Newswise — Advances in trauma care, medical technology and management of severe illnesses have led to the relatively quick adoption of the open abdomen technique for patients with many life-threatening medical and surgical diagnoses.
First used in trauma care in the 1990s, the open abdomen technique is fast becoming the standard of care for patients who have experienced devastating intra-abdominal catastrophes such as traumatic injury, severe bleeding, infection and abdominal compartment syndrome (ACS).
The potentially lifesaving intervention involves intentionally leaving patients’ abdomens open as a temporary measure after surgery, allowing clinicians to have access to the abdominal contents while protecting patients with a short-term postoperative covering.
The use of the technique has improved survival and overall patient outcomes after severe trauma and major vascular surgery.
Because of the expanded indications for the technique, critical care nurses are caring for more patients with open abdomens and temporary abdominal closures, according to an article in Critical Care Nurse (CCN).
“Open Abdomen in Trauma and Critical Care” outlines the clinical priorities of patient care and discusses the medical and nursing management strategies involved. Published in the journal’s October 2017 issue, the article also describes the most common indications, potential complications and nutritional considerations related to the technique.
Author Eleanor Fitzpatrick, RN, MSN, ACNP, CCRN, is a clinical nurse specialist for surgical critical care at Thomas Jefferson University Hospital, Philadelphia.
“All types of critical care units will have patients with an open abdomen, because the indications for the procedure have increased dramatically. Nurses need to become familiar with the technique and what it means for their patients,” Fitzpatrick said. “This is a temporary but necessary measure that can improve the viability of the organs and possibly prevent multiple organ failure.”
The technique allows clinicians to monitor the abdomen closely for bleeding, infection and other complications while easily assessing the amount of fluid being drained.
One indication for the technique is the need for the clinical team to have ongoing access to the abdominal area prior to a planned, second-look surgery for patients with bowel or intra-abdominal issues. Clinicians can evaluate and treat any infectious processes, assess the viability of the bowel and monitor for signs of increasing intra-abdominal pressure and progression to ACS.
The article includes case studies of patients with two common indications for damage control surgery and the open abdomen technique - a patient with multiple gunshot wounds in the abdomen and a patient with a ruptured abdominal aortic aneurysm.
Throughout the article, photos illustrate types of temporary abdominal closures, including their uses and disadvantages. Detailed tables provide nurses and other clinicians with additional information about management priorities and common complications.
As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity, progressive and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.
Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 107,000 and can be accessed at http://ccn.aacnjournals.org/.
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the United States. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.