. Analysis of rate of healing was performed with the Mann-Whitney U test; cost analysis was completed with a t test. Findings Subjects were studied for 3 to 9 days. Groups were homogeneous at the start of treatment with respect to age, length of operation, wound volume, nutritional status, and perfusion. There was no difference in rate of wound healing between the clean and sterile groups. Mean cost was significantly less for the clean group than for the sterile group. Conclusion These pilot study data show no difference in rate of wound healing with clean versus sterile technique, and clean technique is less expensive. These findings need to be confirmed with a larger sample; type II error cannot be ruled out.

Adapting wound care for complex patients

This article describes the management of complex patients with wounds. Basic prin ciples of wound care, understanding the patients underlying condition, interdiscipli nary approaches to care, and case studies are included.

Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse.

PURPOSE: The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care (LTC) facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse. DESIGN: Secondary analysis of narrative data obtained from a mixed-methods study. SUBJECTS AND SETTING: The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high-ITS facility and 13 from the low-ITS facility. Respondents included certified nurse assistants, certified medical technicians, restorative medical technicians, social workers, RNs, licensed practical nurses, information technology staff, administrators, and directors. METHODS: This study is a secondary analysis of interviews regarding communication and education strategies in 2 LTC agencies. This analysis focused on focus group interviews, which included both direct and nondirect care providers. RESULTS: Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high-ITS and low-ITS facilities in regard to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting. CONCLUSIONS: Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS.