Nurten ÖNAL, ÖZLEM BİLİK, Ayşegül SAVCI, Özlem ALTIPARMAK, Perihan KUZU, Zühriye KAR, Rüya KESKİN

Ortopedi Hastalarında Nörovasküler İzlem Sıklığı Ne Olmalı?

Giriş: Ortopedi hastaları için nörovasküler tanılama (NVT) önemli olmasına rağmen, ne sıklıkta yapılması gerektiğine ilişkin yeterli bilgi bulunmamaktadır. Amaç: Ortopedi hastalarının nörovasküler tanılama sıklığını saptamaktır. Yöntem: Tanımlayıcı ve retrospektif çalışmada, Aralık 2010-Mart 2011’de klinikte yatan 70 hastanın DEÜ Hemşirelik Hizmetleri Müdürlüğü’nün geliştirdiği NVT formundaki verileri sayı, yüzde, ortalama ve bağımlı gruplarda tekrarlı ölçümlerde varyans analizi kullanılarak değerlendirilmiştir. Bulgular: Yaş ortalaması 50.81±22.05 olan hastaların %54.3’ü kadındır, %71.4’ünde kronik hastalık yoktur. Sıklıkla artroskopik girişim (%28, 6) ve kırık nedeniyle ameliyat (%21.4) uygulanan hastaların ameliyat sonrası 0. günde %94,3’ü yatak içi hareketlidir. Ameliyat sonrası saat başı ilk 8 saatlik NVT’de renk, ısı ve ağrı değerlendirmeleri arasında anlamlı fark olduğu (F=2.250, p=.041; F=4.528, p=.000; F=3.436, p=.004); his, hareket, kapiller dolum, nabız ve ödem ölçümlerinde anlamlı fark olmadığı saptanmıştır (p>.05). İlk 8 saatten sonraki NVT’nın istatistiksel değerlendirmesinde renk, ısı, ağrı, his, kapiller dolum, nabız ve ödem açısından anlamlı fark olmadığı belirlenmiştir (p>.05).Sonuç: Hemşirelerin iş planını ve standardizasyonu sağlamak amacıyla NVT’nın ameliyat sonrası ilk 4 saatte saat başı, sonra sistem tanılama içinde günde 2 kez olabileceği; hastanın durumuna ve kurum politikalarına göre izlem sıklığının belirlenebileceği söylenebilir.

Anahtar Kelimeler:

Nörovasküler tanılama, Ortopedi hemşireliği, Kompartman sendromu

How Frequency Neurovascular Assessment Should be Performed for the Orthopedic Patients?

Introduction: The neurovascular assessment (NVA) is very importmant for orthopaedic patients. But there wasn’t evidence related frequency of NVA in the literature. Aim: The purpose of the study to determine the frequency of NVA for the orthopedic patients. Methods: The desciriptive and retrospective study received approval from the institution where the study was conducted. The NVA data was obtained from the sample included 70 orthopedic patients hospitalized December 2010 and March 2011. The data was evaluated using descriptive analysis, mean, and variance analysis by repeated measurements in dependent groups. Results: The mean age of the patients was 50.81±22.05, 54.3% of the patients were female, 71.4% has no chronical disease. The patients were frequently operated on for arthroscopic intervention (28.6%) and fracture reduction (21.4%). 94.3% of the patients were moved in bed on postoperative day 0. It was determined that there was significant difference between hourly color, temperature and pain values for the first 8 hours NVA postoperatively (F=2.250, p=.041; F=4.528, p=.000; F=3.436, p=.004). There was no significiant differences for the assessments of sensation, movement, capillary refill, pulse and edema (p>.05). After the first 8 hours NVA postoperatively there wasn’t significant difference between for all parametres (p>.05). Conclusion: We changed NVA protocol in DEU Hospital as postoperatively first 24 hours following the first four hours per hourly, the second four hours per 2 hours, during 16 hours per 4 hours, after completed the first 24 hours per 12 hours. If occurs differences of NVA, the assessment conducted per 1-2 hours depend on the patients. If there was no differences of NVA, nurses stop the assessment on the fifth day, if occurs any problem of NVA, nurses continues the assessment.

Keywords:

Neurovascular assessment, Orthopaedic nursing, Compartment syndrome,

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