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Odkażanie wodą utlenioną i moczenie w szarym mydle – jakie mity wciąż funkcjonują w leczeniu ran?

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Dziedzina leczenia ran nieustannie się rozwija. Dzisiaj pacjenci mogą korzystać ze specjalistycznych opatrunków, technologii i innowacyjnych terapii, które w skuteczny sposób pozwalają leczyć skomplikowane i trudne przypadki ran. Tymczasem personel medyczny i pacjenci nie zawsze dysponują odpowiednią wiedzą – korzystają z przestarzałych lub błędnych zaleceń, które mogą być tragiczne w skutkach.

Niezwykle ważne jest przestrzeganie odpowiednich, popartych wiedzą medyczną metod pielęgnacji i leczenia ran. Stosowanie prawidłowych procedur zapobiega pojawieniu się poważnych komplikacji zagrażających zdrowiu i życiu pacjenta. Dlatego istotne jest, by unikać praktykowania i rozpowszechniania błędnych praktyk, które mogą zaszkodzić, zamiast pomóc w leczeniu.

  1. Rany leczą tylko lekarze

Skuteczne leczenie ran nie jest zasługą jednego specjalisty, lecz efektem pracy interdyscyplinarnego zespołu terapeutycznego. W zależności od potrzeb pacjenta, chorób współistniejących i etiologii rany w leczenie zaangażowani mogą być różni specjaliści.

Oprócz chirurgów, ortopedów i lekarzy specjalizujących się w leczeniu ran w tym procesie uczestniczyć mogą podolodzy – specjaliści z zakresu leczenia i profilaktyki chorób stóp, diabetolodzy – których udział jest istotny w terapii ran pacjentów chorujących na cukrzycę, czy fizjoterapeuci – zajmujący się zabiegami wspomagającymi proces gojenia rany czy mobilizacji blizn. Bogate doświadczenie i specjalistyczną wiedzę z zakresu gojenia ran posiadają również pielęgniarki. Wiele pielęgniarek prowadzi również indywidualne praktyki i zapewnia pacjentowi kompleksową opiekę w miejscu jego zamieszkania. Proces leczenia ran niejednokrotnie wspierają również dietetycy, farmaceuci, a nawet psycholodzy.

  1. Leczenie ran polega tylko na zmianie opatrunków

Wielu pacjentów wierzy w to, że leczenie rany polega wyłącznie na zmianie opatrunków. Tymczasem proces gojenia jest zależny od prawidłowego funkcjonowania całego organizmu. Konieczne jest m.in. unormowanie choroby podstawowej (np. cukrzycy) czy wprowadzenie odpowiedniego żywienia. Zły stan odżywienia wiąże się z zaburzeniami procesu gojenia rany, a także działania układu immunologicznego.

Na proces gojenia się ran wpływ ma również samopoczucie psychiczne pacjenta, a także odpowiednia aktywność ruchowa. Proces gojenia ran wspiera również prehabilitacja, czyli kompleksowe przygotowanie pacjenta do operacji, a także rehabilitacja po zabiegu chirurgicznym.

  1. Sucha rana goi się szybciej

Odsłonięta i niezabezpieczona opatrunkiem rana to zwiększone prawdopodobieństwo zakażenia. Infekcja bakteryjna jest poważną przeszkodą w procesie gojenia się rany i stanowi zagrożenie dla zdrowia i życia pacjenta. Ponadto to nieprawda, że rana, która jest sucha, będzie goiła się szybciej. Wręcz przeciwnie – suche środowisko spowalnia proces leczenia i sprzyja powstawaniu blizn. Sucha rana często pokrywa się złogami włóknika, ziarnina w dnie ulega zwłóknieniu, a brzegi rany nie ulegają prawidłowemu naskórkowaniu.

Rana do gojenia potrzebuje optymalnie wilgotnego środowiska – nie może być ono ani zbyt mokre, ani zupełnie suche. Pozwala to na zachowanie równowagi enzymatycznej oraz ograniczenie bólu. Ponadto odpowiednio wilgotne środowisko rany przyspiesza gojenie i zmniejsza ryzyko obumierania tkanek.

  1. Ranę należy moczyć w szarym mydle

Część personelu medycznego i wielu pacjentów wciąż wierzy w to, że moczenie rany w mydle sprzyja usuwaniu bakterii i wspomaga proces gojenia. Zbyt rozmoczona skóra jest jednak podatna na wtórne uszkodzenia. Ponadto długotrwałe moczenie rany zwiększa ryzyko rozprzestrzeniania się zakażeń. Utrzymywanie rany w ciągłej wilgoci może również spowodować macerację brzegów rany lub przesuszenie skóry otaczającej ranę. Dlatego zamiast długich i gorących kąpieli pacjentom z ranami zalecane są krótkie i niezbyt ciepłe prysznice. Obecnie wiele nowoczesnych opatrunków jest na tyle szczelnych, że pozwala dbać o higienę bez ryzyka zamoczenia rany.

  1. Ranę najlepiej odkazić wodą utlenioną albo alkoholem

Polewanie rany wodą utlenioną lub preparatami na bazie alkoholu salicylowego może przynieść więcej szkód niż korzyści. Alkohol działa na ranę drażniąco i wysuszająco. Właściwości bakteriobójcze wody utlenionej w kontakcie ze świeżymi zranieniami są krótkotrwałe i nie zmniejszają ryzyka zakażenia. Woda utleniona może działać niszcząco na zdrowe tkanki, natomiast szczypanie, które można odczuć po zaaplikowaniu wody utlenionej, nie jest wynikiem zabijania bakterii, lecz oznacza podrażnienie zranionej tkanki.

