Warming garments; lavage lung biopsy; surgical site infection - Evidence For Practice

AORN Journal,  July, 2003  by George Allen

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This information is intended for general use only. The clinical implications are specific to the abstracted article only. Individuals intending to put these findings into practice are strongly encouraged to review the original article to determine its applicability to their setting.

Use of water warming garments BMC Anesthesiology Nov 19, 2002

Intraoperative hypothermia may promote surgical wound infection by triggering thermoregulatory vasoconstriction, resulting in decreased subcutaneous oxygen tension. Reduced oxygen levels in tissue impair oxidative killing by neutrophils and decrease the strength of wound healing by reducing the deposition of collagen.

This prospective, randomized study compared two methods of maintaining intraoperative normothermia during orthotopic liver transplantation (OLT). (1) The first method used conventional forced air warming blankets, and the second method used a new device that circulates warm water through a special garment. Twelve patients were assigned randomly to receive warming therapy using forced air warming blankets (ie, the control group), and 12 patients were assigned randomly to receive warming therapy using water garments (ie, the treatment group). In the control group, forced air warming blankets were applied to patients after induction of anesthesia. In the treatment group, water garments were activated before induction of anesthesia. Patients' core body temperatures were measured in the distal esophagus and tympanic membrane.

Findings. Mean core temperatures during incision, one hour after incision, and during skin closure were significantly higher in patients in the treatment group (P [less than or equal to] .05). Additionally, core body temperatures of patients in the treatment group were maintained more consistently during the entire OLT procedure and immediately postoperatively compared to core body temperatures of patients in the control group.

Clinical implications. Studies of other surgical procedures also have found that patients maintain moderately higher core temperatures intraoperatively and postoperatively when the water-warming garment system is used. This new device, however, is more expensive than conventional warming devices. Perioperative managers should conduct a cost efficiency evaluation before adopting this method of maintaining normothermia.

High- versus low-pressure lavage The Journal of Bone and Joint Surgery British volume, September 2002

High-pressure pulsatile lavage commonly is used to irrigate contaminated open fractures. Compared to bulb syringe irrigation, this method is believed to be extremely effective in removing particulate debris and bacteria from bone. Recent studies indicate that mesenchymal stem cells not only differentiate into osteoblasts but also into adipocytes. Indeed, some conditions that lead to bone loss often involve a stem cell switch from the osteoblast to the adipocyte lineage.

This study examined the effects of high-pressure lavage on the number of adipocytes and osteoblasts in vitro. (2) Calvaria-derived bone cells from mice were exposed to either low- or high-pressure irrigation with normal saline. The osteoblasts and adipocytes were quantified, and a standard quantitative reverse transcription polymerase chain reaction was performed. High pressure was defined as 8 psi, and low pressure was defined as a range of 1 psi to 2 psi. Single factor analysis of variance techniques were used to compare low- and high-pressure lavage.

Findings. High-pressure lavage resulted in a 49.5% increase of adipose-like cells compared to low-pressure lavage (P [less than or equal to] .05). Reverse transcription polymerase chain reaction revealed that a marker for adipocytes was 1.3 times greater in cells exposed to high-pressure irrigation than cells exposed to low-pressure irrigation. The decline in osteoblasts correlated highly with an increase in adipocytes as the irrigation pressure increased (r = 0.82).

Clinical implications. These findings suggest that along with mechanical damage, high-pressure irrigation may result in delayed healing and nonunion in open fractures. Perioperative nurses must ensure that pressure settings on lavage devices adhere to manufacturers' recommendations.

Transbronchial lung biopsy The Journal of Heart and Lung Transplantation February 2003

Transbronchial lung biopsy is the gold standard for evaluating pulmonary allografts to assess for acute rejection and opportunistic infection in lung transplant recipients. Lung transplant recipients, however, are reported to have a higher risk of bleeding from this procedure.

The objective of this prospective study was to assess the specific risk factors associated with bleeding after transbronchial lung biopsy in lung transplant recipients. (3) During a two-year period, 363 consecutive transbronchial lung biopsy procedures conducted on 69 lung transplant recipients were studied. All procedures were performed using similar techniques and equipment. Blood loss was estimated and classified as either less than 25 mL or greater than 25 mL. Logistic regression procedures were used to examine the following risk factors: acute rejection, bronchiolitis obliterans syndrome status, infections, number of biopsies obtained per procedure, serum creatinine level, and postoperative day since transplantation. Bleeding was controlled by the back-and-forth technique, meaning the tip of the fiberoptic bronchoscope advanced close to the segmental opening, suction was applied, and the fiberoptic bronchoscope was withdrawn in one motion.