Volgehoue versus intermitterende pneumatiese kompressie as behandelingsmodaliteite in pasiënte met veneuse onderbeenulkusse - Gerber, Johannes Benjamin (University of the Free State, 2006)
Epidemiological studies have shown that vascular diseases and specifically venous diseases are the cause of lower leg ulcers, that venous diseases are the cause of 70% of lower leg ulcers in the United Kingdom and 70 to 90% of all ulcers in North America and England. In North America 10 to 15% of ulcers are the result of a combination of venous and arterial insufficiency. Two treatment modalities are available for venous lower leg ulcers: - sustained compression and - intermittent pneumatic compression. The aim of this study was to compare the usefulness and effectiveness of intermittent pneumatic and sustained compression with each other. To attain this objective: - the profile of patients with venous lower leg ulcers was described. - the effectiveness of sustained versus intermittent pneumatic compression modalities regarding wound healing were compared. - the effectiveness of sustained versus intermittent pneumatic compression modalities regarding pain were compared. - The factors that influence the feasibility of the two treatment modalities were identified. This study consisted of two components. In the first place a descriptive study was undertaken of the patients with venous lower leg ulcers who visited the out-patient department of a Tertiary hospital in the greater Bloemfontein area. The second component was an experimental study in which the effectiveness of the two treatment modalities were compared. The patients in the experimental study were allocated to the experimental and control groups by means of a random list. Patients in the experimental group were treated with intermittent pneumatic compression for twelve weeks, while those in the control group were treated with four-layer compression bandages for the same period. The study lasted for 27 months until the desired sample size was reached. Data confirmed the information available in the literature regarding venous lower leg ulcers. Outstanding characteristics of the profile were the majority of the patients were obese and hypertensive. The misuse of topical antimicrobic drugs became clear from the patients’ history. It also appeared that many of the patients lacked knowledge of and insight into the causes and nature of venous lower leg ulcers, as well as their prevention and treatment. It became clear that the ulcers of more patients treated by means of sustained compression were healed than those with intermittent pneumatic compression. This difference in wound healing was, however, not statistically significant. The pain levels of the patients of both groups decreased with treatment between the first and last assessment. However, the difference between the pain levels of the experimental and control groups was not statistically significant. The most import factors that influence the feasibility of the two treatment modalities were the following: - A shortage of nursing staff and doctors were experienced due to the labour intensity of the study; - Communication problems (it was necessary to use an interpreter at times); - A shortage of wound dressings and bandages due to unforeseen circumstances; - The Department of Health under-estimated the cost implications of the treatment modalities; - Intermittent pneumatic compression as a treatment modality was available only to patients in the greater Bloemfontein area. Volgehoue versus intermitterende pneumatiese kompressie as behandelingsmodaliteite in pasiënte met veneuse onderbeenulkusse 35 - Sustained compression – patients from outside the greater Bloemfontein area missed a treatment session if they missed the ambulance that transported them to the hospital. - Patients experienced transport problems due to high taxi fares and transport was not always readily available on public holidays or over weekends. - The continuity of sustained compression had, in some cases, to be broken for some patients if the patient presented with clinical signs and symptoms of infection.

