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Background: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries., Methods: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery., Results: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group., Conclusions: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The purpose of this meta-analysis was to assess the effects of Modified Robert Jones Bandage (MRJB) in primary total knee arthroplasty (TKA)., Methods: PubMed, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were systematically searched for randomized controlled trials (RCTs). All RCTs were compared to receive either MRJB (study group) or conventional wound dressing (control group) in TKA. Statistical analysis was assessed using RevMan 5.3 software., Results: A total of 5 RCTs involving 362 patients were included in the meta-analysis. No significant difference between the 2 groups was found in terms of total blood loss (Mean difference [MD], -25.41; 95% confidence interval [CI], -90.52 to 39.70; P = .44), intra-operative blood loss (MD, -13.77; 95% CI, -31.84 to 4.29; P = .14), drain blood loss (MD, 0.83; 95% CI, -30.07 to 31.72; P = .96), and transfusion rate (risk ratio, 0.95; 95% CI, 0.55-1.64; P = .86); There was also no significant difference in terms of range of motion (MD, -0.93; 95% CI, -3.64 to 1.79; P = .50), visual analog scale pain sores (MD, -0.02; 95% CI, -0.34 to 0.30; P = .90), and operative time (MD, -3.12; 95% CI, -13.42 to 7.18; P = .55), without increasing the risk of wound-related complications (risk ratio, 0.75; 95% CI, 0.27-2.08; P = .58) in both groups. No deep venous thrombosis occurred in all studies., Conclusions: The current meta-analysis of the available evidence indicates patients with MRJB had not required the additional advantage compared to the conventional wound dressing for TKA. However, more high-quality studies are needed to confirm the above conclusions., Level of Evidence: Level I, therapeutic study., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To investigate the protective effect of a hydrocolloid nasal dressing on the incidence and severity of nasal injury and continuous positive airway pressure (CPAP) failure in preterm infants receiving nasal CPAP (N-CPAP)., Methods: A randomized controlled trial was conducted over 4 months in 2019 at level 3 neonatal ICUs in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. Eighty eligible infants were born at 32 weeks of gestation or younger and/or with a birth weight of 1,500 g or less and had received between 4 and 72 hours of CPAP. Infants were randomly assigned to two groups; the intervention group used a protective dressing, and the control group received routine care. Data collection tools included a demographic questionnaire and nasal injury assessment score chart., Main Outcome Measures: The incidence and severity of nasal injury in preterm infants undergoing N-CPAP., Results: Infants in the intervention group had a significantly lower incidence and severity of nasal injury compared with the control group: 15 of 40 (37.5%) versus 37 of 40 (92.5%; P < .001). Overall, the injuries identified in this study were mostly mild and moderate, with only three severe injuries in the intervention group and five in the control group. No significant differences were detected in CPAP failure (P > .05)., Conclusions: The studied nasal barrier dressing is a safe and convenient solution to reduce nasal injury in preterm infants receiving N-CPAP., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations . It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.

Background: Venous leg ulcers (VLUs) are common throughout the world, which seriously affects the patient's work and life. Relevant researches suggested that sclerosing foam (SF) has potential benefits for VLUs. However, there is no consistent conclusion. The purpose of our study is to assess whether SF is effective and safe for VLUs., Methods: Relevant clinical randomized controlled trials will be obtained from a search of 8 databases (with no language restrictions) from their inception to May 2020: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biological Medicine. Data will be analyzed using RevMan 5.3 after literature screening and data extraction according to predefined inclusion and exclusion criteria. Cochrane Collaboration Risk of bias Tool will be applied in evaluating the quality of enrolled articles. The primary outcome is Closure of venous leg ulcers, ulcer healing rate, adverse events related to SF. The secondary outcomes include ulcer healing time, ulcer recurrence rate, pain. Risk ratio will be used for categorical data; mean differences will be used for measurement data. Where possible and appropriate, meta-analysis will be performed for each outcome., Results: To clarify whether Sclerosing foam can be safe and efficient on treating venous leg ulcers., Conclusion: Our review will provide useful information to judge whether Sclerosing Foam is an effective and safe intervention for patients with venous leg ulcers.

