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An Innovative Approach to Specialized Surgical Care

Nurses Leading Innovation
May 3, 2018
An Innovative Approach to Specialized Surgical Care

Omphalocele is a birth defect of the abdominal wall in which an infant’s intestines, liver, or other organs stick outside the belly through the belly button. According to the Centers for Disease Control and Prevention (CDC), as many as 775 babies in the United States are born with an omphalocele each year.​1 Omphaloceles can come in different sizes and the larger it is, the longer an infant may need to wait for a life-saving surgery, leaving these tiny patients vulnerable to infection or restricted blood flow. For years, the best practice for protecting an omphalocele before surgery was to dry it out, which shrinks the surface area of the exposed organs, but requires a lengthy hospital stay.  

Enter Roxana Reyna, MSN, RNC-NIC, WCC, CWOCN, FNP-C, a nurse with 20 years experience as a nurse in the neonatal intensive care unit (NICU). Roxana realized her passion for surgical and wound care early in her career, and discovered there was not a wound care specialist at her hospital, Driscoll Children’s Hospital in Corpus Christi, Texas. Determined to fill this need, Roxana attended the Wound Care Education Institute, obtained a wound care certification (WCC) and became a certified wound ostomy continence nurse (CWOCN). Through her extensive education on wound care, bowel and bladder complications, and restoring damaged tissue, Roxana began searching for a better way to protect omphaloceles before surgery.

“I thought to myself, ‘Is there a way we can heal this rather than drying it out?’ These organs are living tissue,” Roxana said.

She dove into research and collaborated with other nurses and doctors who shared her vision. After many years and a fierce commitment to identifying the best solution, Roxana and her team developed a new technique for keeping omphaloceles infection-free until a patient’s surgery – a specialized dressing.

“It was like being a fashion designer, in a way – I had to pick just the right fabric to suit my models,” Roxana said. “I knew the right dressing would be antimicrobial, provide moisture and warmth and be manipulatable to fit each patient perfectly, but there was a lot of troubleshooting at first. We had to figure out how long to leave the dressing on, and each patient was different.”

As a nurse, Roxana was in a unique position to bring this innovation to life.

“A doctor may be with a patient for a few minutes, but a nurse is with a patient for their entire shift,” Roxana said. “We’re taking care of the patient, intimately know the needs of patient, can make the most personalized recommendations and help the parent feel confident caring for their child.”

Roxana’s innovation is paving the way for other nurses to implement new ideas. Research about her dressing has been published in the Journal of Pediatric Surgery, and Roxana gives lectures, hosts educational phone conferences, and is involved in the MakerNurse program to continue sharing her findings with other nurses.  

“It’s a nurse’s job to bring the research to their team and say, ‘this could work for our patient – let’s try this,’” Roxana said. “If there isn’t data, find a way to create the data yourself. Bring together a team who shares your vision and develop the best solution possible, then share what you learned with other nurses.”

Roxana implemented this new and improved dressing for the first time 10 years ago, on a newborn baby named Kayla. Watch the below video to see Roxana and Kayla’s story come full circle.

 
1. CDC: "Facts About Omphalocele." www.cdc.gov/ncbddd/birthdefects/omphalocele.html

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