Bedsore is a common complication in patients with neurological disorders. Prolonged pressure on the local soft tissue causes continuous ischemia and hypoxia, malnutrition and tissue necrosis, which is the result of multiple factors interacting with each other. Clinically, it is divided into three stages: hematoma and erythema stage, inflammatory infiltration stage, and ulcer stage. In this article, alginate AG dressing plus standard ulcer dressing is used for local dressing change in the ulcer stage of bedsore, and the clinical effect is satisfactory.
Ⅰ. Alginate AG dressing treatment method:
Disinfect the wound surrounding with conventional disinfection methods, wash the wound with sterile saline, wait for the wound to dry a little, fill the affected area with alginate AG dressing (for wounds with scabs, remove the scabs first), and then cover the wound with a standard ulcer dressing to isolate the wound from the outside world. Change dressings every other day, and fully fill the wound if it is deep. For patients with more exudate, change dressings once a day until the ulcer heals. At the same time, prevent pressure on the bedsore area and turn over once every 2 hours.
Ⅱ. Observation of the therapeutic effect of alginate AG dressings:
About 1 week after changing the dressing with alginate AG dressing, the yellow necrotic tissue gradually transforms into red tissue, and granulation tissue appears on the ulcer surface. When washing the wound during dressing change, the local capillaries bleed significantly, and the wound area gradually decreases. For wounds with deep ulcers or more exudate, the exudate gradually decreases, and the wound gradually becomes dry. New granulation tissue begins to grow after about 10 days, and complete healing can be achieved within a month. During dressing change, the foam alginate dressing is easy to peel off, and most patients feel no pain with the turnover of their bodies.
Among 10 patients with bedsores, the ulcer surfaces completely healed in an average of 15 days. During the dressing change, the pain was significantly reduced, and there were no signs of infection on the ulcer surface. Another patient with a deep ulcer healed slowly due to extreme weakness, combined with pulmonary and urinary tract infections, but the ulcer gradually shrank and improved after daily dressing changes.
Ⅲ. Nursing of alginate AG dressing:
1. The principle of local treatment is to relieve pressure, clean the wound, rinse with sterile saline, and keep the surrounding skin dry.
2. Turn over the patient regularly and pat the back every 2 hours. The turnover card is hung by the bedside, and change of shifts every shift. After the patient's condition stabilizes, the frequency of turnover can be increased. The three-step turn-over method (upper body, lower limbs, abdomen and buttocks) should be used gently to avoid rubbing, pulling, pushing and other movements to prevent skin abrasions. Apply Vaseline to the susceptible parts of the bedsores and keep the bed sheets clean and dry. Change clothes when wet, and wash with warm water in the morning and evening.
3. Sleep on an air-cushioned bed. For protruding bone parts, use air cushions, sponge cushions or cotton cushions to suspend the presses area to prevent it from being pressed again.
4. Special attention should be paid to the position of the paralyzed patient, and assist the patient in choosing a suitable position. For example, the prone position is prone to sacral and heel bedsores, and the lateral position is prone to hip bedsores. When lying on your side, keep a 45-degree angle between the bed and patient's back.
5. Strengthen nutrition: Generally, bedridden patients will have malnutrition, and due to the long-term chronic wounds, the patient's consumption increases, and the body is in a negative nitrogen balance. Patients who are extremely weak or have severe illness are at high risk of developing bedsores, therefore, the whole-body nutrition should be strengthened, and protein, vitamins, trace elements, amino acids, and plasma substitutes should be supplemented.
Antimicrobial alginate dressing is one type of contemporary moist dressing. Currently, it is believed that moist conditions are conducive to the formation of epithelial cells on the wound, avoiding scabbing, promoting the growth of granulation tissue, and accelerating wound healing.
The active ingredient is alginates in seaweed, which has a highly hydrophilic property, is similar to gel and can be biodegraded, and interacts with calcium chloride to produce silk-like fibers. These fibers are interwoven and arranged in a certain order, and a 2mm-thick alginate AG dressing can be formed under pressure.