We present an illustrative case of unintentional burns to the feet of a 15-month-old child following the application of raw garlic as a home remedy for fever. We provide an overview of the historical medicinal uses of garlic as well as its unintended adverse effects. This case underscores the importance of clinicians' ability to recognize unusual presentations of injury due to culturally based practices that require care in emergency settings. This is particularly important in patient populations for whom abusive etiology would be considered.

Epidermolysis bullosa (EB) refers to a heterogeneous group of genetic disorders characterized by epithelial fragility. We provide guidelines for management of pediatric patients with EB in the emergency department based on a review of literature, as well as insights from our own experiences caring for patients with EB. The purpose of the guidelines proposed is prevention of avoidable iatrogenic trauma to the skin and mucosa of patients with EB who are presenting to the emergency department for a variety of reasons.

Purpose: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration., Methods: We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0)., Results: Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure., Conclusions: This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.

Pediatric patients are unique both in their diagnosis and clinical presentation before implantation of a ventricular assist device (VAD) and in their driveline site characteristics post-implant. There is limited evidence in scholarly literature that describes complications of pediatric VAD driveline sites or approaches by which to manage them. The Cardiac Center at The Children's Hospital of Philadelphia (CHOP) follows a standard of care for HeartWare VAD (HVAD) dressing changes in the inpatient setting with the goal of transitioning patients to weekly dressing changes by the time they are discharged to home. As a patient with an HVAD nears discharge, members of an interprofessional team collaborate with insurance providers and home care agencies to procure the appropriate supplies needed at home. Individualized plans of care are necessary for patients who are unable to transition to weekly dressings; however, customized products (such as silicone foam border dressings and antimicrobial agents) may be challenging to supply as single items from home care agencies. Between March 2014 and June 2017, 15 patients underwent HVAD implantation, and eight (53%) were discharged home. Ten patients (67%) were able to transition to weekly dressing changes. Individualized plans of care for driveline site management were required for six (40%) patients with persistent drainage. Three patients (20%) experienced a driveline site infection. This article describes how a quality improvement (QI) initiative using rapid-cycle improvement methodology was executed to standardize HVAD dressing changes in our pediatric population.

Introduction: Central line-associated blood stream infection (CLABSI) is a preventable burden to our current health care system. Inconsistencies in knowledge and practice of central venous catheters (CVC) dressing change procedures are associated with CLABSI. We hypothesized that participation in a "just-in-time" and "just-in-place" CVC dressing change program would improve nurses' knowledge, confidence, and psychomotor performance on mannequins (eg, T1 outcomes). Moreover, this simulation program would be associated with improved procedural competence on real patients (T2 outcomes) and hospital CLABSI rate (T3 outcomes)., Methods: We conducted a prospective before and after timed series study at a large urban children's hospital. This program provided an opportunity to practice a CVC dressing change using a simulated patient chest/arm. Cognitive and psychomotor skills were evaluated using a pre-self-assessment/post-self-assessment, written knowledge test and direct observation using a standardized checklist. Central line-associated blood stream infection rates were monitored monthly by the Office of Quality and Patient Safety., Results: Five hundred twenty-four inpatient nurses participated in this program between November 2008 and May 2010. Knowledge and self-confidence improved significantly (knowledge, 4.1 [0.7] vs. 4.6 [0.5], P < 0.001; self-confidence, 4.1 [0.8] vs. 4.6 [0.6], P < 0.001). Of 2469 real-patient CVC dressing changes observed, dress rehearsal trainees required fewer corrective prompts (9% vs. 21%, P < 0.001), and CLABSI rates decreased from 5.3/1000 to 2.9/1000 line days (P < 0.001) during the study., Discussion: This program improved nurse's knowledge, self-confidence, and psychomotor skill performance on mannequins (eg, T1 outcomes). These improvements were associated with improved procedural competence on real patients (T2 outcomes) and a temporal association with decreased hospital CLABSI rates (T3 outcomes).

