. Objectives. HxPt populationsGuidelinesPrevent. ComplicationsPost. Pt outcomes. Medicinal Leech Therapy. History. First used 2500 years agoThe bite of a leech producesAn anticoagulantA local vasodilatorThis mimics venous circulation in compromised tissueBleeding can continue up to 48 hours after leech detachment.
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1. Leech Mania Anne Redick, RN, CNL
10 East Surgical Oncology
3. Objectives Hx
Post. Pt outcomes
4. Medicinal Leech Therapy
5. History First used 2500 years ago
The bite of a leech produces
A local vasodilator
This mimics venous circulation in compromised tissue
Bleeding can continue up to 48 hours after leech detachment
6. Patient Populations Microvascular anastomoses (Flaps)
Head & Neck Cancer
Ring avulsion injury
Patients may catch their wedding band or other finger ring on moving machinery or on a protrusion from a surface as they jump or move away from it Patients may catch their wedding band or other finger ring on moving machinery or on a protrusion from a surface as they jump or move away from it
7. Guidelines Provides standardized guidelines for prescribing, dispensing and applying medicinal leeches
Guidelines divided into three sections for clarity: Pre-procedure, procedure, post-procedure
8. Pre-Procedure Physician
obtains informed consent
Writes order for sterile medicinal leeches
Specifies number of leeches, and area to be treated
Orders baseline hemoglobin and hematocrit
Orders supplies to be kept at bedside
Suggested supplies listed in guidelines
Provide patient teaching
Collect supplies & begin procedure
9. Procedure Nursing cleanses treatment area
Applies leech to area specified by physician
Monitors the leech frequently to prevent migration to non-treatment area
Allows the leech to remain in place until fully distended (10-15 minutes)
Allows the leech to detach naturally or apply salt to the head
10. Post-procedure Place used leech in cup containing 70% alcohol and screw on cap
Place used leech in red bag and dispose of according to MUHA infectious waste policy
Encourage bite to bleed by removing locally forming clots
11. Appendices Appendices from Leeches U.S.A. LTD
Fact sheet on leeches
Procedure for attaching leeches
Equipment needed to apply leeches
Maintenance of leeches
Disposal of leeches
General patient care and post bite care of wounds
12. Preventing Complications Observe Leech during treatment for migration
Check Hemotocrit/Hemagolbin pre-procedure and at least every 48 hours
Prophylactic antibiotics (Keflex PO)
13. Positive Outcomes STATS ?
ENT & Plasics state satisfaction with results
$4-$6 per Leech vs. Surgical Revision
Decrease LOS / Prevent Readmission for Surgery
Emotional Impact Dr O (plastics) stated that he hasn’t lost a flap but has had to do partial revisions, he also stated that the tissue was already is poor condition when the leeches were applied so in his opinion partial success was good success. Dr Hornig (ENT) stated that out of 4 cases ( one pec flap, two skin flaps, one free flap) he hasn’t lost a complete flap although two had partial flap loss. Dr O (plastics) stated that he hasn’t lost a flap but has had to do partial revisions, he also stated that the tissue was already is poor condition when the leeches were applied so in his opinion partial success was good success. Dr Hornig (ENT) stated that out of 4 cases ( one pec flap, two skin flaps, one free flap) he hasn’t lost a complete flap although two had partial flap loss.
14. Success Stories Mr. A is a 23 y.o . White male with SCCA of the Anus s/p APR with flap closure by plastics. Several days post-op Nursing staff noted that the flap was dusky & was unable to obtain a venous doppler signal.
Leech therapy was initiated by plastic surgery team
3-4 leeches were applied every 2 hours to rectal flap.
Treatment continued for 2 weeks with decreasing placement intervals
Pain Nurse & Psychiatric Nurse Liaison Consult were made due to pt anxiety and poor pain tolerance
Patient discharged with viable flap
However, Mr. A. was readmitted 10 days after discharge with complications due to poor hygiene and noncompliance. The flap developed a foul odor and necrotic edges. Cultures obtained were positive for pseudomonas. Wound Vac was placed after wound debriedment.
15. Success Stories cont. Mrs. L a 67 y.o.white female with SCCA of the Lip underwent multiple resections and reconstructions beginning in 1996. Her most resent hospitalization was for lower lip soft tissue defect s/p recurrent cancer resection.
After transfer to the floor her lip flap became dusky and was concerning for venous congestion.
She received a single leech to her lip every 2 hours for several days.
The flap remained pink and soft with good viability after the discontinuance of leech therapy.
She continues to seek further reconstruction for appearance and function
16. Success Stories cont. Other patients
Head & Neck Cancer
Other facial and neck flaps