A Comprehensive Nursing Care Approach In Patients Receiving Lateral Incision Combined Laparotomy Necrosis Debridement For Severe Acute Pancreatitis

Background In patients with severe acute pancreatitis (SAP), the classic surgical approach for the treatment of the life-threatening infected pancreatic necrosis is the middle abdominal approach. However, the classic approach is not appropriate to handle this kind of necrosis as the majority of pancreatic necrosis is distributed in the retroperitoneal cavity. Therefore, the retroperitoneal approach, which is superior for the less stress and convenience of the drainage, is adopted, but the. Incisions of this kind of surgery are characterized by the continuous drainage fluid and the nursing care for this kind of patients is troublesome. The caustic drainage fluid may damage the skin around the incision and become the medium of the bacteria. Accordingly, we proposed a comprehensive nursing care approach which contained an ostomy bag assisted drainage, an adjustable incision shield and continuous peritoneal irrigating devise. In this study, the effect of the comprehensive nursing care approach was evaluated by comparing the in-hospital mortality, the incidence of intestinal fistula and the length of hospital stay.Patients and methods Patients with SAP receiving the retroperitoneal combined middle abdominal surgical approach during January 2006 and July 2010 were retrospectively reviewed. The demographic data including sex, time between the onset of symptoms and admission, APACHE-II score on admission and etiology was collected. In evaluating the effect of comprehensive nursing care, the in-hospital mortality, length of hospital stay, the incidence of intestinal fistula and the satisfaction of the nursing care were compared between the two different groups.Results Compared with those receiving conventional nursing strategies, the patients receiving comprehensive nursing strategies had a lower rate of re-operation (5/26 versus 10/20, p=0.027) a shorter length of hospital stay(26.08±8.48 vs. 31.95±8.82,P=0.03) and a high proportion of satisfaction for nursing services (98.5% versus 90%). The incidence of postoperative fistula (1/26 versus 4/20, p=0.081), in-hospitalization mortality (0/26 versus 3/20, p=0.041) had a tendency of decrease in patients receiving comprehensive nursing strategies. The frequencies of change dressings(2.3±0.8 vs. 8.2±3.5, P=0.03), change sheets(1.3±0.4 vs. 5.4±1.8, P=0.02) were significantly decreased and the recovery time of the incision is shorter in patients receiving systemic nursing care(20.3±5.7 vs. 26.3±8.4, P=0.04). Conclusions For the SAP patients receiving lateral Incision combined laparotomy necrosis debridement, the comprehensive nursing care, which contained a ostomy bag assisted drainage, an adjustable incision shield and continuous peritoneal irrigating devise may decrease the incidence of reoperation and the length of hospital stay, and increase the satisfaction of patients for the nursing care. In addition, the in-hospital mortality and the incidence of intestinal fistula is likely to be decreased.