Objective: Acute lateral ankle sprain accounts for 85% of all sprains, being generally accepted as the most common sports-related ligamentous injury. There is a lack of consensus about the optimal management of these injuries despite their frequency. The time-honoured mantra of rest, ice, elevation and compression is still commonly used, even though the current evidence for compression is conflicting., Methods: A prospective randomized controlled clinical trial was carried out in the emergency department of a regional hospital in Ireland to compare outcomes, in terms of ankle function, pain improvement and return-to-work times, in adults presenting within 24 h of first-time acute lateral ankle sprain, among three external supports., Results: We found no statistically significant differences among all three treatments in terms of ankle joint function, using the Karlsson ankle function scale, at 10 or 30-days follow-up. There was a tendency for Elastoplast bandaging to provide better average ankle function at both time points, when compared with double tubigrip and no support. Participants returned to work an average 2 days earlier, if treated with Elastoplast., Conclusion: This study found no statistically significant difference in ankle function between double tubigrip bandage, Elastoplast bandage and no support at 10 or 30-days follow-up.

Adverse outcomes related to tracheal occlusion and peritracheal skin breakdown stimulated a review of tracheostomy care. An evidence-based practice approach was taken to evaluate the problem. Organizational tracheostomy care policies were reviewed. Subcategories related to tracheostomy care were queried including securing devices, sutures and their removal, type and choice of dressings, prevention of skin breakdown, frequency of care and role delineation, and suctioning. A literature review was done. National experts were surveyed. A geographical survey was taken and vendors of tracheostomy products were interviewed. Collected evidence was scored along a continuum. Costs of supplies were evaluated. Physicians, staff, and patients were interviewed. Skin maceration on the neck was found on multiple audits. The type of tie was identified as a problem. Nurses and respiratory therapists reported difficulty providing tracheostomy care due to suturing technique and securing methods. The stocked dressing was too large to fit under sutures. Several conflicting policies existed regarding tracheostomy care, none of which identified responsibility for performing care: respiratory versus nursing or time standards for care. New supplies were trialed. A list of practice changes were agreed upon by respiratory, nursing, and medical staff. Primary responsibility for tracheostomy care was shifted to the registered nurse.

Purpose: Current protocols call for stopping adjunctive skin care treatments during hyperbaric oxygen therapy (HBOT) because the hyperbaric environment is considered unsafe for skin care products. The elevated oxygen fraction and the increased pressure in the hyperbaric chamber dramatically increase the flammability potential of materials, leading to the need for rigorous standards to prevent flame ignition. A scientific method of evaluating the flammability risks associated with skin care products would be helpful. Several skin care products were tested, using established industrial techniques for determining flammability potential with some modification. The information obtained from these tests can help clinicians make more rational decisions about which topical products can be used safely on patients undergoing HBOT., Methods and Materials: Wendell Hull & Associates conducted independent studies, comparing the oxygen compatibility for leading skin care products. Oxygen compatibility was determined using autogenous ignition temperature (AIT), oxygen index (OI), and heat of combustion (HoC) testing. AIT, a relative indication of a material's propensity for ignition, is the minimum temperature needed to cause a sample to self-ignite at a given pressure and oxygen concentration. OI, a relative indication of a material's flammability, is the minimum oxygen percentage that, when mixed with nitrogen, will sustain burning. HoC is the absolute value of a material's energy release when burning, if ignition occurs. Products with a high AIT, a high OI, and a low HoC are more compatible in an oxygen-enriched atmosphere (OEA). An acceptability index (AI) based on these 3 factors was calculated for the products, so the testers could rank overall material compatibility in OEAs (Lapin A. Oxygen Compatibility of Materials. International Institute of Refrigeration Commission Meeting; Brighton, England; 1973)., Results: Test results for the skin products varied widely. The AIT, OI, HoC, and AI were determined for each product under described circumstances. The AIT results indicate that all products in 99.5% oxygen concentration under pressure will ignite and that a pattern based on the absence or presence of petroleum-based ingredients does not seem to exist. Products containing petrolatum, mineral oil, paraffin, and paraffin wax had a HoC that equaled or exceeded the HoC of gasoline, whereas products without petroleum-based ingredients had a significantly lower HoC. The OI of skin products not containing petrolateum-based ingredients was significantly higher than the OI of products containing it. The AI values the OI as the most important value: the higher the AI, the more acceptable the product is for use with oxygen. The silicone-containing, petroleum-free products received an AI up to 25 times higher than the petrolatum-based products. These findings suggest a wide variation in the safety profiles of skin products. Skin products being considered for use in an OEA should be screened for flammability risks. This screening will allow informed decisions about the fire safety of the products. Further research is indicated.

