Clinical experience of acticoat™ treatment in extensive burn wounds.

Acticoat™ (Smith & Nephew, Hull, UK) is a relatively new form of silver antimicrobial barrier dressing produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. The benefits of acticoat™ in the management of extensive burn wounds have been well established. Acticoat™ has been reported to reduce wound infection and promote healing. No evidence has emerged of resistance or cytotoxicity to acticoat™. Given these potential advantages, we have used acticoat™ in a variety of treatment of extensive burn wounds at burn unit, Siriraj Hospital during September 2002-May 2005. We reviewed with attention to wound etiology, % of organism colonization, efficacy and cost effectiveness. Due to its long lasting properties led to less frequent dressing changes and reduce trauma and pain to burn patients. It is particularly benefit to patients who suffered from partial thickness burn wound especially in children and high% of total body surface area (TBSA) patients (>15%). Acticoat™ treatment in extensive burn wounds also confirmed its efficacy, low labor cost set up and cost effectiveness compared to conventional dressing with silver sulfadiazine.

The factors influenced on the length of hospital stay in burn patients.

The aim of this study was to analyse association between the factors ; (the extent of burn, patient’s age, type of micro-organism, severity of infection and patient’s past medical illness) and the length of hospital stay among 147 survived burn patients who were admitted to the Burn Unit, Siriraj Hospital during January 1, 1994 to August 31, 1997. By using analysis of variance (ANOVA) for bivariate analysis. It was found that statistical significant determinants for variance in the length of hospital stay were extent of burn (F=43.130, df=1,145, p-value<0.0001), type of micro-organism (F=40.792, df=1,145, p-value<0.0001). severity of infection (F=24,409, df=1,145, p-value<0.0001), and type of burn (F=12.815, df=1,145, p-value<0.0001). When we entered these 4 influential independent variables in a final multiple classification analysis, the total explained variance in the length of hospital stay was 44.4% whereas the explained variance were 12.25%, 10.24%, 3.61% and 3.61% for extent of burn, type of micro-organism, severity of infection and type of burn, respectively.

Peripherally inserted centeal catheter line for central access, experience in Siriraj Hospital.

Introduction : Central access is important for parenteral nutrition, chemotherapy, some kinds of drugs. Selection of catheter and method of access are also important to ensure that Patients are safe from complications. PICC line (Peripherally Inserted Central Catheter) is made from polyurethane, and is designed for percutaneous insertion through superior vena cava. Methods : We have studied and used the PICC line with patients who need parenteral nutrition or long-term intravenous fluid application in Siriraj Hospital since November 1995. Results : A total of 35 patients received a PICC line, 23 males and 12 females. The average age was 53.6 years. Indication for central access was parenteral nutrition (28 patients) and for longterm IV fluid (7 patients). We used the pericubital fossa vein in 32 patients and the femoral vein in three patients. The methods of insertion were percutaneous puncture in 24 patients, direct puncture in one patient, and venesection with 10 patients. The PICC line can be use for a maximum of 40 days, but 18.5 days on average. At the time of this report, three patients were continuing the use of PICC lines. We found only one accidenetal arterial puncture at the cubital fossa, and no other serious complication. Reasons for removal were cure in 13 patients, clotting in three patients, phleditis in 10 patients, accidental removal in two patients and death from other problems in four patients, but no cases of infection at the tip of the catheter. With regard to nursing care, a PICC line should be filled with fluid at all times, and care should be taken not to draw the blood back and that there is no unnecarrary flexing of the elbow. Conclusion : From this preliminary study, we have shown that a PICC line, made from polyurethane, can be used with patients who need parenteral nutrition, intravenous drugs, or long-term IV fluid for at least 17 days without any problems. The method of insertion for a PICC line is more superior than the conventional method in the view of low risk of anatomical complication.