CLINICAL QUESTION

What is the best available evidence on prophylactic dressings to prevent medical device related pressure injuries (MDRPI)?

SUMMARY

Medical device related pressure injuries (MDRPI) occur from the use of devices designed and applied to the body for diagnostic purposes or for the delivery of treatment. The MDRPI occurs as a result of ongoing pressure on the skin from the device or from fixations used to secure the device.

CLINICAL QUESTION

What is the best available evidence on effectiveness of exercise for healing venous leg ulcers (VLUs)?

SUMMARY

Evidence from small clinical trials suggests that range of motion, strength and aerobic exercises (including walking) are effective in improving strength and flexibility.

CLINICAL QUESTION

What is the best available evidence on positioning strategies to prevent pressure injuries (PIs) of the heel?

SUMMARY

Heel are a common anatomical location in which pressure injuries occur. Due to their small surface area and minimal tissue protection over the bony prominence, interface pressure at the heel is high when an individual is lying in bed, particularly when that individual has reduced mobility.

Polyhexamethylene biguanide is an antiseptic available as solution, gel or impregnated in wound dressings. Bench research indicates that PHMB products have broad-spectrum antimicrobial activity against Gram-positive and Gram-negative bacteria (including biofilms), methicillin-resistant Staphylococcus aureus (MRSA), fungus and viruses.

Super-oxidised solutions are a low cost topical antiseptic option for chronic wounds. Antibacterial, antimicrobial and anti-fungal properties of SOSs have been established in laboratory research.

Octenidine dihydrochloride (OCT) is an antiseptic that has been used as a wound treatment for over 20 years. Bench research indicates that OCT products have broad-spectrum antimicrobial activity against Gram-positive and Gram-negative bacteria, fungus and MRSA.

Medical-grade honey refers to honey that has been sterilised by gamma radiation, provides an indicator of the level of the honey’s antibacterial activity, is registered for medical purposes and meets national requirements for medical product labelling.

Silver, in the form of salts (e.g. silver nitrate), creams (e.g. silver sulphadiazine) and impregnated wound dressings, has been used widely as an antimicrobial agent in wound management.

Iodophors ombine elemental iodine with a surfactant for use in decreasing wound surface bacteria. The two iodophors commonly used in wound management are povidone iodine (PVP-I) and cadexomer iodine.

Active support surfaces are technologically advanced mattress or bed systems designed to promote pressure redistribution and microclimate control, thereby reducing the risk of pressure injuries, or promoting healing in existing pressure injuries.

Overweight and obesity are excessive fat accumulation that can impair health status. These individuals are more likely to exhibit factors significantly associated with an increase in pressure injuries risk. Conducting a structured risk assessment and implementing individualised preventive strategies are cornerstone principles in reducing the risk of pressure injuries.

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Heel are a common anatomical location in which pressure injuries occur. Due to their small surface area and minimal tissue protection over the bony prominence, interface pressure at the heel is high when an individual is lying in bed, particularly when that individual has reduced mobility.

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

Medical device related pressure injuries (MDRPI) occur from the use of devices designed and applied to the body for diagnostic purposes or for the delivery of treatment. The MDRPI occurs as a result of ongoing pressure on the skin from the device or from fixations used to secure the device.

Bench research provides evidence that moisture, temperature and humidity influence the coefficient of friction between the skin and fabrics, and that performance differs between fabrics.

Expert opinion suggested that the urgency of debridement, vascularisation of the wound bed, type of tissue to be debrided, the patient’s tolerance of the treatment, and financial cost are all considerations when selecting a method for debriding pressure injuries.

Recommended practice: procedure for performing an ABPI.

A range of reliable and valid tools that evaluate signs of symptoms of venous disease can be used to determine disease severity, and change over time, particularly when evaluating response to treatment.

Compression therapy is recognised as gold standard treatment for promoting healing of VLUs. The best available evidence on short-stretch bandages indicates that this form of compression therapy is effective in promoting venous leg ulcer healing.

Evidence from small randomised controlled trials suggests that electrical stimulation therapy is associated with more rapid healing of venous leg ulcers, primarily when it is used in conjunction with compression therapy.

Compression therapy is recognised as gold standard treatment for promoting healing of venous leg ulcers. The best available evidence indicates that a multi-layer bandaging system that incorporates an elastic bandage is one of the most effective compression therapy types.

Compression therapy is recognised as gold standard treatment for promoting healing of venous leg ulcers. The best available evidence indicates that pneumatic compression is effective in promoting healing.

Compression therapy is recognised as gold standard treatment for promoting healing of venous leg ulcers. The best available evidence indicates that compression stockings are one of the most effective compression therapy types for healing.