Epidemologiese studies het aangetoon dat vaskulêre siektes en spesifiek veneuse siektes, die oorsaak van onderbeenulkusse is. Veneuse siektes is die oorsaak van 70% van die onderbeenulkusse in die Verenigde Koninkryk. Veneuse onderbeenulkusse 70 tot 90% van alle ulkusse in Noord-Amerika en Engeland uitmaak. In Noord -Amerika is 10 tot 15% van die ulkusse as gevolg van ‘n kombinasie van veneuse en arteriële ontoereikendheid. Daar is twee behandelingsmodaliteite vir veneuse onderbeenulkusse beskikbaar: - volgehoue kompressie en - intermitterende pneumatiese kompressie. Die doelstelling van hierdie studie is om die bruikbaarheid en doeltreffendheid van intermitterende pneumatiese- en volgehoue kompressie met mekaar te vergelyk. Om hierdie doel te bereik, is: - die profiel van pasiënte met veneuse onderbeenulkusse beskryf. - die effektiwiteit van volgehoue versus intermitterende pneumatiese kompressiemodaliteite met betrekking tot wondgenesing vergelyk. - die effektiwiteit van volgehoue versus intermitterende pneumatiese kompressiemodaliteite met betrekking tot pyn vergelyk. - die verskillende faktore wat die uitvoerbaarheid van die verskillende behandelingsmodaliteite beïnvloed, geïdentifiseer. Hierdie studie het uit twee komponente bestaan. Eerstens is ‘n beskrywende studie gedoen van die pasiënte met veneuse onderbeenulkusse wat ‘n buite-pasiëntafdeling van ‘n Tersiêre hospitaal in die groter Bloemfontein-area besoek het. Die tweede komponent was ‘n eksperimentele studie waartydens die effektiwiteit van die twee behandelingsmodaliteite met mekaar vergelyk is. Die pasiënte van die eksperimentele studie is volgens ‘n ewekansigheidslys aan die eksperimentele en kontrolegroepe toegewys. Pasiënte in die eksperimentele groep is vir twaalf weke met intermitterende pneumatiese kompressie behandel, terwyl die pasiënte in die kontrolegroep vir dieselfde tydperk met vierlaagkompressieverbande behandel is. Die wonde is weekliks vir twaalf weke beraam. Die studie het 27 maande geduur totdat die verlangde steekproefgrootte bereik is. Die data het die inligting wat reeds in die literatuur met betrekking tot veneuse onderbeenulkusse beskikbaar is, bevestig. Uitstaande kenmerke van die profiel was dat die meerderheid van die pasiënte vetsugtig en hipertensief was. Die misbruik van topikale antimikrobe middels het ook uit die geskiedenisvasstelling na vore gekom. Dit het ook geblyk dat baie van die pasiënte ‘n gebrek aan kennis en insig het met betrekking tot die oorsake en aard van veneuse onderbeenulkusse, sowel as die voorkoming en behandeling daarvan. Dit blyk dat meer pasiënte wat met volgehoue kompressie behandel was se wonde in vergelyking met pasiënte wat met intermitterende pneumatiese kompressie behandel was, genees het. Nogtans is hierdie verskil in wondgenesing nie statisties beduidend nie. Dit blyk dat pasiënte van beide groepe se pynvlakke tussen die eerste en die laaste beraming met behandeling verminder het. Nogtans was daar nie ‘n statistiese beduidende verskil tussen die eksperimentele en kontrolegroepe se pynvlakke nie. Die belangrikste faktore wat die uitvoerbaarheid van die verskillende behandelingsmodaliteite beïnvloed het, was as volg: - Weens die arbeidsintensiteit van die studie is ‘n tekort aan verpleegpersoneel en geneeshere ondervind. - Kommunikasieprobleem (‘n tolk moes met tye gebruik word). - Tekort aan verbindsels en verbande weens onvoorsiene omstandighede. - Die Departement van Gesondheid het die koste-implikasie van die behandelingsmodaliteite onderskat. - Intermitterende pneumatiese kompressie as behandelingsmodaliteit was net vir pasiënte van die groter Bloemfontein-area beskikbaar gewees. - Volgehoue kompressie – pasiënte van die platteland slaan ‘n behandelingsessie oor indien hul die ambulans verpas het. - Pasiënte ondervind probleme met vervoer weens verhoogde taxi-gelde en vervoer was ook nie altyd op publieke vakansie dae en oor naweek geredelik beskikbaar nie. - Die aaneenlopendheid van volgehoue kompressie moes soms by sekere pasiënte onderbreek word aangesien die pasiënt met kliniese tekens en simptome van infeksie gepresenteer het.
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2006
Keywords: Leg -- Ulcers -- Treatment; Wounds and injuries -- Treatment