Manual on wound care after open-window thoracostomy

Objective: To produce and validate a manual on wound care after open-window thoracostomy for healthcare professionals. Methods: This is an experience report. Initially, articles in Portuguese, Spanish and English were selected from 2010 to 2018 in the Cochrane, SciELO, LILACS, PubMed and Google Academic databases and search sites for the development of the material. The following descriptors were used: “thoracotomy”, “thoracostomies”, “thoracic cavity”, “pleura”, “pleural cavity”, “injuries and lesions”. After consultation, the text was prepared, followed by illustrations and layout design. The completed manuscript was sent to experts for validation. The content validity index (CVI) was used to validate the manual. Results: The manual developed has thirty-six pages and seven chapters with the following themes: introduction, wound care after open-window thoracostomy, wound cleansing/debridement, dressings, care record, final considerations, and bibliography. Conclusion: It was possible to develop and validate a manual on wound care after open-window thoracostomy for the consultation of health professionals.


INTRODUCTION
Open-window thoracostomy consists of an opening surgically made in the thoracic cavity maintained for an indefinite period until the pleural space is clean and properly drained, allowing the mobility of the chest wall and diaphragm to be reestablished, lung reexpansion, promoting the normalization of respiratory function and reducing the length of stay. This period may be longer than 12 weeks of treatment 1 . No consensus was found in the literature among the authors regarding the typology and denomination of this opening; therefore, the term "wound after open-window thoracotomy" is used in this study to describe this opening. This procedure is performed for the treatment of lung diseases associated with parapneumonic pleural effusion (PPE), which is defined as the abnormal accumulation of fluid caused by lung abscess or bacterial pneumonia in the pleural cavity. This phenomenon is called pleural empyema and is characterized by the presence of pus in the originally sterile pleural space 2

RESULTS
As a result, the manual consists of 36 pages and 18 illustrations. Fig. 1 shows a chapter in which the dressings that can be used in the treatment of the wound after openwindow thoracostomy were described, highlighting the name, description, mechanism of action, main indications, and period of change. Figure 1. Picture from the introduction chapter and the chapter on dressings.

Manual on wound care after open-window thoracostomy
After analyzing the data, the responses with the "adequate" classification corresponding to item 3 or "fully adequate" corresponding to item 4 were selected. Responses with an "inadequate" classification corresponding to item 1 or "partially adequate" corresponding to item 2 and "not applicable" were excluded. under "Structure and Evaluation" as "partially adequate".
In question 2 (the messages are presented in a clear and objective manner), one expert pointed out two answers, presenting no suggestions for improvement or alteration for this item; in this context, the answer was excluded.
On question 7 (the information is well structured in concordance and spelling), the experts scored some typos that were punctually corrected. Table 2 shows that 15 (53.6%) considered the content "fully adequate", 12 (42.9%) as "adequate" and 1 (3.5%) as "partially adequate". All the subitems of the category were validated after the adaptations suggested by the experts for didactic improvement of this criterion. Table 1. Expert assessment for structure and presentation of the manual.

1.
The guidelines presented in the manual are suitable to assist in planning nursing care.

DISCUSSION
The manual presents a set of opinions regarding