Leech Mania

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Leech Mania

• Anne Redick, RN, CNL
• 10 East Surgical Oncology

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(No Transcript)
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Objectives

• Hx
• Pt populations
• Guidelines
• Prevent. Complications
• Post. Pt outcomes

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Medicinal Leech Therapy
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History

• First used 2500 years ago
• The bite of a leech produces
• An anticoagulant
• A local vasodilator
• This mimics venous circulation in compromised
  tissue
• Bleeding can continue up to 48 hours after leech
  detachment

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Patient Populations

• Microvascular anastomoses (Flaps)
• Head Neck Cancer
• Plastic Surgery
• Tissue reattachment
• Digits
• Ring avulsion injury

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Guidelines

• Provides standardized guidelines for prescribing,
  dispensing and applying medicinal leeches
• Guidelines divided into three sections for
  clarity Pre-procedure, procedure, post-procedure
  

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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
• Nurse
• Provide patient teaching
• Collect supplies begin procedure

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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

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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

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Appendices

• Appendices from Leeches U.S.A. LTD
• Http//www.leachesusa.com
• 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
  

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Preventing Complications

• Observe Leech during treatment for migration
• Check Hemotocrit/Hemagolbin pre-procedure and at
  least every 48 hours
• Prophylactic antibiotics (Keflex PO)
• Assess Flap
• Doppler
• Color
• Temperature
• Capillary Refill
• Turgor

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Positive Outcomes

• STATS ?
• ENT Plasics state satisfaction with results
• Cost Savings
• 4-6 per Leech vs. Surgical Revision
• Patient Satisfaction
• Decrease LOS / Prevent Readmission for Surgery
• Emotional Impact

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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.

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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

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Success Stories cont.

• Other patients
• Head Neck Cancer
• Ear
• Other facial and neck flaps
• Plastic
• Breast
• Rectal
• Shoulder
• Abdomen

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