Wczesne rozpoznanie zakażenia w ranie i jego skuteczna terapia to wyzwania, z którymi personel medyczny mierzy się w praktyce zawodowej codziennie. Powodzenie w radzeniu sobie z nimi jest kluczowe nie tylko ze względu na zdrowie pacjenta, ale też koszty opieki zdrowotnej. Często zależy ono w dużej mierze od doboru najlepszego, specjalistycznego opatrunku. Sprawdź, o czym musisz pamiętać w leczeniu rany zakażonej.
1. Objawy zakażenia – rany ostre i rany przewlekłe
Specjaliści wskazują na odmienność objawów infekcji w ranach ostrych (chirurgicznych, urazowych, oparzeniach) oraz w ranach przewlekłych, takich jak owrzodzenia stopy cukrzycowej, owrzodzenia żylne, owrzodzenia tętnicze nóg oraz owrzodzenia odleżynowe. Do objawów zakażenia miejscowego ran ostrych należą: pojawienie się bólu lub narastanie poziomu istniejącego bólu, zaczerwienienie, miejscowy wzrost ciepłoty, obrzęk, ropna wydzielina, gorączka, opóźnienie lub zatrzymanie procesu gojenia, ropień, nieprzyjemny zapach. W przypadku oparzeń to także odrzucenie przeszczepu skóry, a w przypadku ran głębokich – stwardnienie, powiększenie rozmiaru rany, niewyjaśniony wzrost białych krwinek lub objawy zakażenia uogólnionego.Wśród objawów zakażenia miejscowego ran przewlekłych wymienia się natomiast: pojawienie się bólu lub narastanie poziomu istniejącego bólu, a także zmiany jego poziomu, opóźnienie lub zatrzymanie procesu gojenia, obrzęk wokół rany, krwawienie lub kruchą ziarninę, nieprzyjemny zapach (lub zmianę zapachu), zmianę zabarwienia łożyska rany, zmieniającą się ilość ropnego wysięku, stwardnienie tkanek.
2. Leczenie miejscowe – strategia TIME
Leczenie miejscowe powinno opierać się na założeniach strategii TIME (tissue debridement – usuwanie tkanek martwych, infection and inflammation control – kontrola zakażenia i zapalenia, moisture balance – zapewnienie optymalnej wilgotności rany, epidermization stimulation – pobudzenie naskórkowania), która na każdym etapie ma na celu rozpoznanie przeszkód hamujących proces gojenia rany i przeciwdziałanie im. Postępowanie w leczeniu rany zakażonej opiera się więc na kilku działaniach: leczeniu chirurgicznym oraz prawidłowym zaopatrzeniu rany w specjalistyczne opatrunki oraz, w razie konieczności, wdrażaniu antybiotykoterapii ogólnoustrojowej.
3. Dobór odpowiedniego opatrunku do rany zakażonej
W ranach zakażonych należy stosować opatrunki o właściwościach przeciwdrobnoustrojowych i posiadające zdolność sekwestracji wysięku wraz z drobnoustrojami, a także pochłaniające zapach. Do polecanych w leczeniu ran zakażonych zalicza się m.in. opatrunki ze srebrem, takie jak Atrauman® Ag firmy Hartmann.
Atrauman® Ag jest antybakteryjnym, jałowym opatrunkiem ze srebrem, impregnowanym maścią niezawierającą składników czynnych. Materiał nośny opatrunku wykonany jest z hydrofobowej siatki poliamidowej, pokrytej srebrem metalicznym. Atrauman® Ag znacznie ogranicza zakażenie bakteriami Staphylococcus aureus, Staphylococcus aureus (oporny na metycylinę), Staphylococcus epidermidis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis.Pod wpływem wydzieliny z rany, z opatrunku uwalniają się jony srebra o antybakteryjnym działaniu. Dodatkowo maść pielęgnuje brzegi rany, zapewnia ich elastyczność, zapobiega przyklejaniu się opatrunku do rany. Można go stosować do miejscowego leczenia ran zakażonych, do oparzeń II st., również jako opatrunek zapobiegający infekcjom u pacjentów z osłabionym systemem immunologicznym. Może też być doskonałym rozwiązaniem w przypadku zaopatrywania ran zabrudzonych. Opatrunek może pozostawać na ranie do 7 dni.
4. Zasady stosowania antyseptyków w ranach z infekcją
Antyseptyki ograniczają namnażanie drobnoustrojów lub je niszczą, co zapobiega rozwojowi zakażenia. W doborze antyseptyków należy się kierować dwoma kryteriami: aktywnością przeciwdrobnoustrojową (skuteczność i zakres działania) oraz stopniem tolerancji tkankowej (zdolność do alergizacji, potencjalny efekt cytotoksyczny).
5. Metody wspomagające leczenie rany zakażonej
W celu usprawnienia procesu gojenia przewlekłej rany zakażonej i ograniczenia ryzyka powstania blizny specjaliści w wielu przypadkach zalecają włączenie do praktyki klinicznej metod fizykoterapeutycznych. Należą do nich m.in. elektrostymulacja, magnetoterapia, światłolecznictwo, laseroterapia, sonoterapia, hiperbaria tlenowa.
W leczeniu rany zakażonej niezwykle ważne jest dobór odpowiedniego specjalistycznego opatrunku, który z jednej strony zapobiegnie namnażaniu bakterii i stworzy optymalne środowisko biologiczne dla gojenia rany, natomiast z drugiej zapewni pacjentowi komfort i uchroni go przed dodatkowymi dolegliwościami bólowymi. Ta decyzja może mieć ogromny wpływ na sukces terapeutyczny i tempo gojenia się rany.
Artykuł powstał we współpracy z firmą Paul Hartmann.
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