Application of the Care Bundle in Perioperative Nursing Care of the Type A Aortic Dissection

Abstract

Background To investigate the effect of the care bundle in the nursing care of the type A aortic dissection (TAAD). Methods A total of 161 patients with TAAD were included in the study. They were divided into control group (n=79) and care bundle group (n=82). The patients in the control group received routine nursing, while the patients in the care bundle group received routine nursing and care bundle. IL-2, IL-6 and IL-10 levels in the three periods of T0 (before anesthesia), T1 (before anesthesia to 6 h after surgery) and T2 (6–24 h after surgery), intraoperative blood loss, postoperative recovery, ICU stay time, intraoperative pressure ulcer rate, postoperative delirium rate, bloodstream infection rate and doctor satisfaction. Results The postoperative T and pH levels in two groups were all in the normal range. The levels of IL-2, IL-6 and IL-10 in the care bundle group at different periods were also significantly different. The levels of IL-2 and IL-10 showed an increased trend, while that of IL-6 showed a downward trend. The intraoperative blood loss, postoperative recovery and ICU stay time, intraoperative pressure sore rate, postoperative delirium rate, and bloodstream infection rate were lower, whereas doctor satisfaction was all significantly higher in care bundle group. Conclusion Care bundle increased the safety of the operation, and it was beneficial to the postoperative rehabilitation for TAAD patients. Relevance to Clinical Practice Patients with TAAD who underwent operation need higher quality care during the entire operation. Cluster nursing is the kind of the nursing model that can better meet the requirements of the intraoperative nursing quality. The intervention methods in this study include 5 core nursing measures. These measures are implemented together in a synergistic manner to effectively improve the quality of nursing care in operating room and the health outcomes of patients with TAAD. Care bundle is worthy of clinical application.

Preventing pressure injury in open‐heart surgical patients: A systematic review

“…The specialist nursing team in Li et al study implemented a special model for the prevention of pressure ulcers, containing seven elements for skin protection, as a part of care bundle, include laying cotton pads, applying colloids, adhering dressings, moderate lifting, dynamic inspection and handover inspection and restoring normal body temperature, applying foam dressings to the head, shoulders, sacral tail and heels that are prone to pressure sores and lifting patients gently for 10 min at an interval of about 1 h; and consistent with previous studies, 32,33 Li mentioned that the intraoperative pressure ulcer rate in the care bundle group was significantly lower than control group, indicating that this skin protection model was effective in preventing Type A Aortic Dissection operative pressure ulcers and could significantly reduce the incidence of pressure ulcers, thereby reducing postoperative complications 17 …”

“…care bundles and multiple intervention programs are a set of evidence‐based interventions that when performed together had a better and positive impact on patient outcomes when compared with individual interventions 24 . Two included studies with implementation multiple intervention program were effective in decreasing the incidence of PIs 15,17 …”

“…Regarding the PI preventive interventions, most of the featured studies focused on multilayer silicone foam. 16,18,20 Other studies were about implementation of donut-shaped cushions, 14 Care bundles including skin protection 17 multiple intervention programs including educating operating room and cardiovascular surgical intensive care unit staff on PIP strategies, 15 alternative inflatable head pads, 19 thermoactive viscoelastic foam pad, 21 foam mattresses and electric bed frames, 22 and low-air loss bed. 23 There was inadequate data about the effectiveness of other PI preventive strategies and interventions such as mobilization and repositioning, creams, and nutritional supplements.…”

“…studies, the PI prevention interventions resulted in significant decreases in PI cumulative incidence [15][16][17][18][19]22 ; and a decrease in PI cumulative incidence with no statistical significance reported in four studies 14,20,21,23 ; two studies reported estimated reduced costs, with one reported savings of $78,660 after the implementation focused on Multiple intervention programs, 15 and another with a saving of $1,435,728 annually after the placement of a prophylactic anisotropic multilayer silicone foam dressing on the patient's sacrum before surgery. 18 The present systematic review identified four domains in terms of PI prevention among the included studies: multilayer silicone foam, Care bundle and multiple intervention programs, alternative inflatable head pads, pressure-reducing foam mattresses, and electric bed frames.…”

The Efficacy of Targeted Perioperative Management for Diabetic Patients with Traumatic Calcaneal Fractures

“…us, patients' blood glucose during perioperative management requires timely control and observation of complications to enhance the therapeutic efficacy of surgery [13][14][15]. Targeted management is a high-quality management model developed in recent years and refers to the adoption of targeted perioperative management measures to promote early recovery and shorten the hospital stay of patients [16][17][18]. Fracture, surgery, and diabetes are prone to interact with each other and become a vicious circle.…”