Authors (including presenting author) :
Lee KC(2), Tsang YT(1), Kwan KY(1), Pang SH(1), Yu KH(1), Leung YW(1), Yue CS(1), Chow KS(1), Ngan PL(1), Law KF(1), Ng YB(1)
Affiliation :
(1)Medicine & Geriatric Department, United Christian Hospital (2) Nursing Services Division, United Christian Hospital
Introduction :
In United Christian Hospital, post-CIED implanted patients were traditionally discharged with “Heavy” dressing until first visit in Cardiac Nurse Pacemaker (CNP) Clinic. However, around 30% dressing was found loosen in clinic due to skin irritation and discomfort reported by patients. On the other hand, “Heavy” dressing also affected wound observation which would hinder wound healing in a consequence. Therefore, a pilot study of shifting “Heavy” to “Light” CIED dressing was conducted from 1st March to 31st May 2018.
Objectives :
•To compare the effect of “Light” and “Heavy” dressing on ease of wound observation and patients’ comfort. •To examine any confounding factors contributing to CIED wound bleeding.
Methodology :
A specialty-trained CIED Wound Care Workgroup was established in 4Q2017 and a CIED assessment form was designed for wound evaluation. 5 briefing sessions were delivered to cardiologists and approximately 70 nurses in multiple units prior to pilot study. All patients with CIED newly implanted or re-implanted in pectoral site were recruited, however, patient allocation in each group was according to cardiologists’ preferences. Serial wound assessment was performed by nurses in ward, during CNS visits and in CNP Clinic. Outcomes assessed including wound complications such as bleeding and hematoma, dressing integrity, skin irritation and skin itchiness. Moreover, factors that may prone to higher bleeding tendency were also studied. Finally, patients’ and nurses’ perceptions were addressed by interview and satisfaction surveys respectively. Data collected was analyzed using Chi-Square test by Statistical Package for the Social Science (SPSS).
Result & Outcome :
47 cases were recruited, compliance rate of “Light” dressing was 51%. After SPSS analysis, although wound complications and patient discomfort in both groups were statistically insignificant (p>0.05), there was clinical significance due to high event rate of wound complications (Bleeding: 17.4% vs 4.2%; Haematoma: 8.7% vs 0%) and patient discomfort (Loosen Dressing: 21.7% vs 0%; Skin redness: 26.1% vs 4.2%; Skin itchiness: 17.4% vs 0%) by using “Heavy” dressing. Moreover, results showed that confounding factors had no correlation with wound bleeding and haematoma formation. Furthermore, staff satisfaction surveys revealed that 100% agreed that “Light” dressing could facilitate wound observation and 100% supported the new practice change.
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