المؤلفون: Catherine R. Ratliff

المصدر: Journal of Vascular Nursing. 38:72-75

مصطلحات موضوعية: Male, medicine.medical_specialty, Heel, medicine.medical_treatment, 030204 cardiovascular system & hematology, Amputation, Surgical, Vascular Nursing, 03 medical and health sciences, 0302 clinical medicine, Wheelchair, Humans, Medicine, Aged, Retrospective Studies, Peripheral Vascular Diseases, Pressure Ulcer, 030504 nursing, Pressure injury, business.industry, Vascular surgery, Sacrum, Medical–Surgical Nursing, Cross-Sectional Studies, medicine.anatomical_structure, Lower Extremity, Amputation, Emergency medicine, Female, 0305 other medical science, business, Risk assessment

الوصف: Individuals with peripheral arterial disease who have undergone below or above knee amputations have limited mobility and may sit for long periods of time in a wheelchair, increasing their risk for pressure injury. The aim of this descriptive cross-sectional research study was to retrospectively review the charts of those patients with peripheral arterial disease undergoing lower limb amputations from 2016 to 2017 at a major academic medical center to determine the frequency of pressure injury. Hospital data were used to identify patients discharged from 2016 to 2017 with primary International Classification of Diseases (10th Revision) codes for below knee amputations/above knee amputations and pressure injury (ulcer). From 2016 to 2017, 46 patients were admitted to the inpatient vascular surgery service for a below or above knee amputation. Seventeen of those patients had documented pressure injuries at hospital discharge for a frequency of 37%. There were 11 males and 6 females with age range of 44 to 82 years with a mean age of 66 years. There was a total of 19 pressure injuries (2 patients had 2 pressure injuries). Ten of those 19 pressure injuries were present on admission to the hospital and 9 pressure injuries were hospital-acquired pressure injuries. Thirteen of the 19 pressure injuries (68%) were on the sacrum. Three of the pressure injuries (16%) were on the heel. Two (11%) were ischial pressure injuries with one knee (5%) pressure injury. Risk assessment is an essential part of vascular nursing practice that aims to identify individuals at risk for pressure injury with appropriate interventions to prevent their occurrence. Vascular nurses should be encouraged to educate patients/family members on the increased risk of pressure injuries in those undergoing amputation during hospitalization and after discharge to prevent them from occurring.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7d399edbfb353f0ab74e10d1c436909aTest
https://doi.org/10.1016/j.jvn.2020.02.003Test

المؤلفون: Gilbert R. Upchurch, Kenneth J. Cherry, David Strider, Catherine R. Ratliff

المصدر: Journal of Vascular Nursing. 36:40-44

مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Femoral artery, Bacitracin, 030230 surgery, 03 medical and health sciences, Pseudoaneurysm, 0302 clinical medicine, Antiseptic, medicine.artery, medicine, Humans, Surgical Wound Infection, Povidone-Iodine, Saline, Retrospective Studies, Groin, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, Femoral Artery, Medical–Surgical Nursing, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Anti-Infective Agents, Local, Female, Complication, business, Vascular Surgical Procedures, medicine.drug

الوصف: The aim of the study was to conduct a retrospective chart review of patients who underwent betadine/bacitracin continuous irrigation (BBCI) for vascular graft infections (VGIs) to review its use as a treatment option. A retrospective chart review from 2013 to 2017 was conducted of patients with VGIs that were treated with BBCI postremoval of the infected graft. The BBCI is a continuous infusion of 0.25% betadine in normal saline at 0.3 mL/kg/h for 48 hours then followed by bacitracin infusion with a concentration of 50,000 units bacitracin/per liter normal saline at 0.3 mL/kg/h for 72 hours. Descriptive statistics were used to describe the sample. The nine adult patients who received postoperative BBCI had an age range of 30–81 years, with average age of 58.8 years. Five of the subjects were females with four males. A total of nine patients with groin infections were identified, with two aortobifemoral bypasses, two axillofemoral bypasses, three femoral-femoral bypasses, one femoral artery pseudoaneurysm repair with Dacron patch, and one common femoral endarterectomy with Dacron patch. VGIs were identified from 10 days up to 72 months from the original vascular procedure. Six patients had negative wound cultures, while two had wound cultures positive for methicillin-resistant Staphylococcus aureus and one patient had positive culture for Escherichia coli . The length of time of BBCI ranged from 48 to 84 hours with average of 57.6 hours (standard deviation [SD] = 12.7 hours). The length of time of the bacitracin irrigation ranged from 30 to 72 hours with average of 48.4 hours (SD = 14.9 hours). All patients healed their groin wounds except for an 81-year-old patient with aortobifemoral bypass graft who developed ischemic bowel and expired. Patients received at least 6 weeks of intravenous antibiotics followed by oral antibiotic suppression therapy for life. VGIs are a devastating complication associated with a high morbidity. BBCI provides an option for antiseptic irrigation of the vascular graft site postgraft removal to promote wound closure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6d0ef6f9a2f6e2569d9033a492a5386eTest
https://doi.org/10.1016/j.jvn.2017.10.001Test

المؤلفون: Catherine R. Ratliff, Suzanne Fuhrmeister, David Strider, Danielle Moses, Kenneth J. Cherry, Mary Baldwin, Jennifer Johnson, Gilbert R. Upchurch, Margaret C. Tracci, Marian Lawson, Alison Okerlund, Tanya R. Flohr, Julie Armatas, Virginia Rovnyak

