Cath Lab Digest

We’ve all experienced opinions that don’t make sense but are repeated so often they are generally accepted. I call these “Common Nonsense” after Tom Paine’s famous pamphlet Common Sense that helped foment US independence. By questioning authority, we open our minds to learning nature’s truths and applying them to improve patient outcomes. If we don’t learn, natural truths continue to baffle us with poor outcomes, making life a puzzle we don’t understand. Scientific method helps us learn without bias what nature tells us so all who dare can follow.

Let’s start with dressing moisture vapor transmission rate (MVTR). Low MVTR (<35 g/m2/hour) is documented as an operational definition of moist wound healing sufficiently effective to speed chronic and acute wound healing.1 When other variables that affect healing (eg, aggressive or too-frequent dressing removal) are controlled, dressings with MVTR above this critical level delay healing.2 Ignoring this science, common nonsense says that high MVTR helps manage exudate. Perhaps so, just as gauze does, but at the risk of delaying healing and increasing pain and infection rates.3 Why trade exudate management for inferior patient and wound outcomes? If extra absorbance is needed to manage exudate, don’t fall for the common nonsense that high MVTR is the answer to the problem. Add an effective absorbent alginate4 or other fibrous dressing5 beneath a low MVTR dressing to continue providing a moist healing environment while absorbing excess exudate. This will prolong wear for the short time while exudate is copious without sacrificing patient and wound outcomes.

We all share time and space so briefly. Let us replace common nonsense with science-based common sense and move forward using truth as a lever to improve our lives and patient outcomes. You are invited to send Barbara Zeiger your own Common Nonsense concepts for this blog. Examples are wound, ostomy, and incontinence rules, jargon, or modalities you are forced to use without validation or evidence of efficacy. The goal is to replace myth with science to light the way for all, so be sure to offer a science-based antidote to the nonsense. Or request supporting randomized controlled study evidence from journal editor(s) when you see ads or articles based on common nonsense. Together we can wield knowledge to improve patient outcomes.

References

1. Bolton LL. Evidence-based Report Card: Operational definition of moist wound healing. JWOCN. 2007;34(1):23–29.
2. Bolton, LL, Monte K, Pirone LA. Moisture and healing: beyond the jargon. Ostomy Wound Manage. 2000;46 (suppl 1A):51S–64S.
3. van Rijswijk L. Bridging the gap between research and practice: moist dressings are better than dry ones. Am J Nurs. 2004;104(2):28–30.
4. Lyon R, Veith FJ, Bolton L, Machado F, and the Venous Ulcer Study Group. Clinical benchmark for healing of chronic venous ulcers. Am J Surg, 1998;176:172–175.
5. Bolton L, McNees P, van Rijswijk L et al. Wound healing outcomes using standardized care JWOCN. 2004;31(3):65–71.