Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Yoğun Bakımda Basınç Yarası Gelişmş Hastaların Değerlendirilmesi
Evaluation of Cases with Pressure Ulcer in Intensive Care Unit
Onur AVCIa
aAnesteziyoloji ve Reanimasyon ABD, Sivas Cumhuriyet Üniversitesi Tıp Fakültesi,
Sivas, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2019;11(3):239-45
doi: 10.5336/nurses.2018-64013
Article Language: TR
Full Text
ÖZET
 Amaç: Basınç yaraları; morbiditeyi, mortaliteyi ve hastanede yatış süresini artıran bir sağlık sorunudur. Bu çalışmada; kliniklerden ve acil servisten anestezi yoğun bakıma yatırılan hastalarda basınç yarası görülme sıklığını, oluşma sürecini, Waterlow risk skoru ile korelasyonunu, en sık basınç yarası gelişen bölgeleri ve diğer kliniklerde basınç yarası gelişen hasta sayısı ile anestezi yoğun bakımda basınç yarası gelişen hasta sayısının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Girişimsel olmayan klinik uygulamalar etik kurulu alındıktan sonra; anestezi yoğun bakım ünitesinde Mart 2013-Nisan 2016 tarihleri arasında, yatmakta olan 1.739 hastadan basınç yarası gelişen 201 hastada tanımlayıcı tipte, retrospektif, tek merkezli bir çalışma olarak planlandı. Çalışmamızda hastaların demografik bilgilerini, Waterlow risk skorlarını, basınç yarası evrelerini, anestezi yoğun bakıma devir alındıkları klinikleri ve basınç yarası oluşan bölgeleri içeren bir tanımlama formu kullanılmıştır. Bulguların değerlendirilmesinde SPSS Windows 22.0 programı kullanıldı. Bulgular: Yoğun bakım ünitesinde Mart 2013-Nisan 2016 tarihleri arasında basınç yarası gelişme oranı %11,55 olarak hesaplandı. Basınç yarası kaydı yapılan 201 hastanın %47,8?i erkek, %52,2?si ise kadın hasta idi. Ortalama Waterlow risk skoru 23,22 olarak hesaplandı. Basınç yarası oluşma süresi ise ortalama olarak 22,94 gün olarak bulundu. Yoğun bakım hastalarının (n=201) %28?inde evre 1, %52?sinde evre 2, %16?sında evre 3 ve %2,4?ünde evre 4 basınç yarası gelişmiştir. Yoğun bakıma kabul edilen ve basınç yarası gelişen hastaların kabul edildiği klinikler incelendiğinde, %40,8 ile dâhiliye kliniğinden gelen hastaların olduğu saptanmıştır. Bu hastalarda en sık olarak da sakrum ve koksiks bölgesinde basınç yarası geliştiği görülmüştür. Sonuç: Anestezi yoğun bakım ünitesinde basınç yarası gelişen hasta sayısının; kliniklerden kabul edilen basınç yarası tanısı almış hasta sayısına kıyasla anlamlı düzeyde yüksek olduğu saptanmıştır. Yoğun bakımda çalışan ekibin niteliklerinin artırılması, hizmet içi eğitimler, düzenli basınç yarası risk skoru analizi ve basınç yarası önleyici uygulamalarla basınç yarası oluşumunun önlenmesi önerilmektedir.

Anahtar Kelimeler: Basınç yarası; Waterlow risk skoru; yoğun bakım
ABSTRACT
 Objective: Pressure ulcer is a health problem that increases morbidity, mortality and duration of hospitalization. The aim of this study is to determine the frequency of pressure ulcers, average of pressure ulcer formation process, the correlation with Waterlow risk score, the most frequent locations of pressure ulcers, and to compare the number of patients with pressure ulcers inside and outside anesthesia intensive care units. Material and Methods: After approval of the ethics committee of non-interventional clinical practice were taken; 1.739 patients who were treated between March 2013-April 2016 in anesthesia intensive care unit were included in this definitive, retrospective, one-centered study. A definition form which includes demographic informations, Waterlow risk scores, pressure ulcer stages, clinics which the patients were taken to anesthesia intensive care unit and regions with pressure ulcers of the patients was used in this study. SPSS for Windows 22.0 program was used to evaluate findings from the research. Results: Between March 2013-April 2016, pressure ulcer occurrence rate was 11.55%. 201 patients with pressure ulcers 47.8% were male, 52.2% were female. Average Waterlow risk score was 23.22. Average time for pressure ulcer generation was 22.94 days. Of the 201 patients diagnosed with pressure ulcers in intensive care unit, 28% were stage 1, 52% were stage 2, 16% were stage 3 and 2.4% were stage 4. Between the patient group taken from another service, the patients that were taken from internal medicine had the most number of pressure ulcer diagnosis with 40.8%. The most common locations of pressure ulcers were sacrum and coccyx. Conclusion: The number of patients diagnosed with pressure ulcers in our anesthesia intensive care unit was found to be significantly higher than the number of patients that taken from clinics with pressure ulcer diagnosis. We suggest to prevent pressure ulcer occurrence with in-service trainings, more qualified medical staff in intensive care units, regular pressure ulcer risk score analysis and preventive applications.

