Prevention of iatrogenic ulcers produced by therapeutic immobilization with a lower limb splint in children. Clinical trial
Abstract
Introduction: Immobilization with plaster cast in lower limb is a frequent procedure for children in the emergency services, which is not without risks related to immobility and pressure, on these factors nurses have to adopt preventive care.
Objective: To verify the efficacy of the polymeric heel patch in the prevention of iatrogenic ulcers in children immobilized with a plaster splint in the lower limb.
Material and method: Preventive randomized clinical trial on pediatric patients aged 0 to 14 years who require immobilization with a lower limb cast cast. Simple blind non-probabilistic consecutive sampling was performed. Descriptive statistical analysis of the variables and X2 test with the application variables of the patch and the appearance of ulcers.
Results: A total sample of n = 74 patients was obtained. Ulcer was observed in 21.7% of patients, whole skin (48.2%) and erythema that pales 30.1%. The X2 test was applied for the application of polymer patch and ulcer appearance variables, obtaining X2 = 0.135 with p = 0.713, and therefore, there is no statistical significance between these two variables.
Conclusions: There is no direct relationship between the prevention of pressure ulcers in children immobilized with plaster splint and the application of polymeric protective patch. It is very important that nurses offer a quality health education in the care and maintenance of the splint to avoid complications.
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References
Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008;16(1):30-40.
(2) Balch Samora J, Samora WP, Dolan K, Klingele KE. A Quality Improvement Initiative Reduces Cast Complications in a Pediatric Hospital. J Pediatr Orthop. 2018;38(2):43-9.
(3) Illgen R, Rodgers WB, Hresko MT, Waters PM, Zurakowski D, Kasser JR. Femur fractures in children: treatment with early sitting spica casting. J Pediatr Orthop. agosto de 1998;18(4):481-7.
(4) Lubicky JP, Bernotas S, Herman JE. Complications related to postoperative casting after surgical treatment of subluxed/dislocated hips in patients with cerebral palsy. Orthopedics. 2003;26(4):407-11; discussion 411.
(5) Podeszwa DA, Mooney JF, Cramer KE, Mendelow MJ. Comparison of Pavlik harness application and immediate spica casting for femur fractures in infants. J Pediatr Orthop. 2004; 24(5):460-2.
(6) Marson BM, Keenan MA. Skin surface pressures under short leg casts. J Orthop Trauma. 1993; 7(3):275-8.
(7) Mohler LR, Pedowitz RA, Byrne TP, Gershuni DH. Pressure generation beneath a new thermoplastic cast. Clin Orthop. enero de 1996;(322):262-7.
(8) Davids JR, Frick SL, Skewes E, Blackhurst DW. Skin surface pressure beneath an above-the-knee cast: plaster casts compared with fiberglass casts. J Bone Joint Surg Am.1997; 79(4):565-9.
(9) Forni C, Zoli M, Loro L, Tremosini M, Mini S, Pirini V, et al. [Cohort study of the incidence of heel pressure sores in patients with leg casts at the Rizzoli Orthopedic Hospital and of the associated risk factors]. Assist Inferm E Ric AIR. 2009; 28(3):125-30.
(10) Bakody E. Orthopaedic plaster casting: nurse and patient education. Nurs Stand R Coll Nurs G B. 2009; 23(51):49-56; 57.
(11) DiPaola MJ, Abzug JM, Pizzutillo PD, Herman MJ. Incidence and etiology of unplanned cast changes for fractures in the pediatric population. J Pediatr Orthop. septiembre de 2014;34(6):643-6.
(12) Nguyen S, McDowell M, Schlechter J. Casting: Pearls and pitfalls learned while caring for children’s fractures. World J Orthop. 2016;7(9):539-45.
(13) Difazio RL, Harris M, Feldman L, Mahan ST. Reducing the Incidence of Cast-related Skin Complications in Children Treated With Cast Immobilization. J Pediatr Orthop. 2017; 37(8):526-31.
(14) Raymond Y, Craig R, Born T, Lareau M. Novel posterior splinting technique to avoid heel ulcers. Orthopedics. 2013; 36(1):31-2.
(15) Deignan BJ, Iaquinto JM, Eskildsen SM, Woodcock CA, Owen JR, Wayne JS, et al. Effect of pressure applied during casting on temperatures beneath casts. J Pediatr Orthop. 2011;31(7):791-7.
(16) Veronesi L, Merola EP, Schiavone M, Forni C. Efficacy of splint with heel off-loaded in children with lower limbs plaster cast. Randomised open label trial. Assist Inferm E Ric AIR. 2016; 35(2):62-9.
(17) Torra i Bou J-E, Rueda López J, Camañes G, Herrero Narváez E, Blanco Blanco J, Martínez-Esparza EH, et al. [Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel]. Rev Enfermeria Barc Spain. 2002; 25(5):50-6.
(18) Marshall J, Branthwaithe H, Chockalingam N. Heel pressures with generic and focused rigid heel cast devices while in a static supine and seated position. J Wound Care. 2016; 25(6):328-34.
(19) Forni C, Loro L, Tremosini M, Mini S, Pignotti E, Bigoni O, et al. Use of polyurethane foam inside plaster casts to prevent the onset of heel sores in the population at risk. A controlled clinical study. J Clin Nurs. 2011;20(5-6):675-80.
(20) Torra I Bou J-E, Rueda López J, Camañes G, Herrero Narváez E, Blanco Blanco J, Ballesté Torralba J, et al. Preventing pressure ulcers on the heel: a Canadian cost study. Dermatol Nurs. 2009;21(5):268-72.
(21) Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006; 296(8):974-84.
(22) García FP, Soldevilla J, Pancorbo PL, Verdú Soriano J, López P, Rodríguez M. Prevención de las úlceras por presión. Documento técnico GNEAUPP. 2aed. Logroño: Grupo nacional para el estudio y asesoramiento en úlceras por presión y heridas crónicas; 2014.
(23) Registered Nurse Association of Ontario (RNAO). Risk assesment and prevention of pressure ulcers [Internet]. Toronto: Nursing Best Practice Guideline; 2011. Consultado: enero de 2017. Disponible en: https://rnao.ca/sites/rnao-ca/files/Risk_Assessment_and_Prevention_of_Pressure_Ulcers.pdf
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