The field of wound care has been inundated with "active" dressings--those that deliver biologically active substances to the wound site--and much attention has been given to those containing silver. Silver is a broad-spectrum agent: it is bactericidal to a large number of Gram-positive and Gram-negative microorganisms, many aerobes and anaerobes, and several antibiotic-resistant strains. More than 10 dressings containing pure silver are currently available; all claim to enhance wound healing through the antimicrobial activity of silver. But research findings on silver's antimicrobial efficacy are often inconclusive or contradictory. How, therefore, can clinicians decide which dressing is most appropriate for each patient? A grading system for reviewing the literature is presented.

The purpose of this study was to compare the effectiveness of gentian violet and nonadherent absorbent dressing in the healing of postirradiation wounds in nasopharyngeal carcinoma patients. This was a randomized controlled trial. A sample of 146 nasopharyngeal carcinoma patients who had developed postirradiation wounds was assessed. Comparisons were made regarding parameters related to wound healing, including healing time, presence of infection, and wound pain, and also regarding the impact of wound on the patient, including mood changes, restriction of neck movement, social isolation, sleep problem, and disturbance in body image. The results showed that patients in the 2 groups did not have any significant difference on wound-healing time, disturbance in mood, sleep, social interaction, appearance, and neck mobility. However, there was a trend of higher wound pain score, not reaching statistical significance, in the gentian violet group.

Objective: To assess intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE)., Methods: The authors randomly allocated patients with a documented intracerebral hemorrhage (ICH) to elastic stockings (ES) alone or combined with IPC. The primary outcome was a combined criteria assessed at day 10: a symptomatic and well-documented VTE, or a death arising before day 10 and related to pulmonary embolism (PE), or an asymptomatic deep vein thrombosis (DVT) of the lower limbs detected by compression ultrasonography (CUS). Outcome assessment was blinded., Results: One hundred fifty-one patients were randomized; 133 (88%) patients were evaluated at day 10. No clinical suspicion of VTE arose before day 10. Fourteen patients died before having a CUS but no death was definitely related to PE. Fourteen asymptomatic DVT were detected by CUS: three (4.7%) in the ES + IPC group (all distal) and 11 (15.9%) in the ES group (three proximal and eight distal). ES combined with IPC is associated with a reduced risk of asymptomatic DVT compared to ES alone: relative risk, 0.29 (95% CI 0.08 to 1.00)., Conclusions: Asymptomatic deep vein thrombosis (DVT) was detected at day 10 in 15.9% of patients wearing elastic stockings alone. Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage.

Background: The Rapid Deployment Hemostat (RDH) Bandage was developed for the rapid control of bleeding caused by trauma., Methods: An extremity wound involving skin, muscle, bone, and femoral arterial injury and a 1-cm vertical incision in the abdominal aorta in swine were studied to compare the RDH Bandage, a fibrin sealant dressing and gauze to restore hemostasis. The total blood loss was determined and the survival of animals was measured., Results: In the extremity injury model, the RDH Bandage reduced blood loss by 63% compared with the gauze control. In the aorta arterial incision model, the RDH Bandage required a significantly lower compression time to control bleeding compared with gauze and TachoComb. The RDH Bandage was able to stop bleeding from this injury in 100% of the tests., Conclusion: The RDH Bandage was superior to a commercially available fibrin bandage in controlling hemorrhage, decreasing blood loss, and increasing survival.

Background: Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury., Methods: A complex groin injury was created in 72 swine (37 +/- 0.8 kg). This included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 3 minutes, the animals were randomized to 1 of 10 groups: group 1, no dressing (ND); group 2, standard dressing (SD); group 3, SD + 3.5 oz ZH with 1% RM (1% ZH); group 4, SD + 3.5 oz ZH with 4% RM (4% ZH); group 5, SD + 2 oz ZH with 1% RM (1% ZH 2oz); group 6, SD + 3.5 oz ZH with 8% RM (8% ZH); group 7, SD + chitosan-based hemostat, HemCon (HC); group 8, SD + 3.5 oz nonzeolite mineral hemostat, Quick Relief (NZH); group 9, SD + bovine clotting factors-based hemostat, Fast Act (FA); and group 10, SD + 30 g of starch-based hemostat, TraumaDex (TDex). Resuscitation (500 mL of Hespan over 30 minutes) was started 15 minutes after injury and hemodynamic monitoring was performed for 180 minutes. Primary endpoints were survival for 180 minutes and blood loss. In addition, maximum wound temperatures were recorded, and histologic damage to artery, vein, nerve, and muscle was documented., Results: Use of 1% ZH decreased blood loss and reduced mortality to 0% (p < 0.05). Increasing the RM adversely affected efficacy without any significant decrease in wound temperatures. Minimal histologic tissue damage was seen with ZH independent of the percentage of RM., Conclusion: The use of zeolite hemostatic agent (1% residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.