Keywords: Pressure ulcer, Waterlow risk score, intensive care unit
REFERENCES:
  1. Luce MJ. Approach to the patient in a critical care setting. In: Goldman L, Bennett JC, eds. Cecil Textbook of Internal Medicine. 21th ed. Philadelphia: W.B. Saunders Comp; 2000. p.483-98.
  2. Coyer F, Tayyip N. Risk factors for pressure injury development in critically ill patients in the intensive care unit: a systematic review protocol. Syst Rev. 2017; 6(1):58. [Crossref]  [PubMed]  [PMC] 
  3. Doley J. Nutrition management of pressure ulcers. Nutr Clin Pract. 2012;25(1):50-60. [Crossref]  [PubMed] 
  4. Dorner B, Posthauer ME, Thomas D. The role of nutrition in pressure ulcer prevention and treatment: National pressure ulcer advisory panel white paper. Adv Skin Wound Care. 2009;22(5):212-21. [Crossref]  [PubMed] 
  5. Pajk M. Pressure sores. In: Beers M, Berkow R, eds. The Merck Manuel of Geriatrics. 3rd ed. Whitehouse Station, N.J: Merck Research Laboratories; 2000. p.1261-76.
  6. Hampton S, Collins F. Reducing pressure ulcer incidence in a long-term setting. Br J Nurs. 2005;14(15):S6-12. [Crossref] 
  7. Efteli EÜ, Güneş Ü. [The effect of perfusion values in the development of pressure ulcers]. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2014;17(3):140-4.
  8. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Yara Ostomi İnkontinans Hemşireleri Derneği, çeviri editörü. Basınç Ülserlerini Önleme: Hızlı Başvuru Kılavuzu. Ankara: Yara Ostomi İnkontinans Derneği; 2010. p.25.
  9. Özyürek P, Yavuz Van Giersbergen M. [Pressure Ulcer]. Aslan FE, Olgun N, editörler. Yoğun Bakım Seçilmiş Semptom ve Bulguların Yönetimi. 1. Baskı. Ankara: Akademisyen Kitabevi; 2016. p.182-215.
  10. Risk Assessment & Prevention of Pressure Ulcers Registered Nurses' Association of Ontario Nursing Best Practice Guidelines Program; 2011. Www.Rnao.Org/Bestpractices (Erişim Tarihi: 17.01.2016).
  11. Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in venous cathater associated blood stream infections. Infect Control Hosp Epidemiol. 1996;17(3):150-8. [Crossref]  [PubMed] 
  12. Balzer K, Pohl C, Dassen T, Halfens R. The Norton, Waterlow, Braden and care dependency scales: comparing their validity when identifying patients pressure sore risk. J Wound Ostomy Continence Nurs. 2007;34(4): 389-98. [Crossref]  [PubMed] 
  13. Defloor T, Grypdonck MF. Pressure ulcers: validation of two risk assesment scales. J Clin Nurs. 2005;14(3):373-82. [Crossref]  [PubMed] 
  14. Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care. 2002;15(3):125-31. [Crossref] 
  15. Tel H, Özden D, Güneş Çetin P. [Determination of risk for pressure ulcer development in bedridden patients and preventive measures that nurses use for these patients]. Hemşirelikte Araştırma Geliştirme Dergisi. 2006;(2):35-45.
  16. Inan DG, Oztunç G. Pressure ulcer prevelance in Turkey: a sampke from a university hospital. J Wound Ostomy Continence Nurs. 2012;39(4):409-13. [Crossref]  [PubMed] 
  17. Knudsen CW, Tønseth KA. Pressure ulcers--prophylaxis and treatment. Tidsskr Nor Legeforen. 2011;131(5):464-7. [Crossref]  [PubMed] 
  18. Kurtuluş Z, Pınar R. [Relation between albumin levels and pressure sore in high risk patients defined with Braden's risk assessment tool]. C.Ü. Hemşirelik Yüksek Okulu Dergisi. 2003;7(2):1-10.
  19. Fife C, Otto G, Capsuto EG, Brandt K, Lyssy K, Murphy K, et al. Incidence of pressure ulcers in a neurologic intensive care unit. Crit Care Med. 2001;29(2):283-90. [Crossref]  [PubMed] 
  20. Serpa FL, Santos VL, Campanili TC, Queiroz M. Predictive validity of Braden scale for pressuer ulcers risk in critical care patients. Rev Lat Am Enfermagem. 2011;19(1):50-7. [Crossref]  [PubMed] 
  21. Hug E, Ünalan H, Karamehmetoğlu SS, Tüzün S, Gürgöze M, Tüzün F. [Prevalence of pressure ulcers in a training hospital and effective risk factors in pressure development. Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi. 2001;47(6):3-11.
  22. Pang SM, Wong TK. Predicting pressures or risk with the Norton, Braden and Waterlow scales in a Hong Kong Rehabilitation Hospital. Nurs Res. 1998;47(3):147-53. [Crossref]  [PubMed] 
  23. Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-nieto C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs. 2006;54(1):94-110. [Crossref]  [PubMed] 
  24. Thoroddsen A. Pressure sore prevalence: a national survey. J Clin Nurs. 1999;8(2):170-9. [Crossref]  [PubMed] 
  25. Ortak T, Özdemir R, Taner ÖF, Ünlü RE, Şensöz Ö. [Etiological and surgical evaluation of 476 patients with pressure sores]. Turkiye Klinikleri J Med Sci. 2003;23(1):18-22.

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com