Basınç Yarası
Özet
Basınç yaraları, deri ve deri altı dokuların uzun süreli basınca maruz kalmasıyla oluşan, hastanın yaşam kalitesini düşüren ve bakım maliyetlerini artıran önemli bir sağlık sorunudur. Yoğun bakımlarda ve diğer klinik birimlerde sıklıkla görülen bu yaraların oluşumunda dış basınç, sürtünme ve makaslama kuvvetlerinin yanı sıra hareketsizlik, yaş, nem, yetersiz beslenme ve kronik hastalıklar gibi çoklu risk faktörleri rol oynamaktadır. Sakrum, topuk ve iskium gibi kemik çıkıntılarının bulunduğu bölgeler en yüksek riskli alanlardır. Basınç yaralarının önlenmesi ve yönetiminde Braden, Norton ve Waterlow gibi objektif risk değerlendirme ölçeklerinin sistemli kullanımı büyük önem taşır. NPUAP sistemine göre yara bütünlüğü ve derinliğine bağlı olarak 1. Evre (sağlam deride solmayan kızarıklık) ile 4. Evre (tam kalınlıkta deri ve doku kaybı) arasında sınıflandırılan bu yaralar, ayrıca evrelendirilemeyen ve derin doku yaralanması olarak da değerlendirilir. Hemşirelik bakımı; risklerin periyodik takibi, koruyucu cilt bakımı, bireyselleştirilmiş yüksek proteinli beslenme programları, en geç iki saatte bir pozisyon değişimi ve uygun destek yüzeylerinin kullanımı gibi kanıta dayalı, bütüncül ve bütünleşik uygulamalarla bu yaraları önlemede ve iyileştirmede kritik bir sorumluluğa sahiptir.
Pressure injuries are significant health problems that arise from prolonged pressure on the skin and subcutaneous tissues, reducing patients' quality of life and increasing care costs. Frequently observed in intensive care and clinical units, their development is driven by external pressure, friction, and shearing forces, combined with multiple risk factors such as immobility, age, moisture, malnutrition, and chronic diseases. Bony prominences including the sacrum, heels, and ischium carry the highest risk. Systematic utilization of objective risk assessment tools like Braden, Norton, and Waterlow scales is crucial for prevention and management. Classified under the NPUAP system based on tissue integrity and depth, they range from Stage 1 (non-blanchable erythema) to Stage 4 (full-thickness skin and tissue loss), alongside unstageable and deep tissue injuries. Nursing care bears a critical responsibility in preventing and healing these wounds through evidence-based, holistic interventions, including periodic risk monitoring, protective skin care, individualized high-protein nutrition, repositioning at least every two hours, and deploying appropriate pressure-redistributing support surfaces.
Referanslar
EPUAP (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. National Pressure Ulcer Advisory Panel,2014; 75.
Taylor C, Lynn P, Bartlett J. Skin Integrity and Wound Care In: Fundamentals of nursing: The art and science of person-centered care. Lippincott Williams & Wilkins; 2018, 916-957.
Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. American family physician; 2008; 78(10): 1186-1194.
Margolis DJ, Knauss J, Bilker W, Baumgarten M. Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age and ageing; 2003;32(3):259-264.
Benbow M. Pressure ulcer prevention and pressure–relieving surfaces. British Journal of Nursing; 2008;17(13), 830–835.
Hess, CT. Wound care (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.
Bengy AF, Lamartine J, Sigaudo-Roussel D, Fromy B. Newborn and elderly skin: two fragile skins at higher risk of pressure injury. Biological Reviews; 2022; 97(3); 874-895.
Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, ... & Blot SI. Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive care medicine; 2021;47(4): 503-520.
Ayello EA, Delmore B, Smart H, Sibbald RG. Survey Results From The Philippines: NPUAP Changes in Pressure İnjury Terminology and Definitions. Advances in Skin & Wound Care; 2018; 31(1): 601-6.
EPUAP, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. Emily Haesler (Ed.) EPUAP/NPIAP/PPPIA; 2019.
Yara Ostomi İnkontinans Hemşireleri Derneği (YOİHD). Basınç Yarası ve Aşamaları. Yara Ostomi İnkontinans Hemşireleri Derneği 2018 Erişim Tarihi: 20.06.2022. https://www.yoihd.org.tr/images/cust_files/161118082243.pdf
Shiffman MA. Pressure Ulcers (Injury): Etiology, Prevention, Classification, Risk Assessment, and Treatment. In Pressure Injury, Diabetes and Negative Pressure Wound Therapy(pp. 3-9). Springer, Cham; 2017..
Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, ... & Schlüer AB. Device-related pressure ulcers: SECURE prevention. Journal of Wound Care; 2022; 31(Sup3a):S1-S72.
Leblebici B, Turhan N, Adam M, Akman MN. Clinical and epidemiologic evaluation of pressure ulcers in patients at a university hospital in Turkey. Journal of Wound Ostomy & Continence Nursing; 2007; 34(4): 407-411.
Tsaras K, Chatzi M, Kleisiaris CF, Fradelos EC, Kourkouta L, Papathanasiou IV. Pressure ulcers: developing clinical indicators in evidence-based practice. A prospective study. Medical Archives; 2016; 70(5): 379.
Mondragon, N., & Zito, P. M. Pressure injury. In StatPearls StatPearls Publishing, 2021.
Kuffler D. Techniques for wound healing with a focus on pressure ulcers elimination. The Open Circulation & Vascular Journal; 2010; 3(1).
Romanelli M, Clark M, Gefen A, Ciprandi G. (Eds.). (2006).Science and practice of pressure ulcer management. Springer-Verlag London Limited; 2006,67-73.
Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology; 2019; 81(4): 881-890.
Efteli EU, Gunes UY. A prospective, descriptive study of risk factors related to pressure ulcer development among patients in intensive care units. Ostomy Wound Manage; 2013; 59(7): 22-7.
Visscher M, Narendran V. The ontogeny of skin. Advances in wound care; 2014; 3(4): 291-303.
Greenhalgh M, Landis JM, Brown J, Kulich H, Bass S, Alqahtani S, ... & Cooper, RA. Assessment of usability and task load demand using a robotic assisted transfer device compared to a Hoyer advance for dependent wheelchair transfers. American journal of physical medicine & rehabilitation; 2019; 98(8): 729.
Sezgünsay E, Başak T. Yaşlılarda Basınç Yaralanması Risk Faktörleri. Geriatrik Bilimler Dergisi; 2019; 2(2): 50-57.
Karadağ, A, Karabağ Aydın A. Basınç ülserlerinde etyoloji ve fizyopatoloji. Kronik Yarada Güncel Yaklaşımlar; 2013; 1: 116-37.
Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C., ... & Nelson EA. A new pressure ulcer conceptual framework. Journal of advanced nursing; 2014; 70(10): 2222-2234.
Agrawal K, Chauhan N. Pressure ulcers: Back to the basics. Indian J Plast Surg; 2012; 45(2):244-54.
Tanrıkulu F, Dikmen Y. Yoğun bakım hastalarında basınç yaraları: risk faktörleri ve önlemler. Journal of Human Rhythm; 2017; 3(4): 177-182.
Moore ZE, Webster J, Samuriwo R. Wound-care teams for preventing and treating pressure ulcers. Cochrane Database of Systematic Reviews, 2015;9.
Yücel A. Bası Yaraları Tanı ve Tedavisi. Ş. K. Erdost, & O. Çetinkale içinde, Yara Bakımı ve Tedavisi. İstanbul: Aksu Basım Yayın; 2008.
Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von RentelnKruse W. Decubitus ulcers: pathophysiology and primary prevention. Dtsch Arztebl Int; 2010; 107(21):371-81.
Altunel CT, Kartal SP,. Dekübit ve bası ülserleri. Akgül A, (ed). Gerontolojik/65+ Deri ve Sorunları; 2019;1: 87-94.
Jiang Q, Li X, Qu X, Liu Y, Zhang L, Su C, et al. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China. Int J Clin Exp Pathol; 2014;7(5):2587-94.
Sullivan N, Schoelles KM. Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy. Annals of Internal Medicine; 2013; 158: 410-416.
Alderden J, Cummins MR, Pepper GA, Whitney JD, Zhang Y, Butcher R, Thomas D. Midrange Braden Subscale Scores Are Associated with Increased Risk for Pressure Injury Development among Critical Care Patients. Journal of Wound, Ostomy and Continence Nursing; 2017; 44(5): 420–428.
Ayello EA, Baranoski S, Lyder CH, Cudigan J. Pressure ulcer, Baranoski S, Ayello AE, Wound care essentials: Practice principles, First ed, Philadelphia:Lipincott Williams&Wilkins, 2004;240-270.
Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care; 2002;15(18):125-131.
Karadağ A. Basınç ülserleri: Değerlendirme, önleme ve tedavi. C.Ü. Hemşirelik Yüksekokulu Dergisi; 2003;7(2):41-48.
Anthony D, Parboteeah S, Saleh M, Papanikolaou P. Norton, Waterlow and Braden scores: A review of the literature and a comparison between the scores and clinical judgement. J Clin Nur, 2008; 17(5): 646-53
Pancorbo-Hidalgo PL, Garcia-Fernandez FP, LopezMedina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: A systematic review. J Adv Nurs, 2006; 54(1): 94-110. [CrossRef]
Avşar, P. ve Karadağ, A. (2016). Waterlow Basınç Ülseri Risk Değerlendirme Ölçeği’nin Türkçeye Uyarlanması, geçerlik-güvenirlik çalışması. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 3(3), 1–15
Bergstrom N, Demuth PJ, Braden BJ. A clinical trial of the Braden Scale for predicting pressure sore risk. The Nursing Clinics of North America; 1987; 22(2): 417-428.
Kılıç HF, Sucudağ G. Basınç yarası değerlendirilmesinde sık kullanılan ölçekler. JAREN; 2017; 3(1): 49-54.
Adıbelli Ş, Korkmaz F. Yetişkin hastalarda basınç yarası gelişme riskini değerlendirmede kullanılan ölçekler. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi; 2018; 9(2): 136-140.
Qaseem A, Mir TP, Starkey M, Denberg TD. Clinical Guidelines Committee of the American College of Physicians*Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Annals of internal medicine; 2015; 162(5): 359-369.
Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L. Sieggreen M. Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised pressure injury staging system. J Wound Ostomy Continence Nurs; 2016; 43: 585-597.
Gencer ZE, Özkan Ö. Basınç Ülseri Sürveyans Raporu. Türk Yoğun Bakım Derneği Dergisi; 2015;13: 26-30. https://doi.org/10.4274/tybdd.81300
Çelik S, Dirimeşe E, Taşdemir N, Açık Ş, Demircan S, Eyican S, Güven B. Hemşirelerin Bası Yarasını Önleme ve Yönetme. Bakırköy Tıp Dergisi; 2017;13:134-139.
Lee TT, Lin KC, Mills ME, Kuo YH. Factors related to the prevention and management of pressure ulcers. CIN: Computers, Informatics, Nursing; 2012; 30(9):489-495.
Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S. ve ark. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline Journal of tissue viability; 2019; 28(2): 51-58.