This study tested whether central venous catheter (CVC)-related sepsis could be reduced by removing a hypothesized reservoir for pathogens, the CVC exit site dressing. Seventy-eight individuals with cancer, stratified for gender (37 men and 41 women) and transplant status, with newly inserted CVCs were recruited and randomly assigned to receive either a gauze dressing or no dressing, once their catheter insertion site had healed (3 weeks). Because there was no difference in CVC-related septic episodes based on gender or transplant status, the stratification was not maintained for remaining analyses. Although there was no significant difference in CVC-related septic episodes (P =.28) or rehospitalization rates (P =.41) because of CVC-related sepsis between the dressing and no-dressing group, individuals in the dressing group developed CVC-related sepsis sooner (P =.02) than did individuals in the no-dressing group.

Background: This study reviews the efficacy of vacuum-assisted wound closure (VAWC) to obtain primary fascial closure of open abdomens after severe trauma., Methods: The study population included shock resuscitation patients who had open abdomens treated with VAWC. The VAWC dressing was changed at 2- to 3-day intervals and downsized as fascial closure was completed with interrupted suture. The Trauma Research Database and the medical records were reviewed for pertinent data., Results: Over 26 months, 35 patients with open abdomens were managed by VAWC. Six died early, leaving 29 patients who were discharged. Of these, 25 (86%) were successfully closed using VAWC at a mean of 7 +/- 1 days (range, 3-18 days). Of the four patients that failed VAWC, two developed fistulas. No patients developed evisceration, intra-abdominal abscess, or wound infection., Conclusion: VAWC achieved early fascial closure in a high percentage of open abdomens, with an acceptable rate of complications.

Background: Hemorrhage is a leading cause of death from trauma. An advanced hemostatic dressing could augment available hemostatic methods. We studied the effects of a new chitosan dressing on blood loss, survival, and fluid use after severe hepatic injury in swine., Methods: Swine received chitosan dressings or gauze sponges. Standardized, severe liver injuries were induced. After 30 seconds, dressings were applied and resuscitation initiated. Blood loss, hemostasis, resuscitation volume, and 60-minute survival were quantified., Results: Posttreatment blood loss was reduced ( p< 0.01) in the chitosan group (264 mL; 95% confidence interval [CI], 82-852 mL) compared with the gauze group (2,879 mL; 95% CI, 788-10,513 mL). Fluid use was reduced ( p= 0.03) in the chitosan group (1,793 mL; 95% CI, 749-4,291) compared with the gauze group (6,614 mL; 95% CI, 2,519-17,363 mL). Survival was seven of eight and two of even in the chitosan and gauze groups ( p= 0.04), respectively. Hemostasis was improved in the chitosan group ( p= 0.03)., Conclusion: A chitosan dressing reduced hemorrhage and improved survival after severe liver injury in swine. Further studies are warranted.

Strategies for preventing central venous catheter (CVC)-related bloodstream infection are most likely to be effective if guided by an understanding of the risk factors associated with these infections. In this critical review of published studies of risk factors for CVC-related bloodstream infection that were prospective and used multivariable techniques of data analysis or that were randomized trials of a preventive measure, a significantly increased risk of catheter-related bloodstream infection was associated with inexperience of the operator and nurse-to-patient ratio in the intensive care unit, catheter insertion with less than maximal sterile barriers, placement of a CVC in the internal jugular or femoral vein rather than subclavian vein, placement in an old site by guidewire exchange, heavy colonization of the insertion site or contamination of a catheter hub, and duration of CVC placement > 7 days. Prospective studies or randomized trials of control measures focusing on these risk factors have been shown to reduce risk significantly: formal training in CVC insertion and care, use of maximal sterile barriers at insertion, use of chlorhexidine rather than povidone-iodine for cutaneous antisepsis, applying a topical anti-infective cream or ointment or a chlorhexidine-impregnated dressing to the insertion site, and the use of novel catheters with an anti-infective surface or a contamination resistant hub. Better prospective studies of sufficient size to address all potential risk factors, including insertion site and hub colonization, insertion technique, and details of follow-up care, would enhance our understanding of the pathogenesis of CVC-related bloodstream infection and guide efforts to develop more effective strategies for prevention.

