Nazogastrik tüp kaynaklı basınç yaralanmalarının önlenmesinde kanıt temelli deri bakımı ve hidrokolloid örtünün etkisi: Randomize kontrollü çalışma
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Dosyalar
Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Nazogastik tüp (NG) kaynaklı basınç yaralanmaları, NG tüpün oluşturduğu basıncın etkisiyle burun mukozasında, burun derisinde ve/veya deri altı dokuda veya tüp tespit materyali altında gelişen lokalize doku hasarıdır. Bu araştırmada, kritik hastalarda NG tüp kaynaklı basınç yaralanmalarını önlemede kanıt temelli deri bakımı ve hidrokolloid örtünün etkisini belirlemek amaçlandı. Prospektif paralel, üç kollu (hidrokolloid, kanıt temelli deri bakımı, kontrol) randomize kontrollü tipteki bu araştırma, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesinde (YBÜ) gerçekleştirildi. Araştırma kapsamına, Eylül 2020-Haziran 2022 tarihleri arasında YBÜ'ne kabul edilen, NG tüp takılan, 18 yaş üzeri 102 hasta dahil edildi. Randomizasyonla her bir kola 34 hasta atandı. Veri toplayan araştırmacı ve hastalar grup atamasına körlendi. Araştırma öncesi etik kurul ve kurum izinleri alındı. Hidrokolloid örtü kolundaki hastaların burun mukozasına ve burun kanadına NG tüp takıldıktan sonra yarı saydam hidrokolloid örtü uygulandı ve tüp bu örtü ile tespit edildi. Sonra günde bir kez hidrokolloid pansuman çıkarılarak alttaki cilt ve mukoza değerlendirildi, burun derisi ve çevre deri temizlendi, kurulandı ve yeni hidrokolloid örtü uygulandı. Deri bakım kolundaki hastalara rehberlerde yer alan kanıt temelli deri bakım girişimleri günde iki kez uygulandı. Veri analizinde, tanımlayıcı istatistikler, Ki-Kare testleri, Bağımsız Örneklem t testi, Mann-Whitney U testi, Tek Yönlü Varyans Analizi, Kruskal-Wallis testi ve regresyon analizi kullanıldı. Kontrol kolundaki hastalarının %97,1'inde, deri bakımı kolundakilerin %94,1'inde NG tüp kaynaklı basınç yaralanması oluşurken, hidrokolloid örtü kolundaki hiçbir hastada basınç yaralanması oluşmadı (p<0,001). Kontrol kolu ile kıyaslandığında hidrokolloid örtü uygulaması NG tüp kaynaklı basınç yaralanmasını önlemede %97; deri bakımı uygulaması ile kıyaslandığında ise %94'lük bir etki oluşturdu. Deri bakım kolundakilerde evre 1, kontrol kolundakilerde ise evre 2 basınç yaralanması oranı daha yüksekti ve kontrol kolunda basınç yaralanması oluşma süresi anlamlı olarak daha kısaydı (p<0,005). Çok değişkenli penalized lojistik regresyon analizi sonuçları, hidrokolloid örtü uygulanmamasının NG tüp kaynaklı basınç yaralanması riskini 20,3 kat artırdığını (p<0,001), ventilasyon süresi bir birim artığında ise riskin %18 oranında azaldığını (p=0,038) gösterdi. Sonuç olarak araştırma bulguları, hidrokolloid örtünün NG tüp kaynaklı basınç yaralanmalarını önlemede etkili olduğunu, deri bakım girişimlerinin ise aynı etkiyi göstermediğini ortaya koydu. Bu bulgular doğrultusunda NG tüp kaynaklı basınç yaralanmalarını önlemede hidrokolloid örtü kullanımına yönelik protokollerin geliştirilmesi ve sağlık profesyonellerinin bilgilendirilmesi, deri bakım girişimlerinin etkinliğine yönelik yeni çalışmaların yapılması önerilir.
