Basınç Yarası Önleme Çalışmaları: Güncel Bakış

Yıl 2024, , 242 - 250, 27.08.2024

Zeynep Çor Ganime Esra Soysal

https://doi.org/10.46332/aemj.1419517

Öz

Basınç yaraları, yoğun bakımlarda sıkça karşılaşılan ağrılı ve önlenebilir yaralardır. Bu çalışmanın amacı, basınç yaralarının önlenmesi ve kontrolüne ilişkin en iyi kanıtları özetlemek, basınç yaralarının insidansını azaltmak ve bakım kalitesini artırmak için bir güncel bir kaynak oluşturmaktır. Bu amaçla basınç yaralarının önlenmesine yönelik rehberler ve son yayınlanan rehberlere ek olarak kanıt düzeyi yüksek çalışmaların yeni önerileri incelendi. Basınç yarası ile ilgili çalışmalar son dönemlerde arttığı görülmekle birlikte ve özellikle COVID-19 döneminde kullanılan yüzüstü pozisyonun basınç yaralarında da kullanılabileceği bildirilmektedir. Ancak, basınç yarası önlemede rehberlerin henüz bu pozisyonun belli bir kanıt seviyesinde önermediği görülmektedir. Basınç yaralarının önlenmesi için risk faktörlerinin değerlendirmede Braden Ölçeğinin kullanılması, deri değerlendirme ve bakımı, destek yüzeylerin birbirine üstünlüğü, yara örtüleri ile ilgili karşılaştırmalar ve eğitim konusu güncel çalışmalar ve kanıtlar sunularak ele alınmıştır. Bu bağlamda, güncel perspektifleri temel alarak basınç yaralarını önleme yöntemlerine odaklanan ve etkili stratejilerin belirlenmesine yönelik yeni yaklaşımların derlendiği bir çalışma sunulmaktadır.

Anahtar Kelimeler

basınç yarası, önleme, yara

Pressure Ulcer Prevention Studies: Current Perspectives

Öz

Pressure ulcers are common and painful wounds encountered in intensive care settings that are preventable. The aim of this study is to summarize the best evidence on the prevention and management of pressure ulcers, aiming to reduce their incidence and improve care quality by providing an updated resource. In addition to guidelines for pressure ulcer prevention and the latest published recommendations, new proposals from high-evidence studies were reviewed. Recent studies have shown an increase in research related to pressure ulcers, particularly highlighting the potential use of prone positioning, which was also utilized during the COVID-19 pandemic, in preventing pressure ulcers. However, guidelines for pressure ulcer prevention have not yet recommended this position at a certain level of evidence. The study also addresses the evaluation of risk factors using the Braden Scale, skin assessment and care, comparisons of support surfaces, comparisons of wound dressings, and educational strategies, all based on current research and evidence for preventing pressure ulcers. Thus, this study presents an overview of new approaches focusing on methods to prevent pressure ulcers, aiming to identify effective strategies based on current perspectives.

