Applewhite Andrew, Chowdhry Saeed A, Desvigne Michael, Gabriel Allen, Hill Rosemary, Obst Mary Anne, Shepherd Dawn, Speyrer Marcus, Treadwell Terry, Waddell Lindsey
Baylor University Medical Center, Comprehensive Wound Center, Dallas, TX.
Advocate Christ Hospital, Chicago, IL.
Wounds. 2018 Aug;30(8 supp):S19-S35.
The increase in wound prevalence means more patients with wounds are being transferred through care settings than ever before. Although the goals of therapy may be the same in both settings, wound care therapies and dressings differ in availability and appropriateness for each setting. Negative pressure wound therapy (NPWT) modalities and oxidized regenerated cellulose (ORC)/collagen (C)/silver-ORC dressings are available in both inpatient and outpatient care settings, but (to-date) lack comprehensive information regarding best practices in transitioning use of these therapies between various care settings. A panel meeting was convened to provide literature- and experience-based recommendations in transitioning wound care patients between various care settings. The use of NPWT with instillation and dwell time was recommended in wounds contaminated with debris and/or infectious materials or heavy exudate. In addition, ORC/C/silver-ORC dressing application was recommended for surface bleeding and for placement into explored areas of undermining to help promote development of granulation tissue. When transitioning a patient from inpatient to outpatient care, overall health, access to services, severity and complexity of the wound, and equipment availability should be taken into consideration. Treatment modalities to bridge the gap during care transition should be used to help maintain continuous care. For outpatient care, NPWT use was recommended for removal of infectious materials and exudate management. The ORC/C/silver-ORC dressings also may be used to help manage exudate and promote granulation tissue development and moist wound healing. In addition, practice challenges and potential solutions for patient adherence, interrupted care during patient transition, and troubleshooting after hours and weekend device alarms were discussed.
伤口患病率的增加意味着与以往任何时候相比，有更多伤口患者在不同护理机构间转诊。尽管两种环境下的治疗目标可能相同，但伤口护理疗法和敷料在每种环境下的可获得性和适用性有所不同。负压伤口治疗（NPWT）模式以及氧化再生纤维素（ORC）/胶原蛋白（C）/含银ORC敷料在住院和门诊护理环境中均有使用，但（截至目前）缺乏关于在不同护理环境间转换使用这些疗法的最佳实践的全面信息。召开了一次小组会议，以提供基于文献和经验的建议，指导伤口护理患者在不同护理环境间的转换。对于被碎片和/或感染性物质污染或有大量渗出液的伤口，建议使用带滴注和停留时间的NPWT。此外，对于表面出血以及放置在潜行探查区域，建议使用ORC/C/含银ORC敷料，以帮助促进肉芽组织生长。当患者从住院护理转为门诊护理时，应考虑患者的整体健康状况、服务可及性、伤口的严重程度和复杂性以及设备可用性。应采用在护理转换期间弥合差距的治疗方式，以帮助维持持续护理。对于门诊护理，建议使用NPWT来清除感染性物质和管理渗出液。ORC/C/含银ORC敷料也可用于帮助管理渗出液，促进肉芽组织生长和湿性伤口愈合。此外，还讨论了患者依从性、患者转换期间护理中断以及非工作时间和周末设备警报故障排除方面的实践挑战和潜在解决方案。
