600 Nursing Standard of Practice: Assessment & Assistance with Bedside Escharotomy

Abstract

Abstract Introduction An escharotomy is an emergent procedure to treat circumferential, full-thickness burns. If left untreated, distal ischemia, compartment syndrome, respiratory failure, tissue necrosis, or death may occur. This procedure involves an incision through areas of eschar to release pressure within the affected compartment. An escharotomy may be performed at the bedside under sterile conditions by an experienced provider with the assistance of the nursing staff. The assisting nurse must have knowledge of the technique, purpose, and associated complications of the procedure. Nursing responsibilities may include pre-/post-procedure care, assessment, assistance with required equipment, patient teaching, & documentation. Methods Extensive literature review was conducted to identify the existence of nursing standards of practice regarding assessment and assistance with bedside escharotomy. A 20-question survey was sent to burn center nursing staff to evaluate inconsistencies in nursing knowledge and practice during bedside escharotomy. Results Information gathered via literature review revealed no consensus among U.S. burn centers in nursing standard of practice for a bedside escharotomy. Survey results further demonstrated inconsistencies in nursing knowledge and practice. Notable results from the survey included variance in post-procedure assessments, provider presence and skill level, dressing intervention, & obtaining informed consent prior to procedure. Conclusions A procedure was developed to standardize nursing practice during bedside escharotomy. This procedure outlines required supplies and preparation of equipment, implementation of nursing assessment and assistance, special considerations & complications, patient teaching, and required documentation. Images were included in the procedure for reference. Nursing staff received education regarding the purpose and utilization of the procedure. The procedure is available electronically to all health system employees. Future plans include reevaluation of staff knowledge and utilization of the procedure. Applicability of Research to Practice Development of a standard bedside escharotomy nursing procedure has the potential to improve level of knowledge, consistency in practice, and patient outcomes. Continued utilization and evaluation of this standard of practice supports the need for a consensus among U.S. burn centers.