Sternal Wound Management in Pediatric Cardiac Surgical Patients: A Novel Strategic Interprofessional Approach
Neerod Kumar Jha1, Muhammad Shafique, Raisy Thomas
1At Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Neerod Kumar Jha, MD, is Pediatric Cardiac Surgeon; Muhammad Shafique, MD, is Specialist, Internal Medicine; Raisy Thomas, BSc, is Clinical Nurse Educator; Salvacion Pangilinan Cruz, MSc, is Charge Nurse, Wound Care; Gulnaz Tariq, MSc, is Nursing Officer, Wound Care Department; and Laszlo Kiraly, MD, is Pediatric Cardiac Surgeon.
Insights
A new schematic for pediatric sternal wound care streamlines healing after cardiac surgery. This evidence-based approach, incorporating advanced therapies and a clear pathway, improves outcomes for children with sternal wounds.
Area of Science:
- Pediatric Cardiac Surgery
- Wound Management
- Interprofessional Healthcare
Background:
- Limited information exists on sternal wound management in pediatric cardiac surgery patients.
- Current wound care practices may not fully incorporate advanced concepts like wound bed preparation and negative-pressure wound therapy.
- A standardized approach is needed to optimize care for sternal wounds in this population.
Purpose of the Study:
- To develop and implement a pediatric sternal wound care schematic.
- To integrate interprofessional wound care principles and wound bed preparation.
- To expedite and streamline wound management using negative-pressure wound therapy and surgical techniques.
Main Methods:
- Assessed healthcare team knowledge on current wound care concepts (wound bed preparation, infection criteria, advanced therapies).
- Developed management pathways for superficial and deep sternal wounds and a wound progress chart.
- Introduced the schematic and pathways into practice following education and training.
Main Results:
- Initial knowledge gaps in wound care concepts were identified among staff, improving post-education.
- The new management pathway and progress chart were successfully implemented.
- Observed positive outcomes in 16 patients, including complete healing and no mortality.
Conclusions:
- Evidence-based wound care concepts can streamline pediatric sternal wound management post-cardiac surgery.
- Early integration of advanced therapies and surgical closure enhances patient outcomes.
- A dedicated management pathway significantly benefits pediatric sternal wound care.
Objective:
Information on sternal wound management in children after cardiac surgery is limited. The authors formulated a pediatric sternal wound care schematic incorporating concepts of interprofessional wound care and the wound bed preparation paradigm including negative-pressure wound therapy and surgical techniques to expedite and streamline wound care in children.
Methods:
Authors assessed knowledge about sternal wound care among nurses, surgeons, intensivists, and physicians in a pediatric cardiac surgical unit regarding the latest concepts such as wound bed preparation, NERDS and STONEES criteria for wound infection, and early use of negative-pressure wound therapy or surgery. Management pathways for superficial and deep sternal wounds and a wound progress chart were prepared and introduced in practice after education and training.
Results:
The cardiac surgical unit team members demonstrated a lack of knowledge about the current concepts of wound care, although this improved after education. The newly proposed management pathway/algorithm for superficial and deep sternal wounds and a wound progress assessment chart were introduced into practice. Results in 16 observed patients were encouraging, leading to complete healing and no mortality.
Conclusions:
Managing pediatric sternal wounds after cardiac surgery can be streamlined by incorporating evidence-based current wound care concepts. In addition, the early introduction of advanced care techniques with appropriate surgical closure further improves outcomes. A management pathway for pediatric sternal wounds is beneficial.
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