Self-care activities such as leg elevation and performing skin hygiene are recommended practice for people with venous leg ulcers, to be implemented in conjunction with other important interventions such as compression therapy and physical exercise.

Evidence from small clinical trials suggests that range of motion, strength and aerobic exercises (including walking) are effective in improving strength and flexibility.

Intermittent pneumatic compression is used to treat lymphoedema. The application of pressure assists in the reduction of oedema by creating pressure differentials within the affected limb that promote shifting of fluid from interstitial space to the lymph system.

Of the various objective and subjective strategies to assess lymphoedema, circumference measurement has the greatest utility in clinical practice, with demonstrated validity and reliability of measurement and greatest accessibility for most clinicians.

There is a large selection of tools and questionnaires that are valid and reliable in assessment of self-reported symptoms. The most common patient-reported signs and symptoms of lymphoedema are limb heaviness, swelling, redness, tenderness, change in sensory perception and inability to fit clothing.

Perometry is an advanced method by which lymphoedema can be assessed and is not used commonly in most clinical settings. Perometry measures the volume of the limb. Although it is a reliable measure of limb size, perometry is unable to distinguish between muscle, bone, fat and fluid.

Bioimpedance spectroscopy measures measures the resistance (impedance) to electrical current flow of body tissue to assess changes in fluid volume associated with lympoedema. This assessment strategy is valid, and well-correlated with other objective measures of lymphoedema.

Tonometry assesses the resistance of tissue to pressure (i.e. hardness). Because of the difficulties in obtaining precise and consistent measurements, and its limit to measuring the resistance of oedematous tissue to pressure, tonometry should not be used as the sole objective assessment of lymphoedema.

Volumetry is the measure of volume. Water displacement is considered the gold standard method of estimating limb volume. There is good evidence that the strategy is a reliable and valid method by which to measure lymphoedema.

Complex lymphoedema therapy (CLT), also known as complete decongestive therapy (CDT) or complex physical therapy (CPT), is a holistic, multi-component management strategy for reducing the signs and symptoms of lymphoedema.

Manual lymphatic drainage is used to treat lymphoedema. The specialised rhythmic ‘massage’ technique is thought to increase lymphatic drainage. There is evidence that treatment only with MLD produces inferior results compared to other treatment regimens.

Low level laser therapy (LLLT) is a biophysical modality in which low powered laser light is applied to the tissues to reduce the signs and symptoms of lymphoedema. In general, LLLT is used as part of a multi-component regimen

Compression therapy is considered the gold standard treatment for lymphoedema1 (Level 1.b evidence). There is good evidence that compression therapy significantly reduces limb volume in individuals with lymphoedema, with effect commencing within hours of application of compression.

Skin and tissue inflammation and infection is are a common sequelae in individuals with lymphoedema. Ongoing, daily skin care that includes inspecting the skin for breaks and signs of infection and performing hygiene is a well-recognised strategy to preventing infection.

Exercise is generally useful as a component in multimodal, complex lymphoedema therapy, implemented in conjunction with consistent elevation, compression therapy and manual lymph drainage of the affected limb(s).

Lymphoedema staging systems are primarily based on objective assessments of the extent of oedema.1 No single staging system has yet to be adopted or can be recommended above others.

Topical corticosteroid preparations are sometimes suggested in regimens to prevent and treat RD. Level 1 evidence from systematic reviews for preventing RD with corticosteroid creams was conflicting, with only some studies showing reduction in incidence of less severe RD.

Level 1 evidence for soft silicone film dressings used to prevent RD was mixed, with some studies showing decreased severity in RD, including reductions in pain and burning sensations.

Level 1 evidence from systematic reviews showed no effect for a non-pharmacological topical preparation in treating existing RD compared to a placebo or no treatment. Additional Level 1 evidence did not support the use of trolamine, sucralfate cream, aqueous cream and was conflicting on the benefit of hyaluronic acid preparations.

Level 1 evidence suggested using a soft silicone foam dressing to treat moist desquamation was not associated with faster healing but might reduce some signs and symptoms of RD, including pain.

Level 1 evidence reporting effectiveness of barrier films for preventing RD. Some studies showed statistically significant reductions in severity of RD and reduction in patient-reported symptoms; however, the volume of evidence was small.

Turmeric (C. longa) is a spice harvested in India and other Asian countries that has traditionally been used to treat many ailments, including skin conditions. . It has been used traditionally to treat skin conditions including psoriasis, redness, erythema, pain and burning.

Light therapy is also called phototherapy, LED therapy, near infrared therapy, low-level light therapy or photobiomodulation therapy. Light therapy is used to enhance angiogenesis, increase proliferation of fibroblasts, increase collagen synthesis, increase granulation and epithelialisation and to reduce inflammation.