Department of Dermatology, Roskilde Hospital, Health Science Faculty, University of Copenhagen, Roskilde, Denmark.
JAMA Dermatol. 2014 Jul;150(7):730-6. doi: 10.1001/jamadermatol.2013.7962.
Despite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited.
To assess whether home care nurses achieve adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure.
DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional study from March 1, 2011, through March 31, 2012, in home care centers in 2 Danish municipalities. Sixty-eight home care nurses who managed wounds in their everyday practice were included.
Participant-masked measurements of subbandage pressure achieved with an elastic, long-stretch, single-component bandage; an inelastic, short-stretch, single-component bandage; and a multilayer, 2-component bandage, as well as, association between achievement of optimal pressure and years in the profession, attendance at wound care educational programs, previous work experience, and confidence in bandaging ability.
A substantial variation in the exerted pressure was found: subbandage pressures ranged from 11 mm Hg exerted by an inelastic bandage to 80 mm Hg exerted by a 2-component bandage. The optimal subbandage pressure range, defined as 30 to 50 mm Hg, was achieved by 39 of 62 nurses (63%) applying the 2-component bandage, 28 of 68 nurses (41%) applying the elastic bandage, and 27 of 68 nurses (40%) applying the inelastic bandage. More than half the nurses applying the inelastic (38 [56%]) and elastic (36 [53%]) bandages obtained pressures less than 30 mm Hg. At best, only 17 of 62 nurses (27%) using the 2-component bandage achieved subbandage pressure within the range they aimed for. In this study, none of the investigated factors was associated with the ability to apply a bandage with optimal pressure.
This study demonstrates the difficulty of achieving the desired subbandage pressure and indicates that a substantial proportion of patients with venous leg ulcers do not receive adequate compression therapy. Training programs that focus on practical bandaging skills should be implemented to improve management of venous leg ulcers.
尽管临床研究已经证明了压缩疗法的效果，并且该疗法已经广泛应用于临床，但静脉性腿部溃疡的治疗往往时间较长，复发率较高。关于所提供的压缩治疗的数据有限。
评估家庭护理护士在治疗静脉性腿部溃疡患者时是否能够达到足够的次级包扎压力，以及预测达到最佳压力能力的因素。
设计、地点和参与者：我们于 2011 年 3 月 1 日至 2012 年 3 月 31 日在丹麦两个城市的家庭护理中心进行了一项横断面研究。共纳入 68 名在日常实践中管理伤口的家庭护理护士。
参与者用弹性、长拉伸、单组分绷带、非弹性、短拉伸、单组分绷带和多层、双组分绷带进行了次级包扎压力的测量，以及达到最佳压力的能力与职业年限、参加伤口护理教育计划、既往工作经验和包扎能力信心之间的关联。
发现所施加的压力存在很大差异：非弹性绷带的次级包扎压力范围为 11mmHg，而 2 组分绷带的压力范围为 80mmHg。最佳次级包扎压力范围定义为 30 至 50mmHg，其中 62 名护士中的 39 名（63%）使用 2 组分绷带，68 名护士中的 28 名（41%）使用弹性绷带，68 名护士中的 27 名（40%）使用非弹性绷带达到了这一范围。超过一半的使用非弹性绷带（38 [56%]）和弹性绷带（36 [53%]）的护士获得的压力低于 30mmHg。在最佳情况下，只有 62 名护士中的 17 名（27%）使用 2 组分绷带达到了他们所期望的次级包扎压力范围。在这项研究中，没有调查到的因素与应用最佳压力绷带的能力相关。
这项研究表明，达到所需的次级包扎压力具有一定难度，并表明很大一部分静脉性腿部溃疡患者未接受足够的压缩治疗。应实施侧重于实际包扎技能的培训计划，以改善静脉性腿部溃疡的管理。
