Technology update Preventing post-operative blisters
The test dressing was applied to the wounds while in theatre and, unless considered necessary (ie as a result of exudate saturation, leakage or bad adhesion), dressings remained in place until the fourth post-operative day when the initial routine dressing change was performed. The reasons for early dressing changes were recorded. At dressing change, wounds were examined
for periwound skin blisters and exudate levels were documented. The test dressing was assessed for its ease of application and removal and nurses were asked to provide an overall evaluation of the dressing. Data from the completed case report forms were entered onto a Microsoft Excel spreadsheet and the results were presented graphically.
RESULTS During the study period, 146 patients had scheduled hip or knee arthroplasty at Alingsas Hospital. The sections of the patient forms relating to periwound skin status were all fully completed so data from all 146 patients were included in the analysis of results. Regarding the other parameters, 29 patient forms were filled in incompletely so data from 117 patients (40 male; 77 female) who underwent hip or knee surgery (62 and 55 patients respectively) were included in the final analysis. The median patient age was 72 years, ranging from 49 to 93 years. Prior to surgical intervention, 94% of patients were reported to have normal skin at the site of incision; 6% of patients had fragile skin, ie minor skin rashes associated with rheumatoid arthritis. Application of the test dressing to the post-
operative wound was graded as either 'easy' or 'very easy' in 5.1% and 94.9% of patients, respectively [Fig 2].
POST-OPERATIVE CARE In 74% of the patients, the initial dressing change was performed on the fourth post- operative day. Due to the high level of exudation, 26% of patients required dressings to be changed earlier in order to avoid the problem of dressing saturation and leakage [Fig 3]. Further analysis of this sub-population revealed more than 75% of these dressing changes were associated with medium to high exuding wounds [Fig 4].
The removal of the test dressing was found to be 'easy' or 'very easy' in 8.6% and 89.7% of patients, respectively [Fig 5]. Furthermore, only one out of the 117 dressings (0.9%) became
100 80 60 40 20 0
Very easy Easy Figure 2: The ease of application of Mepilex Border. Satisfactory Hard Very hard
Day 4: 74% Before day 4: 26%
Saturated: 12% Bad adhesion: 1% Leakage: 7% Other: 1% Saturated leakage: 5%
Figure 3: Times of dressing change and reason.
caught in the wound sutures and there were just five (4.3%) reported occurrences of bleeding upon dressing removal, none of which were deemed by the investigators as being dressing- related [Fig 6].
PERIWOUND SKIN STATUS All 117 patients (100%) showed no signs of blistering to the periwound skin at the initial dressing change following post-operative treatment with the test dressing [Fig 7].
OVERALL ASSESSMENT The overall assessment of the test dressing as a postoperative wound dressing was reported by the nurses to be 'good' or 'very good' in 9.4%
References
7 Jester R, Russell L, Fell S, Williams S, Prest C. A one hospital study of the effect of wound dressings and other related factors on skin blistering following total hip and knee arthroplasty. J Orthopaedic Nurs 2000; 4(2): 71–77.
8Wright M. Hip blisters. Nurs Times 1994; 90(16): 86–88.
9Milne MT, Barrere CC, McLaughlin T, Moore A. Surgical hip dressings: a comparison of taping methods. Orthop Nurs 1999; 18: 37–42.
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Technology and product reviews
Percentage of patients
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