W przypadku świeżych ran, które nie wymagają interwencji chirurga, aby usunąć brud lub inne zanieczyszczenia, można użyć wody z mydłem (bez dodatków zapachowych) lub soli fizjologicznej. W celu usunięcia bakterii z łożyska rany do oczyszczania powierzchownego zaleca się stosowanie antyseptyków, które nie uszkadzają tkanek, wspierają gojenie, a jednocześnie wykazują szerokie spektrum działania bójczego na drobnoustroje.

  1. Preparaty takie jak sudocrem czy jodyna pomagają w leczeniu ran

Jodyna podobnie jak alkohol wysusza skórę, przez co wydłuża się proces gojenia. Sudocrem natomiast ma w składzie alkohol benzylowy i tlenek cynku, które również są substancjami o działaniu wysuszającym. Alkohol podrażnia tkanki i jest dla nich toksyczny.

  1. Małe rany nie wymagają leczenia

Niewielkie rany, drobne skaleczenia czy otarcia zdaniem części pacjentów i personelu medycznego nie wymagają leczenia. Tymczasem nawet najdrobniejsza rana stanowi łatwy cel dla bakterii, co może doprowadzić do zakażenia. Niewielkie obrażenia są szczególnie niebezpieczne dla cukrzyków. Jeżeli diabetyk zignoruje chociażby skaleczenie lub odcisk, może to doprowadzić do groźnych konsekwencji w postaci trudno gojącej się rany. Dlatego każdą ranę należy leczyć z zachowaniem odpowiednich procedur.

  1. Opatrunek należy zmieniać jak najczęściej

Wśród części pacjentów panuje błędne przekonanie, że częste zmiany opatrunków zapewniają bardziej higieniczne środowisko rany. Tymczasem opatrunek powinien być zmieniamy tak rzadko, jak to możliwe.

Opatrunek utrzymuje podwyższoną temperaturę w łożysku rany, co sprzyja tworzeniu się nowych tkanek i regeneracji tkanek uszkodzonych. Częsta zmiana opatrunków może natomiast podrażniać nowe, delikatne tkanki, a także spowalniać procesy naprawcze. Wielokrotne odsłanianie rany naraża ją również na infekcję. Rzadsza zmiana opatrunków jest bardziej komfortowa dla pacjentów, pozwala zmniejszyć koszty i czas trwania terapii oraz ogranicza dolegliwości bólowe.

  1. Na rany zakażone stosuje się tylko antybiotyki

Antybiotyki nie penetrują przez biofilm rany, a bakterie w kontakcie z antybiotykiem mogą wykształcić oporność na jego działanie. Ze względu na rosnący problem antybiotykoodporności drobnoustrojów nie zaleca się stosowania antybiotyków w miejscowym leczeniu ran przewlekłych. Eksperci zalecają, by antybiotyki stosowane miejscowo miały bardzo ograniczoną rolę w praktyce klinicznej. W przypadku infekcji, zgodnie z zaleceniami klinicznymi, wykonuje się:

  • chirurgiczne oczyszczenie rany;
  • miejscowe stosowanie preparatów odkażających;
  • stosowanie opatrunków specjalistycznych z zawartością substancji przeciwdrobnoustrojowej;
  • w ostateczności antybiotykoterapię ogólnoustrojową.
  1. Leczenie nowoczesnymi opatrunkami jest droższe niż tradycyjnymi

Koszt pojedynczego opatrunku specjalistycznego w porównaniu z tradycyjną gazą, bandażem lub plastrem jest wyższy. Jednak sumaryczny koszt terapii opatrunkami specjalistycznymi wiąże się ze znacznymi oszczędnościami zarówno dla pacjenta, jak i dla ośrodka leczniczego. Stosowanie nowoczesnych opatrunków przyspiesza gojenie się ran, co oznacza mniejszą liczbę zmian opatrunków i obniża koszty leczenia. Ponadto specjalistyczne opatrunki ograniczają ryzyko wystąpienia komplikacji, a jednocześnie dochodzi do zmniejszenia częstotliwości wizyt kontrolnych pacjenta w placówkach medycznych.

Ponadto terapia opatrunkami specjalistycznymi wpływa na poprawę wyników leczenia i zmniejszenie liczby osób z niepełnosprawnością, a także umożliwia szybszą rekonwalescencję oraz powrót pacjenta do aktywności.

 

Źródła:

M. Kucharzewski, E. Szkiler, G. Krasowski i wsp., Algorytmy i wytyczne postępowania terapeutycznego w ranach trudno gojących się, Forum Leczenia Ran 2020;1 (3), str. 95-116

M. Bartoszewicz, T. Banasiewicz, K. Bielecki i wsp., Zasady postępowania miejscowego i ogólnego w ranach/owrzodzeniach przewlekłych objętych procesem infekcji, Forum Zakażeń 2019;10 (1), str. 1-30

Przeczytaj także: Naukowcy z USA odkryli nową metodę łagodzenia objawów łuszczycy

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Leczenia Ran”:

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