I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Heel Pressure Ulcers in Orthopedic Patients: A Prospective Study of Incidence and Risk Factors in an Acute Care Hospital
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54 Abstract: Heel pressure ulcers (PU) are a major concern in orthopedic patients. A prospective 6-month study was conducted in an acute care hospital in Canada to determine the incidence of heel PU in an orthopedic population, evaluate the effect of patient and care variables on heel PU incidence, and describe the natural history/sequelae of Stage I heel PU. One hundred and fifty (150) patients (average age 70.6 years) admitted for elective orthopedic surgery or treatment of a fractured hip participated in the study. A direct heel skin assessment was performed following admission and before discharge. Patients with a Stage I ulcer were assessed or contacted 1 week following discharge. The incidence of heel PU in this population was 13.3% CI (range 8% to 19%). Incidence was 16% in the hip fracture and 13% in the elective surgery group. PU incidence in the hip fracture group was significantly lower (P = 0.016) for patients receiving heel pressure relief measures (pillows, rolled sheets). In the elective surgery group, PU incidence rates were higher for patients with respiratory disease, lower hemoglobin, low pulse rate, and altered mental status (P <0.05). When both patient groups were combined, only the presence or absence of respiratory disease significantly affected PU incidence. Length of stay was an average of 3 days longer in all groups with a heel PU but the difference was not statistically significant. One week following discharge, 13 of the 17 (76%) Stage I heel PU had resolved, one remained unchanged, and two were assessed as deep tissue injury (11%) and one as Stage II. These incidence rates are similar to those reported in other countries and confirm that efforts to reduce heel PU incidence rates are needed.
Please address correspondence to: Karen E. Campbell, RN, MScN, PhD, 84 Meridene Circle West, London, Ontario N5X 1G2, Canada; email: Karen.campbell@sjhc.london.on.ca.
The extent of the problem of pressure ulcers (PU) is assessed using prevalence and incidence studies. However, few PU prevalence and incidence of studies have been conducted in Canada. Based on existing data from varied healthcare settings across Canada between 1990 and 2003, obtained from published and unpublished sources,1 Canadian prevalence estimates of PU for individuals of all ages receiving healthcare in hospitals, long-term care facilities, or at home varies from 15% to almost 30%, with an overall prevalence of 26%.1 Variations occur within levels of care; the estimated prevalence in acute care is 25.1%; nonacute care, 29.9%; mixed health settings, 22%; and community care, 15.1%.1
For clarity, prevalence is defined by Baumgarten2 as the proportion of a population that has a disease or condition such as a PU at a particular point in time. PU incidence is defined as the proportion of a population initially free of PU that develops the condition over a particular time period.3 PU incidence varies by level of care (ie, acute, rehabilitation, long-term, and community care). According to North American and international studies, incidence of all PU Stage I and higher in acute care ranges from 1.1% to 17.9%.4–12 Incidence rates in long-term care vary from 2.2% to 23.9%.11–14 Among acute care populations in the US and the Netherlands, PU incidence in surgical patients has been found to range from 13% to 21.5%.15–17 Incidence also can vary within specific patient populations.
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