[3896645]
The patient is critically ill with gunshot wounds to the abdomen with an open abdomen. Current treatment methods for wound closure weren't working so the surgeon requested a specific device, the abra dynamic wound closure system, which was new to this facility. Surgery purchasing staff quickly researched the product, contacted the company and arranged for a representative to come to the facility the day of the procedure. Surgery leadership approved the use of the product. The surgeon applied the abra system according to the manufacturer's instructions. The manufacturer's rep was present for the procedure per the request of the facility's buyer. There was no communication given to the unit nurses prior to the procedure regarding the abra. After the case, the rep. Went to the critical care unit where the patient was transferred and conducted a short in-service for staff on the new device. The first day after the abra was placed; the wound ostomy care (woc) nurse was consulted for pressure ulcer prevention related to the abra device. Nursing demonstrated release of tension for cleansing under the button anchors and for inspection. The duration of the abra system application was one week. The day prior to removal, an enterocutaneous fistula presented. The surgeon indicated the abdomen overall was fast becoming a frozen abdomen. The abra device was removed and an abthera device was placed. The first day after removal of the abra, the woc nurse was consulted regarding multiple "holes" (puncture sites). The woc nurse noted: 1. Right side of incision puncture sites are superficial and primarily dry. 2. Left side distal to tube feeding with a few areas of depth and yellow slough with serious exudate. The woc nurse recommended calcium alginate to distal left puncture sites that have depth and then to cover weepy areas on each side with strip of foam non-adhesive and minimal medipore tape every other day. Padding with foam under disk of tube feeding advised to reduce further risk of pressure. Five days later, the woc nurse was consulted and two areas of concern for pressure ulcers were identified. The first was the skin underneath the peg tube (the tube was removed the evening prior) and nursing noted unstageable slough-covered ulcerations in a circular pattern under the disc. The peg was completely concealed by the abra. The peg was placed based on the patient's anatomy so there were no other options. The second ulceration was located more proximally on the right side and just medial to a puncture site. This was assessed as a stage iii ulcer. Woc gave recommendations on care. With the removal of the abra, there were no longer pressure concerns to these areas and the pressure ulcers healed. The device's post-operative nursing care instructions state the following: "if an ulcer is detected under the button anchor: reduce elastomer tension at that anchor and add padding under the anchor.
Patient Sequence No: 1, Text Type: D, B5