Nasogastric (NG) tube-related pressure injuries are local tissue damage to the nasal mucosa, nasal skin, and/or subcutaneous tissue or under the tube fixation material due to pressure generated by the NG tube. The aim of this study was to determine the effect of evidence-based skin care and hydrocolloid dressing in preventing NG tube-related pressure injuries in critically ill patients. This prospective parallel, three-arm (hydrocolloid, evidence-based skin care, control) randomized controlled trial was conducted in the Anesthesiology and Reanimation Intensive Care Unit (ICU) of Necmettin Erbakan University Meram Medical Faculty Hospital. The study included 102 patients over the age of 18 years who were admitted to the ICU between September 2020 and June 2022 and underwent NG tube placement. 34 patients were assigned to each arm by randomization. Data collecting researcher and patients were blinded to group assignment. Ethics committee and institutional permissions were obtained before the study. After the NG tube was inserted a translucent hydrocolloid dressing was applied into the nasal mucosa and nasal wing of the patients in the hydrocolloid dressing arm and the tube was fixed with this dressing. Then, once a day, the hydrocolloid dressing was removed to assess the underlying skin and mucosa, the nasal skin and surrounding skin were cleaned, dried, and a new hydrocolloid dressing was applied. In the skin care arm, evidence-based skin care interventions included in the guidelines were applied twice daily. Descriptive statistics, Chi-Square tests, Independent Sample t test, Mann-Whitney U test, One-Way Analysis of Variance, Kruskal-Wallis test and regression analysis were used in data analysis. NG tube-related pressure injury occurred in 97.1% of patients in the control arm and 94.1% in the skin care arm, whereas no pressure injury occurred in any patient in the hydrocolloid dressing arm (p<0.001). Compared with the control arm, hydrocolloid dressing application had an effect of 97% in preventing NG tube-related pressure injury, and 94% compared with skin care application. The rate of stage 1 pressure injury was higher in the skin care arm and stage 2 pressure injury in the control arm, and the time to pressure injury was significantly shorter in the control arm (p<0.005). Results of multivariate penalized logistic regression analysis showed that not applying hydrocolloid dressing increased the risk of NG tube-related pressure injury 20.3-fold (p<0.001), whereas the risk decreased by 18% (p=0.038) when the ventilation time increased by one unit. In conclusion, the study's results showed that while skin care measures did not have the same impact, hydrocolloid dressing was effective in preventing pressure injuries caused by NG tubes. The development of protocols for the application of hydrocolloid dressing in the prevention of NG tube-related pressure injuries, education of healthcare personnel, and new research on the efficiency of skin care t interventions are all advised in light of these results.
Nasogastric (NG) tube-related pressure injuries are local tissue damage to the nasal mucosa, nasal skin, and/or subcutaneous tissue or under the tube fixation material due to pressure generated by the NG tube. The aim of this study was to determine the effect of evidence-based skin care and hydrocolloid dressing in preventing NG tube-related pressure injuries in critically ill patients. This prospective parallel, three-arm (hydrocolloid, evidence-based skin care, control) randomized controlled trial was conducted in the Anesthesiology and Reanimation Intensive Care Unit (ICU) of Necmettin Erbakan University Meram Medical Faculty Hospital. The study included 102 patients over the age of 18 years who were admitted to the ICU between September 2020 and June 2022 and underwent NG tube placement. 34 patients were assigned to each arm by randomization. Data collecting researcher and patients were blinded to group assignment. Ethics committee and institutional permissions were obtained before the study. After the NG tube was inserted a translucent hydrocolloid dressing was applied into the nasal mucosa and nasal wing of the patients in the hydrocolloid dressing arm and the tube was fixed with this dressing. Then, once a day, the hydrocolloid dressing was removed to assess the underlying skin and mucosa, the nasal skin and surrounding skin were cleaned, dried, and a new hydrocolloid dressing was applied. In the skin care arm, evidence-based skin care interventions included in the guidelines were applied twice daily. Descriptive statistics, Chi-Square tests, Independent Sample t test, Mann-Whitney U test, One-Way Analysis of Variance, Kruskal-Wallis test and regression analysis were used in data analysis. NG tube-related pressure injury occurred in 97.1% of patients in the control arm and 94.1% in the skin care arm, whereas no pressure injury occurred in any patient in the hydrocolloid dressing arm (p<0.001). Compared with the control arm, hydrocolloid dressing application had an effect of 97% in preventing NG tube-related pressure injury, and 94% compared with skin care application. The rate of stage 1 pressure injury was higher in the skin care arm and stage 2 pressure injury in the control arm, and the time to pressure injury was significantly shorter in the control arm (p<0.005). Results of multivariate penalized logistic regression analysis showed that not applying hydrocolloid dressing increased the risk of NG tube-related pressure injury 20.3-fold (p<0.001), whereas the risk decreased by 18% (p=0.038) when the ventilation time increased by one unit. In conclusion, the study's results showed that while skin care measures did not have the same impact, hydrocolloid dressing was effective in preventing pressure injuries caused by NG tubes. The development of protocols for the application of hydrocolloid dressing in the prevention of NG tube-related pressure injuries, education of healthcare personnel, and new research on the efficiency of skin care t interventions are all advised in light of these results.
Açıklama
Doktora Tezi
Anahtar Kelimeler
Basınç Yaralanması, Deri Bakımı, Hidrokolloid Örtü, Nazogastrik Tüp, Hydrocolloid Dressing, Nasogastric Tube, Pressure Injury, Skin Care
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yeşilyurt, M. (2023). Nazogastrik tüp kaynaklı basınç yaralanmalarının önlenmesinde kanıt temelli deri bakımı ve hidrokolloid örtünün etkisi: Randomize kontrollü çalışma. (Yayımlanmamış doktora tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı, Konya.
