Hydration and pressure ulcer prevention: a pilot study

ABSTRACT: Links between nutrition and pressure ulcer (PU) prevention and wound healing are well known and documented (Saghaleini et al, 2018). Less well documented is the link between hydration and pressure care. It was recognised that many patients admitted to acute hospitals are dehydrated (El-Sharkawy et al, 2015); this is particularly relevant to Gastroenterology patients based on the classifications of dehydration (Posthauer, 2016), although all patients are at risk. Dehydration status is not routinely assessed without painful and costly blood tests. Through the use of an adapted version of the GULP Dehydration risk screening tool (Food First Nutrition and Dietetics Team, 2012) and the implementation of a hydration-focussed care plan, it may be possible for a nurse-led assessment to identify dehydration risk and plan care accordingly. A pilot study showed that 50% of the sample group gained an improved level of hydration throughout their hospital admission and a decrease in their Waterlow score.

KEY WORDS Dehydration risk assessment GULP risk assessment Hydration Pressure ulcer prevention Nurse-led care

KAREN GREEN    Deputy Sister and Chief Nurse   Fellow, University Hospitals of Leicester NHS Trust, Leicester, UK

Maggot debridement therapy for individuals with diabetic foot ulceration: a service evaluation

Objective: To examine the use of maggot debridement therapy (MDT) for individuals with diabetic foot ulcers (DFU) after a change in prescribing policy.

Method: A self completion survey/structured questionnaire to assess healthcare professionals' existing knowledge of MDT was given to those specialist services providing wound care treatments for DFUs.

Results: The results showed that those responding had a basic understanding of MDT and its use. However, further education is required for the type of wounds that maggots can be applied to, and what enzymes are produced. Enablers and barriers to MDT use also included policy and procedures, time constraints and the 'yuck factor'.

Conclusion: While there is good clinical evidence to support the use of MDT, there is a lack of evidence examining the factors that influence healthcare professionals’ decisions to recommend this treatment.

KEY WORDS  Maggot debridement therap  Lucillia sericata   Diabetic foot ulcer  Attitudes/knowledge  Service evaluation

CRAIG FAIREY Tissue Viability Podiatrist, Sound Primary Care Network, Oakside Surgery, Honicknowle Green Medical Centre, UK SAMANTHA HOLLOWAY Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales, UK

Management of complex pressure ulcer affecting paraplegic patient: a case study

Background: Pressure damage in paraplegic patients is difficult to manage due to their limited mobility. Topical Negative Pressure Therapy (TNPT) has successfully been used for different types of wounds, including cavity wounds, leg ulceration and pressure ulcers (PU). The introduction of TNPT with instillation (TNPTi) has increased the categories of wounds that can be treated. Aim: To describe the wound management of an unstageable pressure damage with underlying osteomyelitis. Methods: Observation of the care provided to a patient presenting with an unstageable pressure damage on admission. On further investigation osteomyelitis was found. Results: Following 3 months of the application of TNPTi, the wound size had reduced significantly, making it suitable for flap surgery. The benefits of undertaking flap surgery after an overall short time thanks to this treatment includes also the psychological and social aspects of the patient’s life. This also reflected in a positive impact on the patient's wellbeing and reduced length of hospitalisation. Conclusions: The use of TNPTi positively affected the healing process of an unstageable PU presenting with osteomyelitis. Further studies are needed to validate the effectiveness this treatment regimen.

ALBERTO SPITILLI Specialist Nurse in Tissue Viability, Oxford University Hospital NHS Foundation TRUST

KEY WORDS Osteomyelitis Pressure ulcer Topical negative pressure therapy (TNPT) Paraplegic

Periwound maceration skin management strategies using a skin barrier film on diabetic foot ulcers

Alexandra Freitas

      In the diabetic foot, loss of autonomic nerve supply can alter the vascular perfusion and nerve supply of the skin. This affects the integrity of the skin and its resistance to mechanical and chemical trauma from pressure and wound exudate (Faber et al, 1993). Maceration is a common problem, particularly in the management of chronic wounds (Thomas, 1997). Moreover, diabetic foot ulceration continues to be synonymous with delayed healing, higher infection rates and an increased risk of lower-extremity amputation (Frykberg, 1998). Several factors can affect the local wound environment in diabetic foot ulceration, such as hyperglycaemia, macrovascular and microvascular disease, polyneuropathy, and impaired host immunological defence (Kamal et al, 1996). Maceration of the wound bed and surrounding skin in diabetic foot ulceration may be one of the least well-recognised factors contributing to impaired healing (Cullum et al, 2000). The impact of maceration on skin integrity, and its traditionally poor management and frequency, make it an obvious contender for inclusion as a risk factor in wound care (Cutting and White, 2002b). However, there is little research on the possible implications of maceration in diabetic foot ulceration (Bale et al, 2001). The aims of wound management are to address patient concerns, correct intrinsic and extrinsic factors where possible, and optimise the healing environment. It is also essential to include the periwound margins as an integral part of wound assessment (Cutting and White, 2002a).

