UPP Pediatría

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lunes, 08 julio 2019 20:20
Angy
0 Comentarios

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jueves, 04 julio 2019 20:20
Angy
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Protocolo de prevención y tratamiento de UPP en pediatría del Hospital del Mar certificado por UPPpediatría.org

jueves, 27 junio 2019 18:02
Pablo García Molina
0 Comentarios

Estamos de enhorabuena. A pesar del tiempo que llevamos sin mostrar ninguna entrada, hemos estado trabajando para seguir avanzando en la creación y certificación de materiales documentales dirigidos a mejorar los cuidados de la población dependiente, en especial de los más pequeños.

Antes que nada agradecer la colaboración desinteresada del grupo nacional para el estudio y asesoramiento en úlceras por presión y heridas crónicas (GNEAUPP) al ceder sus materiales y experiencia en la certificación de documentos relacionados con el abordaje de personas en riesgo de úlceras por presión /UPP o que ya las padecen.

Gracias al GNEAUPP, hemos podido contar con documentos acreditativos que hemos adaptado por nuestro grupo científico. Desde esta entrada, por tanto, recalcar de nuevo el espíritu, la generosidad y la gran labor que desde el GNEAUPP se hace para divulgar y acreditar documentos.

Pero hoy queremos hablar sobre el gran trabajo que desde el Hospital del Mar (Barcelona) han realizado. En especial desde la Comisión de Úlceras por Presión y el Servicio de Metodología y Calidad e Investigación. Un protocolo que ha seguido todos los estándares marcados por los revisores de UPPpediatría. Que, a su vez, han seguido las directrices marcadas por el documento AGREE II. Además, este protocolo (en castellano y catalán) se acompaña de dos documentos más que también han sufrido el proceso de evaluación para su acreditación.

Hospital del Mar. Fuente: europapress.

En los siguientes enlaces puedes descargarte los documentos de los que estamos hablando, pues la mejor forma de valorar su contenido es leyéndolos. Cabe recordar que al ser un protocolo se han tenido en cuenta las peculiaridades de su propio contexto sanitario, que en muchas ocasiones no tiene porqué coincidir con el de otros. De ahí las diferencias, por ejemplo, en cuanto a técnica o productos a utilizar.

Seguro que en algunas de las recomendaciones sí que podemos coincidir y en otras no podemos aplicarlas en nuestro contexto sanitario.

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jueves, 20 junio 2019 20:20
Angy
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Efectividad de los apósitos en la prevención de UPP en bebés portadores de VMNI

martes, 12 febrero 2019 16:12
Pablo García Molina
0 Comentarios

Raquel Cubells es enfermera desde junio del año 2018. Y en su corta trayectoria ya cuenta con un premio a la Mejor Comunicación TFG/TFM en el último congreso del GNEAUPP celebrado en Valencia en Octubre del 2018. En esta entrada, Raquel nos cuenta algunos detalles de la investigación que realizó y está a punto de publicar.  


La idea de hacer esta entrada surgió a raíz del trabajo de investigación que llevé a cabo junto con otros profesionales de enfermería en 2018 sobre prevención de úlceras por presión (UPP) en neonatos con ventilación mecánica no invasiva (Figura 1) , ingresados en la Unidad de Cuidados Intensivos Neonatales y Pediátricos del Hospital Clínico Universitario de Valencia.

Figura1: Niño con UPP categoría II, curado con apósito de espuma de poliretano de baja adhesividad. Fuente: Dr. Pablo García Molina

Este proyecto adquiere mucha relevancia debido al creciente número de casos que se evidencian sobre lesiones provocadas por el uso de este tipo de soporte ventilatorio en recién nacidos/as, sobre todo, en prematuros/as. Por ello, consideramos que podría contribuir en la prevención de dichas lesiones y aportar conocimientos prácticos sobre las medidas preventivas necesarias para mantener la integridad cutánea. El enfoque es meramente divulgativo para todos aquellos profesionales que deseen conocer más sobre el tema y que estén en contacto con este tipo de pacientes y para la sociedad afectada o en riesgo.

Cabe destacar, que la ventilación mecánica no invasiva (VMNI) empleada a nivel terapéutico, se ha convertido en el método de ventilación más usado en neonatos, puesto que las dificultades respiratorias constituyen la causa más común de muerte entre la población neonatal.

Sin embargo, la utilización prolongada y de forma incorrecta de esta, se asocia a la aparición de lesiones en la piel y en las membranas mucosas de las fosas nasales. Por ello, son los/as enfermeros/as quienes han desarrollado toda una serie de medidas destinadas a la protección de la piel expuesta a la presión y fricción, tales como el uso de apósitos. Más concretamente, con este proyecto se pretendía probar la efectividad del apósito hidrocoloide (Comfeel Plus Transparent) en comparación con el apósito de espuma de poliuretano (Espuma NeoSeal) (Figura 2).


