Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline

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Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline

Developed by the National Pressure Ulcer Advisory Panel, the European Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance, this guideline presents a comprehensive review and appraisal of the best available evidence to the assessment, diagnosis, prevention and treatment of pressure ulcers. This is a general guide to appropriate clinical practice, to be implemented by qualified health professionals subject to their clinical judgment and the patient’s personal preferences and available resources.

If a patient has both an arterial sheath and a venous sheath, which should be removed first?

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Experts state that the arterial sheet should be removed first on these two webpages within the Cath Lab Digest website.

https://www.cathlabdigest.com/articles/Correct-Way-Pull-Sheath

https://www.cathlabdigest.com/articles/Ask-Clinical-Instructor-A-QA-column-those-new-cath-lab-27

Following is a section in a cardiac cath book that also states that the arterial sheath should be removed first. The citation for the book and a link to access it follows the quote. The path to click to get to the particular passage in the book is also included after the quote.

“Control of the Puncture Site Following Sheath Removal
Originally, standard groin management required the effect of heparin to wear off or be reversed by protamine to an ACT <160 seconds before the arterial catheter and sheath were removed and manual pressure applied, except in the case of bivalirudin as mentioned above. Manual pressure method is best applied using three fingers of the left hand that are positioned sequentially up the femoral artery beginning at the skin puncture. With the fingers in this position, there should be no ongoing bleeding into the soft tissues or through the skin puncture, and it should be possible to apply sufficient pressure to obliterate the pedal pulses and then release just enough pressure to allow them to barely return. Pressure is then gradually reduced over the next 10 to 15 minutes, at the end of which time pressure is removed completely. The venous sheath is usually removed 5 minutes after compression of the arterial puncture has begun, with gentle pressure applied over the venous puncture using the right hand. To avoid tying up the catheterization laboratory during this period, patients were usually taken to a special holding room in the catheterization laboratory or back to their hospital beds before the sheaths were removed. If such relocation is to be performed prior to sheath removal, it is important that the sheaths are secured in place (suture, or at least tape) to prevent them being pulled out during transport.
When procedures are performed using larger arterial sheaths or with thrombolytic agents or IIb/IIIa receptor blockers, more prolonged (30- to 45-min) compression is typically required. To avoid fatigue of the operator or other laboratory personnel performing compression, occasionally a mechanical device (Compressar [Applied Vascular Dynamics, Portland, OR], The Clamp Ease device [Pressure Products Inc., Rancho Palos Verdes, California] or FemoStop [Radi Medical, Wilmington, MA]) can be used to apply similar local pressure. These devices can be equally or even more effective in prolonged holds,22 but are uncomfortable for the patients and human supervision is required while in place; hence manual compression is preferred for removal of smaller (6F) sheaths or in patients with peripheral vascular disease or prior peripheral grafting surgery where occlusive compression or flow restriction might cause arterial occlusion. In every case, however, it should be emphasized that a trained person must be in attendance throughout the compression to ensure that the device is providing adequate control of puncture site bleeding and is not compromising distal perfusion.”
From Grossman and Baim’s Cardiac Catheterization, Angiography, and Intervention; editor, Mauro Moscucci, MD, MBA, professor of medicine, chairman, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. — Eighth edition. Copyright 2014 (new edition will be coming out in 2020). Main page for book > Table of Contents > Section II – Basic Techniques > 6 – Percutaneous Approach, Including Transseptal and Apical Puncture > CATHETERIZATION VIA THE FEMORAL ARTERY AND VEIN > Control of the Puncture Site Following Sheath Removal
Link to book: https://tinyurl.com/y2hqn6wf

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Important message for Emory Decatur Nurses. The link to the book will not work for you. To access the book contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org
404.501.1628

Strategies for reducing interruptions and errors during medication administration

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Here’s how to access a collection of 19 articles on strategies for reducing interruptions and errors during medication administration that are dated within the last five years. Strategies include wearing vests/tabards with signage, educating nurses about safe medication administration and strategies for handling interruptions, creating a safe zone/no interruption zone, involving and educating patients, using signs, using safety pictograms, using a card instructing nurses how to respond to interruptions, integrating mindfulness exercises in medication administration, implementing and supporting nurses’ rights of medication administration, employing behavioral management strategies, and making sure all nurses on a unit do not administer meds at the same time.

a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then paste the following links into your browser: https://tinyurl.com/y5dzngb3
d. The references will appear in PubMed. Click on a reference and you will see a Find it at Emory on the right side of the page which will provide links to full text within Emory University’s licensed resources. Emory Healthcare staff may send citations of needed articles they are unable to access to Ask a Librarian; a library staff person will request the article(s) from an outside library and email them to the EHC staff person upon arrival.

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Important message for Emory Decatur Nurses. The links will not work for you. To access these articles contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org
404.501.1628

Reducing nursing turnover – systematic reviews & meta-analyses

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Here’s how to access a collection of 15 systematic reviews and meta-analyses on reducing nursing turnover and one systematic review on the anticipated turnover scale that can be used for planning purposes.

a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then paste the following links into your browser: https://tinyurl.com/y38jyuza
d. The references will appear in PubMed. Click on a reference and you will see a Find it at Emory on the right side of the page which will provide links to full text within Emory University’s licensed resources. Emory Healthcare staff may send citations of needed articles they are unable to access to Ask a Librarian; a library staff person will request the article(s) from an outside library and email them to the EHC staff person upon arrival.