Citation: Freitas A (2022) Periwound maceration skin management strategies using a skin barrier film on diabetic foot ulcers. The Diabetic Foot Journal 25(3): 34–41

Key words: - Barrier Film - Diabetic foot ulcer - Maceration - Periwound protection - Skin management

This article is sponsored by Medicareplus International

Authors

Alexandra Freitas, Clinical Nurse Advisor, Medicareplus International, London

The prevention of medical-device related pressure ulcers in a Critical Care Unit

This article explores medical-device related pressure ulcers (MDRPU) in an intensive care unit (ICU) at the Royal United Hospitals Bath NHS Foundation Trust (RUH). The data presented outlines a reduction in PU of 66% over a 6-year period and a reduction in MDRPU of 50% over the same period. MDRPU were particularly challenging to prevent in ICU during the COVID-19 pandemic, where there were additional numbers of patients in the ICU with medical devices in place. Additionally, during the COVID-19 pandemic, an increased number of patients in the ICU were nursed prone (face down), adding additional pressure on the facial structure, a range of measures were put in place to avoid those avoidable MDRPU in the ICU at the RUH. Measures focused on skin checking, offloading and rotation of devices, including endotracheal tubes, non-invasive ventilation, nasogastric (NG) and nasojejunal (NJ) tubes and catheters. A specific comfort and pressure care record was developed for ICU to record the assessments of these at risk areas.

KEY WORDS Pressure ulcer  Device-related  pressure ulcer  DRPU Medical-device related pressure ulcers

NICOLA HEYWOOD Tissue Viability Nurse Specialist, Royal United Hospitals Bath NHS Foundation Trust.

STEPHANIE WORTHINGTON Tissue Viability Nurse and Critical Care Sister, Royal United Hospitals Bath NHS Foundation Trust.

MICHAELA ARROWSMITH  Lead Tissue Viability Nurse,Royal United Hospitals Bath NHS Foundation Trust. 

MARGI JENKINS Matron, Critical Care Services, Royal United Hospitals Bath NHS Foundation Trust.

LAURA HERRING  Tissue Viability Nursing Assistant, Royal United Hospitals NHS Foundation

Use of Granulox, a topical haemoglobin spray, to ‘kick start’ the healing of a static pressure ulcer

      Pressure ulcers (PU) are caused when persistent pressure and/or friction/shear force is applied to an area of skin, generally over bony prominences, e.g., heel, trochanter, and sacrum, sufficient to impair the blood supply (National Health Service (NHS) Improvement, 2018; European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), and Pan Pacific Pressure Injury Alliance (PPPIA), 2019). PUs are characterised on a severity scale that ranges from discoloured skin to open wounds with exposed underlying muscle and bone (NPUAP, 2017). Those at risk for the development of a PU are people that are unable to move regularly, especially the critically ill, the elderly, or anyone with a lack of sensory perception, e.g., spinal cord injury or neurological impairment. In addition, the condition of the soft tissue and its microclimate, as well as the nutrition status and comorbidities of the patient, can influence PU formation (NPUAP, 2017). Once a PU has developed, especially if it proves hard-to-heal, it can significantly impact on the quality of life of the patient. Patients report that their emotional, mental, physical, and social wellbeing is affected, especially when an PU proves hard to manage and fails to heal (Gorecki et al, 2012). Therefore, it is imperative that patients are provided with a comprehensive PU treatment plan that ensures the best possible healing outcome for the patient, with the best economic outcome for the healthcare provider.

KEY WORDS Chronic wounds Granulox Haemoglobin Hard-to-heal wounds Pressure ulcer

KATIE JEFFREY Development Community Tissue Viability Nurse, HCRG Care Group, North Kent, Sittingbourne Community Hospital, Sittingbourne, UK