Apósito hidrocoloide (Comfeel Plus Transparent) en comparación con el apósito de espuma de poliuretano (Espuma NeoSeal) Fuente: elaboración Raquel Cubells

La muestra del estudio estaba compuesta por 13 sujetos de los cuales 61,5% fueron mujeres y el restante 38,5% hombres. Se realizó la división de estos pacientes en dos grupos, donde el grupo A empleó el apósito de espuma de poliuretanoy el grupo B utilizó el apósito hidrocoloide.

Una vez realizada la formación de grupos y la valoración inicial de los/as pacientes para descartar la presencia de úlceras por presión nasales y/o faciales previas, comenzó la recogida de los datos mediante la hoja de valoración y la observación directa de los/as mismos/as de forma diaria durante el período de tiempo establecido (de abril a mayo de 2018).

Tras el análisis de los datos, se obtuvo que, del total de pacientes, un 38,5% (5 pacientes) desarrolló UPP relacionadas con la VMNI. Más específicamente, con respecto a la categoría de las lesiones, del total de neonatos con trauma nasal, un 80% presentaba UPP de grado I y un 20% de grado II. Asimismo, el 40% de las lesiones se hallaron en la columela, otro 40% en las narinas y un 20% en el ala nasal.

Para la variable de apósitos, obtuvimos que de los 6 pacientes portadores del apósito hidrocoloide, 3 neonatos desarrollaron UPP. Por el contrario, de los 7 pacientes con el de espuma de poliuretano, tan solo 2 presentaron lesión.

Además, en cuanto a los sistemas y dispositivos de VMNI, cabe destacar que la CPAP presentó mayor porcentaje de no presencia de UPP (50%) que la OAF (oxigenoterapia de alto flujo) (12,5%). Con cánulas RAM, existe un mayor porcentaje de pacientes que no han presentado lesión (87,5%) en relación a los que sí (20%). Del mismo modo, con vástagos nasales todos los neonatos han presentado UPP (40%) y con cánulas de OAF, el porcentaje de pacientes con UPP (40%) es mayor que los/as que no (12,5%).

Tras finalizar el estudio, consideramos que es fundamental la formación específica de todos los/as profesionales sanitarios/as que vayan a responsabilizarse del cuidado y la valoración de este tipo de pacientes para lograr una atención integrada y de calidad.

También se determinó que el apósito más efectivo para la prevención de UPP en los neonatos con VMNI fue la espuma de poliuretano. Por lo que, sería recomendable implantarlo en los servicios de Neonatología y Pediatría del Hospital Clínico Universitario de Valencia, teniendo en cuenta la vigilancia y valoración constantes.

Por último, creemos importante llevar a cabo más estudios centrados en la investigación clínica que puedan dar solución a los problemas que causan los sistemas y dispositivos de VMNI, puesto que los resultados evidencian que con prevención y/o cuidados eficaces se conseguiría reducir el número de pacientes con UPP. Para poder obtener mayor información sobre el estudio, podremos ofrecérosla en breve gracias a su publicación en la revista oficial del GNEAUPP. 

Autora entrada: Raquel Cubells (Enfermera)

Cuidados de la piel del neonato. Los medios de comunicación se hacen eco.

domingo, 06 enero 2019 16:14
Pablo García Molina
0 Comentarios

¡Y es que estamos de enhorabuena! Parte del equipo que participó en el documento de consenso «Cuidados de la piel en neonatos portadores de ventilación mecánica no invasiva» han sido noticia. Los enfermeros de la Unidad de Neonatología del Hospital San Pedro de Logroño, José Antonio León @EnfermerApp @sololeon y María Jesús Díaz (miembros de la SEEN), así como la la pediatra y jefa de servicio, Yolanda Ruiz del Prado fueron los encargados de dar a conocer la importancia de este documento para disminuir las úlceras por presión en los neonatos que llevan máscara o prongs de Ventilación mecánica no invasiva. 

Profesionales de la salud del Hospital San Pedro de Logroño participantes del documento de consenso.

Cualquier profesional sanitario, ya sea TCAE, pediatra o enfermero, encargado del cuidado del neonato, se ha enfrentado a los problemas derivados de llevar una máscara en la nariz durante casi 24 horas. La piel en contacto con la máscara o los prongs está expuesta a un exceso de humedad y a fuerzas de fricción y cizalla que favorecen la aparición de lesiones de diversa gravedad.  

Tanto Europapress como Actualidadriojabaja.com, Harodigital.com y nuevecuatrouno también reproducen la noticia y os mostramos los enlaces que dirigen a las noticias en los diferentes medios de comunicación.

 

Empezar el año con noticias de este tipo facilita que toda enfermera con un sueño crea que es posible realizarlo.  Gracias a todas las colaboradoras del documento de consenso, pues hubiera sido imposible que este proyecto y los que vienen pudiera ver la luz.

En breve desde el grupo upppediatria.org y la SEEN mostraremos los próximos documentos de consenso que se van a llevar a cabo. Si estáis interesados en participar tan solo debéis poneros en contacto con alguno de los miembros de upppediatria.org o de la Sociedad Española de Enfermería Neonatal.

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