المصدر: Journal of Wound, Ostomy & Continence Nursing. 44:524-527

مصطلحات موضوعية: Adult, Male, Volunteered geographic information, medicine.medical_specialty, Transplants, 030204 cardiovascular system & hematology, Hypoxemia, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Internal medicine, Statistical significance, medicine, Humans, Surgical Wound Infection, Vascular Diseases, 030212 general & internal medicine, Aged, Retrospective Studies, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Incidence, Incidence (epidemiology), Virginia, Retrospective cohort study, Perioperative, Middle Aged, medicine.disease, Confidence interval, Medical–Surgical Nursing, Lower Extremity, Female, medicine.symptom, business

الوصف: PURPOSE The purpose of this study was to identify factors that increase the risk of vascular graft infections (VGI) in patients following abdominal or lower extremity revascularization surgery. DESIGN Retrospective, descriptive study. METHODS We reviewed the electronic health records of 223 patients who had undergone abdominal or lower extremity revascularization procedures from July 2012 to November 2014, looking for factors associated with VGI. We reviewed 28 preoperative, intraoperative, and post-operative factors. Descriptive statistics (mean, range, and standard deviation) were used to describe the sample; χ was used to determine correlations between the risk factors and subsequent VGIs. The level of significance was determined at P = .05, with a confidence level of 95%. RESULTS We identified 33 cases of VGIs for the 223 charts reviewed, yielding an incidence rate of 15%. Seventeen of the 33 patients with VGI (51.5%) were male. The average age of patients who experienced VGI was 60.9 years (standard deviation, 12.2 years, range, 29-81 years). Preoperative factors that were shown to show statistical significance for the development of VGI were sequential procedures (P = .003), diabetes mellitus (P = .002), hemoglobin A1c more than 7.0 (P = .0002), blood glucose more than 180 mg/dL (P = .0006), and lack of mobility (0.0097). Intraoperative factors associated with VGI were hemostatic agents applied to the surgical field intraoperatively (P = .003) and perioperative hypoxemia (P = .027). Postoperative factors associated with VGI were discharge from the hospital to skilled nursing facility or acute rehabilitation facility (P = .005) and unscheduled clinic visits (P = .008). CONCLUSION We measured a 15% incidence of VGI and identified multiple pre-, intra-, and postoperative associated factors. Vigilance is required to prevent VGI and knowledge of specific risk factors is important.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f70c4bafe64e1344d802d8faf48da5f3Test
https://doi.org/10.1097/won.0000000000000376Test

المؤلفون: Catherine R. Ratliff, David B. Drake, Helen B. Zuelzer

المصدر: Annals of Plastic Surgery. 64:598-604

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Statistics, Nonparametric, Body Mass Index, Postoperative Complications, medicine, Panniculectomy, Humans, Obesity, Contraindication, Retrospective Studies, Analysis of Variance, Chi-Square Distribution, Abdominoplasty, business.industry, Medical record, Middle Aged, Plastic Surgery Procedures, medicine.disease, Subcutaneous Fat, Abdominal, Surgery, Plastic surgery, Treatment Outcome, Female, Complication, business, Body mass index

الوصف: Medical records of 122 patients who underwent an abdominoplasty or panniculectomy trom 2003 to 2008 were reviewed to determine current rates of wound complications associated with these procedures in the presence of obesity. An additional aim was to determine current rates of complications as compared with those found 10 years ago at our institution to determine if the finding of obesity alone continues to adversely affect wound outcomes. Sixty-three of 122 patients (51.6%) experienced 1 or more wound-related complications. Major complications occurred in 13 patients (10.7%). A striking finding was that the lowest major complication rate 4.5%, was found in patients with extreme obesity (BMI >40). Comparisons between the 1999 and current studies found that the difference in major complications in those classified as obese, with 2 (9%) in the current study and 8 (40%) in the 1999 study, was significant (P = 0.039). Our findings suggest that high rates of major complications found in those with obesity in the 1999 study are not found today. Extreme obesity is not an absolute contraindication to operation and may be performed safely.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7c8c323ef89c34124702855722fb8230Test
https://doi.org/10.1097/sap.0b013e3181cf9f9eTest

المؤلفون: Catherine R. Ratliff, David B. Drake, Tonja Weed

المصدر: Annals of Plastic Surgery. 52:276-279

مصطلحات موضوعية: Bacterial clearance, Wound Healing, medicine.medical_specialty, Time Factors, Debridement, Vacuum, integumentary system, business.industry, medicine.medical_treatment, Suction, Surgery, Bioburden, Treatment Outcome, Bacterial colonization, Treatment modality, Negative-pressure wound therapy, Humans, Surgical Wound Infection, Medicine, business, Wound healing, Beneficial effects, Retrospective Studies

الوصف: The bacterial colonization of a wound is a recognized detrimental factor in the multifactorial process of wound healing. The harmful effects on wound healing are recognized to correspond to a level of > 10(5) colonies of bacteria per gram of tissue. Negative pressure wound therapy has become an accepted treatment modality for acute and chronic wounds with accelerated healing rates observed. It has been previously reported that this therapy enhances bacterial clearance, which may account for the wound healing effects noted. We retrospectively reviewed 25 patients' charts undergoing Wound VAC (Vacuum Assisted Closure Device; KCI International, San Antonio, TX) therapy with serial quantitative cultures and found that there is not a consistent effect of bacterial clearance with the Wound VAC. Furthermore, bacterial colonization increased significantly with Wound VAC therapy and remained in a range of 10(4)-10(6). Despite this finding, the beneficial effects of this treatment modality on wound healing were noted in most cases.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ac73d05611c62bc889f505b439468080Test
https://doi.org/10.1097/01.sap.0000111861.75927.4dTest