Important message for Emory Decatur Nurses. The links will not work for you. To access these articles contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org
404.501.1628

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Bedside shift report and patient satisfaction

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Noteworthy articles:

Scheidenhelm S, Reitz OE. Hardwiring Bedside Shift Report. J Nurs Adm. 2017 Mar;47(3):147-153. doi: 10.1097/NNA.0000000000000457. PMID: 28157819

Ford Y, Heyman A. Patients’ Perceptions of Bedside Handoff: Further Evidence to Support a Culture of Always. J Nurs Care Qual. 2017 Jan/Mar;32(1):15-24. PMID: 27270846

Here’s how to view a collection of 23 articles that includes the aforementioned articles.
a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then paste the following links into your browser:
https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/58614678/public/
d. The references will appear in Pubmed. Click on a reference and you will see a Find it at Emory on the right side of the page which will tellavailability of full text within Emory University’s licensed resources. Emory Healthcare staff may send citations of needed articles they are unable to access to Ask a Librarian; a library staff person will request the article(s) from an outside library and email them to the EHC staff person upon arrival. 

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Mentoring the future generation of nurses

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Important message for Emory Decatur Nurses. The links will not work for you. To access these articles contact the Emory Decatur Library:

Emory Decatur Hospital
Jessica Callaway (Jessica.callaway@emoryhealthcare.org
404.501.1628

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Mentoring in Nursing: A Concept Analysis. (2019). International Journal of Caring Sciences., 12(1), 142.

The Nurse Leader’s Pivotal Role in Retaining Millennial Nurses. (2018). Journal of Nursing Administration., 48(12), 604.

Walking alongside: A qualitative study of the experiences and perceptions of academic nurse mentors supporting early career nurse academics. (2015). Contemporary Nurse : A Journal for the Australian Nursing Profession., 51(1), 69.

Hodges, A. (2018). Mentoring Novice Nursing Faculty; Sustaining the Next Generation. Tar Heel Nurse, 80(4), 12–17.

Non-adherence to immunosuppresant therapy in minority renal transplant patients.

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Ajay K. Israni, Francis L. Weng, Ye-Ying Cen, Marshall Joffe, Malek Kamoun, Harold I. Feldman Electronically-measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation Clin Transplant. Author manuscript; available in PMC 2013 Feb 7.

Coelho Gonçalves, P. R., Ferreira Reveles, A., Fernandes Martins, H. I., Rodrigues, I. L., & Miranda Rodrigues, S. M. (2016). Adherence to Immunosuppressive Therapy in Kidney Transplant Recipients: Integrative Literature Review. Revista de Enfermagem Referência, 4(8), 121–130

Francis L Weng, Sheenu Chandwani, Karen M Kurtyka, Christopher Zacker, Marie A Chisholm-Burns, Kitaw Demissie Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study BMC Nephrol. 2013; 14: 261.

Extending medicare immunosuppressive medication coverage. (2012). Journal of Health Care for the Poor and Underserved., 23(1), 20.

Wilkins, L., Nyame, Y., Gan, V., Lin, S., Greene, D., Flechner, S., & Modlin, C. (2018). A Contemporary Analysis of Outcomes and Modifiable Risk Factors of Ethnic Disparities in Kidney Transplantation. Journal of the National Medical Association., Journal of the National Medical Association. , 2018.

Yadav, K., Vock, D., Matas, A., Robiner, W., & Nevins, T. (n.d.). Medication adherence is associated with an increased risk of cancer in kidney transplant recipients: A cohort study. Nephrology Dialysis Transplantation., 34(2), 364-370.

De Castro Rodrigues Ferreira, F., Cristelli, M., Paula, M., Proença, H., Felipe, C., Tedesco-Silva, H., & Medina-Pestana, J. (n.d.). Infectious complications as the leading cause of death after kidney transplantation: Analysis of more than 10,000 transplants from a single center. J Nephrol, 30(4), 601-606.

Reese, P., Bloom, R., Trofe-Clark, J., Mussell, A., Leidy, D., Levsky, S., . . . Volpp, K. (n.d.). Automated Reminders and Physician Notification to Promote Immunosuppression Adherence Among Kidney Transplant Recipients: A Randomized Trial. American Journal of Kidney Diseases : AJKD : The Official Journal of the National Kidney Foundation., 69(3), 400-409.

Gaynor, J., Ciancio, G., Guerra, G., Sageshima, J., Hanson, L., Roth, D., . . . Burke, G. (n.d.). Graft failure due to noncompliance among 628 kidney transplant recipients with long-term follow-up: A single-center observational study. Transplantation., 97(9), 925-933.

Malat, G., Culkin, C., Palya, A., Ranganna, K., & Kumar, M. (2009). African American kidney transplantation survival: The ability of immunosuppression to balance the inherent pre- and post-transplant risk factors. Drugs., 69(15), 2045-2062.

Brown, K., El-Amm, J., Doshi, M., Singh, A., Cincotta, E., Morawski, K., . . . Gruber, S. (n.d.). Outcome predictors in African-American deceased-donor renal allograft recipients. Clinical Transplantation., 23(4), 454-461.