I have a colostomy, about 1" opening, and for 8 years I had no problem with my pouches. Then for 3 or 4 months I can't seem to have a bag on for more than a day, and there is leakage. What is deep convexity and should I have different kind of pouches that have a deep convexity? Would that help? Thank you.
Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-Sectional, Point Prevalence Study in Switzerland
- 6/30/2012
- 1 Comments
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Index: Ostomy Wound Manage. 2012;58(7):18–31.
Abstract
Pressure ulcers (PUs) are a common concern for hospitalized children and adults, but knowledge about PU risk factors, prevalence, and incidence rates among children remains limited. To assess the prevalence of and risk factors for PUs in pediatric care settings, a 1-day cross-sectional study was conducted among all hospitalized children ages 0 to 18 years in all 14 pediatric hospitals in the German-speaking part of Switzerland. Data collection involved a direct systematic inspection and assessment of the skin. A standardized data collection instrument was used, and each patient was assessed by a previously instructed rater pair. The total number of participating children was 412 (75% of all hospitalized children).
An overall PU prevalence of 35% (including European Pressure Ulcer Advisory Panel category 1 ulcers) was observed. Most patients with PUs (80%) had category 1 ulcers. The prevalence rate was highest among patients in the pediatric intensive care unit (PICU) (16/36, 44%), followed by the department of neonatology (47/109, 43%). The presence of a PU was significantly higher among patients with a medical device, who were young (<1 year old), had a longer length of stay, and low Braden scale score (P <0.05). Rates also varied by institution (P <0.05). Department, patient age, Braden scale score, and institution explained 25% of the variance in PU prevalence. The prevalence of PUs in pediatric patients is higher than expected, and the rate of category 1 PUs suggests that interventions to prevent PUs are needed, especially in the high-risk patients identified. Future studies are needed to further assess these risk factors, especially for patients in PICUs.
Keywords: pressure ulcer, prevalence, PICU, pediatric nursing
Potential Conflicts of Interest: none disclosed
Introduction
A pressure ulcer (PU) is a localized injury to the skin and/or underlying tissue as a result of pressure or pressure in combination with shear forces.1 Although this care problem has gained a great deal of attention in adults, far less is known about PUs in children and neonates.2 Multimorbidity is limited to a small percentage of children only. Because survival rates of both critically and chronically ill infants and children have improved dramatically in recent years, new challenges for medical and nursing care have been introduced; one of these is an increase in PU risk.3 In a retrospective, exploratory study of 50 children by Samaniego,4 as well as in a systematic literature review aimed at identifying factors contributing to the development of PUs in pediatric patients by Cockett,5 several additional PU risk factors in children are described, including the use of additional medical and therapeutic aids, such as wheelchairs, unadjusted ortheses, and prostheses. The consequences of immobility and decreased skin sensitivity are described in a prospective study of 347 pediatric patients by Suddaby et al,6 as well as in a multicenter survey by Willock et al7 that included 54 children ages 0 to 18 years, conducted over 18 months. The latter study’s goal was to identify characteristics of children with PUs. In an earlier prevalence study by Schlüer et al8 in 155 pediatric patients, as well as in a prospective matched case-control study of 271 consecutive admission patients in a pediatric intensive care unit (PICU) setting by Zollo et al,9 risk factors related to equipment such as tubes, IV catheterization, and airway devices were described.
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Chronic cerebrospinal venous insufficiency (CCSVI), or the pathological restriction of venous vessel discharge from the CNS has been proposed by Zamboni, et al, as having a correlative relationship to Multiple Sclerosis. From a clinical perspective, it has been demonstrated that the narrowed jugular veins in an MS patient, once widened, do affect the presenting symptoms of MS and the overall health of the patient. It has also been noted that these same veins once treated, restenose after a time in the majority of cases. Why the veins restenose is speculative. One insight, developed through practical observation, suggests that there are gaps in the therapy protocol as it is currently practiced. In general, CCSVI therapy has focused on directly treating the venous system and the stenosed veins. Several other factors that would naturally affect vein recovery have received much less consideration. As to treatment for CCSVI, it should be noted that no meaningful aftercare protocol based on evidence has been considered by the main proponents of the ‘liberation’ therapy (neck venoplasty). In fact, in all of the clinics or hospitals examined for this study, patients weren’t required to stay in the clinical setting any longer than a few hours post-procedure in most cases. Even though it has been observed to be therapeutically useful by some of the main early practitioners of the ‘liberation’ therapy, follow-up, supportive care for recovering patients post-operatively has not seriously been considered to be part of the treatment protocol. To date, follow-up care has primarily centered on when vein re-imaging should be done post-venoplasty. The fact is, by that time, most patients have restenosed (or partially restenosed) and the follow-up Doppler testing is simply detecting restenosis and retrograde flow in veins that are very much deteriorated due to scarring left by the initial procedure. This article discusses a variable approach as to a combination of safe and effective interventional therapies that have been observed to result in enduring venous drainage of the CNS to offset the destructive effects of inflammation and neurodegeneration, and to regenerate disease damaged tissue.
Reply to this comment »As stated, it has been observed that a number of presenting symptoms of MS almost completely vanish as soon as the jugulars are widened and the flows equalize in most MS patients. Where a small number of MS patients have received no immediate benefit from the ‘liberation’ procedure, flows in subject samples have been shown not to have equalized post-procedure in these patients and therefore even a very small retrograde blood flow back to the CNS can offset the therapeutic benefits. Furthermore once the obstructed veins are further examined for hemodynamic obstruction and widened at the point of occlusion in those patients to allow full drainage, the presenting symptoms of MS retreat. This noted observation along with the large number of MS patients who have CCSVI establish a clear association of vein disease with MS, although it is clearly not the disease ‘trigger’.For more information please visit http://www.ccsviclinic.ca/?p=978
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