Objective: To determine the effect of noncontact normothermic wound therapy (NNWT) versus standard wound care on chronic full-thickness pressure ulcers., Design: Prospective, randomized, controlled trial., Setting: Veterans administration medical center and 7 long-term-care facilities., Patients: 40 inpatients with 43 Stage III and IV pressure ulcers., Interventions: A sterile noncontact wound dressing was applied to 21 wounds for 24 hours per day, 7 days per week. Each day after the wound was irrigated and the noncontact dressing was changed, a heating element in the dressing was activated for 3 1-hour periods for 12 weeks or until wound closure. Twenty-two control wounds were treated with standard, moisture-retentive dressings 24 hours per day, 7 days per week for 12 weeks or until wound closure., Main Outcome Measure: Measurement of wound surface area., Main Results: Healing rate for the NNWT group was significantly greater than for the control group (0.52 cm2 per week and 0.23 cm2 per week, respectively; P<.02). A clinically significant increase was seen among the NNWT group in the incidence of closure among wounds that completed the entire 12-week protocol compared with controls (11 of 14 or 79% and 8 of 16 or 50%, respectively; not significant). The mean slope of the individual regression analyses for the NNWT group was significantly different from the mean slope for the control group (-0.07 and -0.033, respectively; P<.05). Large wounds in the NNWT group demonstrated a significantly greater healing rate than large wounds in the control group (P <.05)., Conclusion: Wounds treated with NNWT healed significantly faster than wounds in the control group. The healing rate was greatest for larger wounds treated with NNWT.

To determine the incidence of peripheral intravenous therapy-related phlebitis in an adult population, 305 peripheral i.v. catheter sites were observed from the time of admission of the patient (or initiation of the first peripheral i.v. catheter) to the time of the participant's discharge from the facility (or 48 hours after the removal of the final catheter). Parameters monitored included patient demographics, diagnosis, i.v. fluids and medications, type of peripheral catheter, dwell time, and dressing integrity. Results showed that of the 10 cases of phlebitis found in nine study subjects, all were associated with catheters indwelling less than 72 hours. In three cases, although the catheter site was clear at the time of catheter removal, postinfusion phlebitis developed within 24 hours. Catheter site locations, diagnoses, medications, and i.v. fluids in these cases were varied.

Previous studies have examined complications with short peripheral catheters, although focus on securement techniques and the relation to catheter dislodgment as an early indicator of potential intravenous complications is limited. The purpose of this study was to examine two methods of peripheral catheter securement: transparent dressing and tape (control group) versus transparent dressing and StatLock i.v./PICC (study group) and their effects on i.v. complications. One hundred five peripheral catheters were evaluated. The use of transparent dressing and StatLock showed a 45% reduction in overall i.v. therapy complications when compared with that of transparent dressing and tape (P = 0.025). In addition, catheter dislodgment episodes were reduced by 40% (P = 0.002) with the average dwell time extended by 21 hours.

Infection has been identified as a potentially life-threatening complication of central venous catheterization. The type of dressing applied to the catheter site has been suggested to influence the incidence of catheter-related infection. Although numerous research studies were conducted before 1990 and in the past 5 years to compare the effect of gauze and transparent dressing on the infection rate of central venous catheters, results are conflicting. This literature review analyzes some of those efforts.

Stabilizing the intravenous catheter after insertion is a significant part of intravenous therapy. Dislodgments of the cannula from its optimal position in the vein can lead to complications such as phlebitis, thrombophlebitis, infiltration, and infection. Intravenous site protector shields are designed to protect the catheter from impact and tissue trauma at the insertion site. Nurses have requested ventilation in these shields to avoid moisture build up that may increase the risk of infections. To address this issue, experimental laboratory testing was performed to determine if moisture accumulation as evidenced by increased weight of the shield and visible evidence of condensation occurred. No moisture condensation problems with the ventilated intravenous site protectors were found.

