Opieka nad raną trudno gojącą się w opiece paliatywnej - na czym polega?
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Opieka nad raną trudno gojącą się w opiece paliatywnej – na czym polega?

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W dniach 10-11 marca odbyła się ogólnopolska interaktywna konferencja „Współczesne Wyzwania Opieki Paliatywnej”. Podczas drugiego dnia wydarzenia odbyła się sesja wykładowa, poświęcona leczeniu ran trudno gojących się u pacjentów objętych opieką paliatywną.

W sesji „Rany trudno gojące się w opiece paliatywnej” udział wzięły cztery specjalistki: mgr Monika Aleksy-Polipowska z Kamiliańskiego Centrum Opieki Paliatywnej, mgr Sylwia Rogowska z hospicjum im. Św. Stanisława Papczyńskiego w Licheniu Starym, mgr Ruth Dudek-Wicher z Katedry i Zakładu Mikrobiologii Farmaceutycznej i Parazytologii UM we Wrocławiu oraz mgr Ewa Woytoń z Poradni Medycyny Paliatywnej i Hospicjum Domowego we Wrocławiu.

Ekspertki omówiły takie tematy, jak „Postępowanie z ranami u pacjentów objętych opieką paliatywną, zgodnie ze strategią higieny rany”, „Owrzodzenia nowotworowe w hospicjach – case study”, „Diabeł tkwi w szczegółach – interakcje fizykochemiczne i substancje pomocnicze w antyseptykach” czy „Specyfika leczenia ran w opiece paliatywnej”.

Po zakończonej sesji specjalistki odpowiedziały na zadane przez uczestników pytania

Jak zaznaczyła podczas swojego wykładu mgr Monika Aleksy-Polipowska, niedługo możemy się spodziewać większej ilości pacjentów wymagających opieki. „Po erze COVID-19 będzie nas czekać tsunami onkologiczne, na pewno paliatywne” – dodała.

Mgr Sylwia Rogowska podczas swojego wystąpienia opowiedziała m.in. o cechach rany nowotworowej, która posiada charakterystyczne guzowate nacieki o nieregularnych kształtach owrzodzeń, takich jak np. kalafiorowatych z dużą ilością zagłębień i przetok wewnętrznych i zewnętrznych. Specjalistka wspomniała również o tkliwości tych ran z bardzo częstym podkrwawianiem, silnym i nieprzyjemnym odorze z rany, ale również wokół pacjenta, a także o bardzo ważnym planie opieki nad raną, uzgodnionym z pacjentem.

– Bardzo ważna jest współpraca z pacjentem i jego motywacja do leczenia, zmiany opatrunków. Przy dużych ranach nowotworowych jest to operacja dość żmudna. Bardzo ważne jest również nasze – specjalistów przygotowanie do opieki nad raną.

Mgr Ruth Dudek-Wicher podkreśliła w swoim wykładzie, iż przy wyborze farmakoterapii zwykle zastanawiamy się nad substancją aktywną, ale tak naprawdę stanowi ona niewielki procent tej właściwej postaci leku.

– Reszta to tak zwane substancje pomocnicze, które muszą wykazywać odpowiednie właściwości, aby spełnić oczekiwane funkcje, np. nadać tą ostateczną postać leku, wpłynąć na właściwości fizycznej, jak smak, zapach czy wygląd, albo poprawić trwałość substancji aktywnej.

Specjalistka zwróciła uwagę na zjawisko „napięcia powierzchniowego”, na które duży wpływ mają właśnie substancje pomocnicze w produktach leczniczych i jakie funkcje powinny one spełniać.

Kiedy należy zrezygnować z leczenia rany nowotworowej u pacjenta paliatywnego?

Jak zwróciła uwagę mgr Ewa Woytoń podczas sesji pytań i odpowiedzi, najpierw należy dokładnie określić stan pacjenta, ponieważ pacjent paliatywny nie równy jest pacjentowi paliatywnemu. Jeżeli stan pacjenta jest terminalny, to oczywiście postępowanie będzie polegało, tylko i wyłącznie na wykonaniu niezbędnych czynności. Mówimy wtedy o postępowaniu zachowawczym, tj. zmianie opatrunku, zabezpieczeniu przed odorem oraz zachowaniu czystości rany. „Stosujemy wówczas te opatrunki, które nie przylegają do rany i które są opatrunkami chłonnymi.”

– Jeżeli chodzi o przeciwwskazania do oczyszczania i higieny rany to wszystko zależy od tego, co to jest za rana, ile ma wykwitów, jaka jest ilość martwej tkanki, kruchej tkanki i jaka jest skłonność do krwawienia, np. czy rana znajduje się w sąsiedztwie głównych naczyń krwionośnych, gdzie zmiana opatrunku i jej oczyszczenie obarczone jest np. masywnym krwotokiem. Dlatego należy wspólnie z Zespołem bardzo dokładnie ocenić i zdecydować na czym ma polegać jej oczyszczanie – dodała specjalistka.

Druga już edycja tej wyjątkowej konferencji odbyła się pod hasłem „Odchodzić w czasach COVID-19…”. W wydarzeniu wzięło udział ponad 500 osób. Organizatorem spotkania „Współczesne Wyzwania Opieki Paliatywnej” było wydawnictwo naukowe Evereth Publishing oraz Ośrodek Hospicjum Domowe.

Na zdjęciu: mgr Sylwia Rogowska, mgr Ewa Woytoń, mgr Monika Aleksy-Polipowska

Przeczytaj także: Dr Paweł Witt: „Odchodzenie w czasach Covid-19 to przede wszystkim krzyk samotności”

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