Anahtar Kelimeler

pressure ulcer, prevention, wound

Kaynakça

• 1. EPUAP/NPIAP/PPPIA. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. the International Guideline 2019; 2019. https://internationalguideline.com/2019. Accessed 01 December, 2023.
• 2. Adıbelli Ş, Korkmaz F. Yetişkin hastalarda basınç yarası gelişme riskini değerlendirmede kullanılan ölçekler. Süleyman Demirel Üniversitesi Sağlık Bilim Derg. 2018;9(2):136-140.
• 3. Kula Şahin S. Basınç yarası ve malnütrisyon. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi. 2020;8(3):923-945.
• 4. Beeckman D, Serraes B, Anrys C, et al. A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents. Int J Nurs Stud. 2019;97:105-113.
• 5. Cox J, Roche S, Murphy V. Pressure Injury Risk Factors in Critical Care Patients: A Descriptive Analysis. Adv Ski Wound Care. 2018;31(7):328-334.
• 6. Soodmand M, Moghadamnia MT, Aghaei I, et al. Effects of hemodynamic factors and oxygenation on the incidence of pressure ulcers in the ICU. Adv Ski Wound Care. 2019;32(8):359-364.
• 7. Labeau SO, Afonso E, Benbenishty J, et al. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med. 2021;47(2):160-169.
• 8. Wu J, Wang B, Zhu L, et al. Nurses’ knowledge on pressure ulcer prevention: An updated systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Front Public Heal. 2022;10:613-620.
• 9. Demarré L, Van Lancker A, Van Hecke A, et al. The cost of prevention and treatment of pressure ulcers: A systematic review. Int J Nurs Stud. 2015;52(11):1754-1774.
• 10. Li Z, Lin F, Thalib L, et al. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546.
• 11. Sayan HE, Girgin NK, Asan A. Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study. J Eval Clin Pract. 2020;26(6):1669-1676.
• 12. Kaşıkçı M, Aksoy M, Ay E. Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study. J Tissue Viability. 2018;27(3):135-140.
• 13. Çavuşoğiu A, Yeni K, İncekara H, et al. Pressure Ulcer Prevalence in a Intensive Care Unit: A Retrospective Study. J Acad Res Nurs. 2020;6(2):203-209.
• 14. Kiraner E, Kaya H. COVİD-19 tanısı ile yoğun bakımda yatan hastalarda basınç yaralanmalarının ve risk faktörlerinin retrospektif analizi. J Turkısh Socıety Crıtıcal Care Nurses. 2021;25(3):139-151.
• 15. Espejo E, Andrés M, Borrallo RM, et al. Bacteremia associated with pressure ulcers: a prospective cohort study. Eur J Clin Microbiol Infect Dis. 2018;37(5):969-975.
• 16. Antony L, Thelly AS, Mathew JM. Evidence-based Clinical Practice Guidelines for Caregivers of Palliative Care Patients on the Prevention of Pressure Ulcer. Indian J Palliat Care. 2023;29(1):75-81.
• 17. Dunk AM, Carville K. The international clinical practice guideline for prevention and treatment of pressure ulcers/injuries. J Adv Nurs. 2016;72(2):243-244.
• 18. Moore Z, Cowman S, Conroy RM. A randomised controlled clinical trial of repositioning, using the 30 tilt, for the prevention of pressure ulcers. J Clin Nurs. 2011;20(17‐18):2633-2644.
• 19. De Meyer D, Verhaeghe S, Van Hecke A, et al. Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool. J Tissue Viability. 2019;28(2):59-69.
• 20. Bereded DT, Salih MH, Abebe AE. Prevalence and risk factors of pressure ulcer in hospitalized adult patients; A single center study from Ethiopia. BMC Res Notes. 2018;11(1):1-6.
• 21. McEvoy NL, Friel O, Clarke J, et al. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care. 2023;28(6):1115-1123.
• 22. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78(10):1186-1194.
• 23. Dave K, Choudhary RD. Effectiveness of a pressure ulcer prevention package (pupp) for patients admitted in intensive care units: An experimental study. Int J Adv Nurs Manag. 2020;8(4):273-278.
• 24. Rahman-Synthia SS, Kumar S, Boparai S, et al. Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis. Enferm. Clin (English Ed). 2023;33(1):4-13.
• 25. Neloska L, Damevska K, Nikolchev A, et al. The association between malnutrition and pressure ulcers in elderly in long-term care facility. Open Access Maced J Med Sci. 2016;4(3):423-427.
• 26. Alhaug J, Gay CL, Henriksen C, et al. Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital population. Food Nutr Res. 2017;61(1):1324230.
• 27. Ter Riet G, Kessels AGH, Knipschild PG. Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers. J Clin Epidemiol. 1995;48(12):1453-1460.
• 28. Raffoul W, Far MS, Cayeux M-C, et al. Nutritional status and food intake in nine patients with chronic low-limb ulcers and pressure ulcers: importance of oral supplements. Nutrition. 2006;22(1):82-88.
• 29. Banks MD, Webster J, Bauer J, et al. Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study. J Wound Care. 2023;32(5):292-300.
• 30. Saghaleini SH, Dehghan K, Shadvar K, et al. Pressure ulcer and nutrition. Indian J Crit Care Med. 2018;22(4):283-289.
• 31. Shi C, Dumville JC, Cullum N, Rhodes S, McInnes E. Alternative reactive support surfaces (non-foam and non-air-filled) for preventing pressure ulcers. Cochrane Database Syst Rev. 2021;5(5):CD013623.
• 32. Shi C, Dumville JC, Cullum N, Rhodes S, McInnes E. Foam surfaces for preventing pressure ulcers. Cochrane Database Syst Rev. 2021;5(5):CD013621.
• 33. Baslı AA. Ameliyathanede Destek Yüzey Kullanımının ve Pozisyonların Arayüz Basıncına Etkisi. PhD Thesis. Ege University; 2019. https://tez.yok.gov.tr/UlusalTezMerkezi/tez. Accessed 17 November, 2023.
• 34. Shi J, Gao Y, Tian J, et al. Negative pressure wound therapy for treating pressure ulcers. Cochrane Database Syst Rev. 2023;5(5):CD011334.
• 35. Qiu X, Luo H, Huang G. Roles of negative pressure wound therapy for scar revision. Front Physiol. 2023;14:1-6.
• 36. Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M. Alginate dressings for treating pressure ulcers. Cochrane Database Syst Rev. 2015;2015(5): CD011277.
• 37. Dumville JC, Stubbs N, Keogh SJ, Walker RM, Liu Z. Hydrogel dressings for treating pressure ulcers. Cochrane Database Syst Rev. 2015;2015(2): CD011226.
• 38. Moore ZEH, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2018;12:1-88.
• 39. Hahnel E, El Genedy M, Tomova-Simitchieva T, et al. The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial. Br J Dermatol. 2020;183(2):256-264.
• 40. Arora M, Harvey LA, Glinsky JV., et al. Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev. 2020;1:1-96.
• 41. Liang Z, Lai P, Zhang J, et al. Impact of moist wound dressing on wound healing time: A meta-analysis. Int Wound J. 2023;20(10):4410-4421.
• 42. Roehrs H, Stocco JG, Pott F, Blanc G, Meier MJ, Dias FA. Dressings and topical agents containing hyaluronic acid for chronic wound healing. Cochrane Database Syst Rev. 2023;7(7):CD012215.
• 43. Cullum N, Liu Z. Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev. 2017;5(5):CD001180.
• 44. Al Aboud AM, Manna B. Wound pressure injury management.https://europepmc.org/article/nbk/nbk 532897. Accessed 17 December, 2023.
• 45. Mao X, Zhu L. Effects of care bundles for patients with pressure ulcers and the impact on self-care efficacy. Am J Transl Res. 2021;13(3):1799-1807.