Objective: To elucidate the time course and magnitude of hemodynamic and fibrinolytic changes associated with sequential gradient intermittent pneumatic compression (SGIPC)., Design: Two-phase, intervention and response investigation in normal volunteers., Materials and Methods: Subjects were assigned to control (phase I) or compression (phase II) groups. Serial blood samples were obtained via femoral venous catheters for tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), tPA-PAI-1 complex (tPA-PAI), and euglobulin lysis time (ELT) from all subjects and for fibrin degradation products (FbDP) and fibrinogen degradation products (FgDP) from phase II subjects. Duplex venous scanning was carried out on phase II subjects before and during SGIPC., Results: Catheter placement caused elevations in PAI-1 and tPA-PAI, which stabilized within 4 hours of catheter insertion. In phase II, SGIPC induced significant increases in FbDP, FgDP, and tPA-PAI and decreases in ELT and PAI-1, all of which quickly reverted to baseline on termination of compression. Femoral venous blood flow increased by more than 100% with SGIPC., Conclusions: Sequential gradient intermittent pneumatic compression induces prompt, but short-lived, alterations in both fibrinolytic and hemodynamic function. Noncontinuous SGIPC may result in suboptimal thromboembolic prophylaxis.

The care of chronic ulcerating metastatic skin lesions is not well established or supported by research. Because these cancerous lesions may be present for many years, patients and their caregivers are confronted with ongoing dressing care to control and prevent odor, bleeding, drainage, and infection. Eleven patients in this study compared Mesalt dressings (Sancella Incorporated, Oakville, Ontario, Canada) with continuous wet saline dressings using a crossover design. Results indicated that Mesalt dressings received significantly higher ratings when compared with continuous wet saline dressings for ease of application and odor control and were significantly preferred by patients. No significant differences were found for ease of removal and comfort of the dressing. Neither were there any significant differences in the occurrence of clinical infection, number of dressing changes, and time spent for the care of the lesion. Mesalt dressings were more expensive than continuous wet saline dressings, but benefits may outweight the costs.

Cultured epidermal allografts have been successfully used to treat a wide variety of skin defects ranging from burns to leg ulcers. Their postulated mechanism of action is through release of multiple cytokines that stimulate epithelialization from the wound periphery as well as from remnant epidermal appendages. A randomized, controlled clinical trial was undertaken to compare the efficacy of cryopreserved cultured allograft dressings (CCAD) with tulle-gras dressings in the treatment of split-skin graft donor sites. Five patients were enrolled in the study and in each patient, half of the donor site was allografted and the other half was treated with tulle-gras control. The mean time to complete healing was 6.2 days for CCAD compared with 9.6 days (p = 0.035) for the tulle-gras controls. Patient assessment of pain with dressing changes was also significantly lower at the CCAD-treated sites than at the control sites (p = 0.001). The results indicate that cultured allografts offer greater patient comfort and earlier maturation of regenerated skin.

To reduce the morbidity and mortality of postoperative deep vein thrombosis and pulmonary embolism, effective prophylactic methods must be used. An assessment of the individual patient's risk is essential in deciding the most appropriate method. In general, women over 40 years of age and all women with other risk factors benefit from some form of prophylaxis. For patients with benign gynecologic conditions, low-dose heparin (every 12 hours) and perioperative intermittent pneumatic calf compression have been shown to be of benefit. Patients at higher risk, such as gynecologic oncology patients, should receive more intense prophylaxis with either low-dose heparin (every 8 hours) or prolonged (5 days) intermittent pneumatic calf compression. Of the two methods, the latter has no significant complications and is therefore our method of choice.

Decision making in topical management of chronic wounds is complex and requires ongoing evaluation of the wound. Here are some useful approaches to managing simple and complex situations.

The purpose of this clinical study was to compare the performance of a new cohesive bandage to that of elastic bandages for joint immobilization. The magnitude of joint immobilization by these bandages was quantitated during isokinetic exercise using a computerized dynamometer. The degree to which the cohesive and elastic bandages reduced range of motion and peak torque of plantar and dorsiflexion was not significantly different. After exercising for 1 hour, the elastic bandage loosens, reducing its ability to immobilize the joint. In contrast, the cohesive bandage maintains its configuration, despite active exercise for 1 hour.