Nordic Network Meeting Copenhagen, October 2, Maria Plaschke, Wound care specialist nurse

Transcription

1 Nordic Network Meeting Copenhagen, October 2, 2014 Maria Plaschke, Wound care specialist nurse

2 Hard- to- heal wounds! Factors like diabetes, overweight, peripheral vascular disease and decreased mobility have impact on wound healing.! Living with a hard- to- heal- wound can be a psychosocial load, which furthermore can slow down healing.! Key psychosocial factors associated with delayed healing are: anxiety, depression, social isolation, economic hardship and pain. European Wound Management Association (EWMA). Position Document: Hard- to- heal wounds: a holistic approach. London: MEP Ltd, October 2, 2014 Maria Plaschke 2

3 Limita3ons in every- day- life! Many patients with hard- to- heal wounds are forced to make considerable changes to their lifestyle! Patients with hard- to- heal- wounds have increased risk for complications and they spend most of their time at home. European Wound Management Association (EWMA). Position Document: Hard- to- heal wounds: a holistic approach. London: MEP Ltd, October 2, 2014 Maria Plaschke 3

4 The key lies in identifying the problems early! European Wound Management Association (EWMA). Position Document: Hard- to- heal wounds: a holistic approach. London: MEP Ltd, October 2, 2014 Maria Plaschke 4

5 Case! 52 years old male with diabetes type 2 and overweight.! Lives with his family and has a big social network.! He has vascular disease and has gone through two by- pass operations, in 2013, from knee to groin of the right leg. October 2, 2014 Maria Plaschke 5

6 Complica3ons! Due to a surgical site infection, after the last operation, there is a defect cicatrise on his inner thigh, reaching up to the groin.! He also had an amputation of 2-4 toe on the right foot.! In hospital, he had Therapy Negative Pressure (TNP) on the thigh. No TNP on the foot due to severe pain.! At discharge from hospital the wound of the thigh is granulating, and healing is expected within short time. October 2, 2014 Maria Plaschke 6

7 Hard to heal! Four months after last surgery the defect still measures 3 x 35 cm! Granulation, clean, no infection, no redness. Heavy exudation and oedema of thigh! Pain: VAS 7, in spite of pain relieve. Removes bandage himself! Anxiety of new infection October 2, 2014 Maria Plaschke 7

8 Homecare nursing and bandage! From March 16 homecare nurse daily for 60 minutes (wounds on thigh and foot) due to heavy exudation and leakage, especially from the wound of the thigh.! Total time for nurse visits per week: 7 hours (3.5 hours for the wound of the thigh)! Current bandage on the thigh: 3 layers of hydrofiber, superabsorbent pad, extra blue absorbing pad and semi permeable film. Compression therapy. October 2, 2014 Maria Plaschke 8

9 Pa3ent wishes! Get back to work! Loose weight! Start in fitness centre! Free of pain! Healing of wound without infection but he is restricted by the bandage, the leakage and the repeated nurse visits! October 2, 2014 Maria Plaschke 9

10 Limita3ons and consequences in daily life Limitations! Problems walking and keeping the bandage in place, bad flexibility indiscrete! Feeling insecured due to leakage! Difficulty being in a fitness centre with others! Shame, feels unclean Consequences Stays at home:! Problems with not being at work! No training! Not loosing weight! Getting discouraged A bad circle. October 2, 2014 Maria Plaschke 10

11 Demands to an op3mal bandage! thin! heavy absorbent no daily changes! semi permeable! adhesive! skin protecting! stay in place! flexible! discrete October 2, 2014 Maria Plaschke 11

12 Start with TNP (PICO ) April 2 Three days later:! No leakage! The bandage stayed in place! Discrete! Flexible! Less pain October 2, 2014 Maria Plaschke 12

13 Decrease in nurse visits! Change of bandage on both wounds (thigh and foot) twice a week for 60 minutes each time! Change of bandage on foot additionally twice a week for 30 min.! Total amount of visits: 4 per week.! Total time for treatment of wound of the thigh: 60 minutes per week. October 2, 2014 Maria Plaschke 13

14 Silverbandage April 12, 2013! Due to pseudomonas aeruginosa in the wound we used a silver contact layer underneath PICO! No pain October 2, 2014 Maria Plaschke 14

15 April 22 End of TNP (PICO )! The wound is almost healed and totally healed a few days later! Closest to the groin there is 3-4 cm of hyper granulation that healed after 10 days with foam bandage! The wound on the foot healed 1 month later. October 2, 2014 Maria Plaschke 15

16 Conclusion! Got back to work Yes! Lost weight Some! Started in fitness centre Yes! Free from pain Yes! Healing of wound without infection Yes October 2, 2014 Maria Plaschke 16

17 Economics for wound on the thigh Usual care 7 visits per week PICO twice a week! Bandage 350 DKK! Nurse costs 875 DKK Total costs per week 1225 DKK. Presumed healing 2.5 months.! Bandage 1440 DKK! Nurse costs 250 DKK Total costs per week 1690 DKK. Healed within 4 weeks. Total costs: DKK Total costs: 6760 DKK Several disadvantages for the patient. Great advantages for the patient. October 2, 2014 Maria Plaschke 17

18 Statement from the pa3ent For me, the bandage and the way it was put on was better, than the bandage we made ourselves, since it was more flexible. Good experience, seamed cleaner October 2, 2014 Maria Plaschke 18

19 Thank you October 2, 2014 Maria Plaschke 19