1 / 21

CIRCUMCISION: medical and Cultural Care for a Person with Hemophilia

CIRCUMCISION: medical and Cultural Care for a Person with Hemophilia. Nairobi, Kenya. June 25, 2013. objectives. Discuss the traditional and cultural aspects of circumcision Explain the reasons for and risks of circumcision in boys with hemophilia

zaide
Download Presentation

CIRCUMCISION: medical and Cultural Care for a Person with Hemophilia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CIRCUMCISION: medical and Cultural Care for a Person with Hemophilia Nairobi, Kenya June 25, 2013

  2. objectives Discuss the traditional and cultural aspects of circumcision Explain the reasons for and risks of circumcision in boys with hemophilia Provide guidelines and protocols for hospital and cultural circumcision Discuss how nurses can assist families with this traditional or hospital procedure

  3. Circumcision and protocol Circumcision is one of the oldest and most commonly performed operations in the world It is also a traditional procedure One in 7 males worldwide is circumcised Timing of circumcision is different depending on race and culture

  4. Cultural integration Social and cultural integration of boys with hemophilia is essential With the availability of factor products, circumcision can be carried out on these patients The addition of tranexamic acid and fibrin glue enhance hemostatic management

  5. Medical reasons for circumcision Some studies have shown that in circumcised males there are: Lower rates of sexually transmitted disease and HIV Lower rates of penile cancer Lower rates of cervical cancer in partners Conflicting studies re: urinary tract infection Evidence of benefit supported by WHO However, many national health organizations suggest the decision should be made by the family and child, if he is old enough to declare

  6. Risks/Complications of Circumcision Pain Excessive bleeding Inadequate removal of the foreskin Meatal stenosis and ulcer Fistulas Loss of penile sensitivity Skin necrosis Amputation Septicemia Dehydration

  7. Circumcision in boys with hemophilia Without proper management, boys with hemophiliaare at risk of death from bleeding at circumcision camps. To ensure the safety of the patient, circumcision should be carried out as a surgical procedure • Performed by qualified medical professionals • Under hygienic conditions and factor cover The duration of factor substitution varies around the world, from 2-8 days In 1998, Martinowitz et al showed that using fibrin glue cut the use of factor products back to 2-4 days

  8. The Izmir protocol: Turkey Hospital circumcision Factor replacement for 3 days with the first day b.d Aim to keep level above 50–60% Fibrin glue at time of circumcision Tranexamic acid commenced 12 hrs pre-op and given orally every 8 hrs for 7 days Despite this 22% had some bleeding

  9. The Hemophilia Nurse Communication and liaison with all players: PWH and families Healthcare personnel Government coordinators Traditional surgeons and healers Traditional leaders and chief in the community

  10. Hospital Circumcision Principles of care Procedure should be in tertiary institution knowledgeable re PWH Planned with the HCCC and relevant urology dept Coordinated by the hemophilia nurse coordinator and/or hematologist Factor replacement therapy to be ordered before procedure. Treat as for major surgical procedure Can be done as outpatient with LA if on established home therapy protocol Follow-up is essential

  11. Hospital circumcision: Pre-Op work-up Must be seen by hematologist within last 6 months Need recent blood results, weight, etc. Do inhibitor screen Must not have had any recent infections or infectious wounds If dental procedure also required, can try to coordinate at the same time to save on factor budgets Can be done as outpatient or inpatient if PWH not on home therapy Order factor replacement therapy for whole procedure and write up pain medication e.g. panadene

  12. Hospital circumcision: Day of and post-op If under general anesthetic: Nil by mouth and routine pre-operative management Give factor as for major bleed 30 minutes prior to surgery Post-op treatment with factor BD after surgery for 2 days, then daily for 5 days Remove dressing and re-assess in clinic after 7 days Some PWH may need factor for a few more days post op. (depends on healing)

  13. Cultural Circumcision School Protocol for Circumcision in Eastern Cape Act No 6 of 2001 (EC) Needs to be utilized for circumcisions done at circumcision school These rules and regulations are in effect to protect the initiate

  14. Cultural circumcision: state Regulations The traditional surgeon needs to be qualified and have permission from the regulator authority to perform the procedure Must use appropriate tools to perform the operation Needs to have permission to have a circumcision school and also written permission from a recognized doctor to perform the procedure

  15. Traditional Circumcision Initiate needs to go via the correct channel Initiate must be seen by one of the hemophilia nurse circumcision coordinators Consent must be signed after consultation with traditional surgeon and initiate’s family members Treatment will be as for hospital circumcision Factor VIII or FIX must be obtained prior to the procedure and decision made of who will be responsible for the treatment of the initiate (dates of procedure, doses of factor, and practical application)

  16. Circumcision School Below age 21, parent or guardian must sign the consent Initiate must be 18 years old or 16 if requested by the parents The traditional nurse can visit the circumcision school to ensure good practice e.g. hydration, choice of instrument, infusion of factor, etc The medical officer can remove the initiate at any time if the initiate is not in good health

  17. Hemophilia Nurse’s Role Be sensitive to community’s beliefs, customs, norms, and other cultural issues in practice Be respectful and mindful of the customs Be understanding, supportive, and provide education to ensure informed and safe decision

  18. Summary Circumcision in boys with hemophilia is possible, provided appropriate care and management We have to understand and be respectful of all the cultural beliefs and practices and the importance of circumcision to ensuring acceptance in certain communities PWH must be educated about the protocols available (hospital or cultural)

  19. References I Sasmaz et al. Circumcision and complications in patients with haemophilia in southern part of Turkey: Cukurova experience. Haemophilia 2012 18; 426 – 430 A single centre experience in circumcision of haemophilia patients : Izmir protocol. Haemophilia 2010; 16, 888-891 Rodriguez et al. To circumcise or not to circumcise? Circumcision in patients with bleeding disorders Haemophilia 2010;16, 272-276 OB Shittu, WA Shokunbi. Circumcision in haemophiliacs: the Nigerian experience Haemophilia 2001; 7, 532-536 Kavakli, Aledort et al. Circumcision and haemophilia: a perspective. Haemophilia 1998; 4, 1-3

  20. Merger avec slide 1 Anne-Louise Cruickshank Haemophilia Nurse CoordinatorWestern Cape South AfricaAcknowledgements:Anne Gilham, MirriamMokwena, Henry Steenkamp, and the Eastern Cape Department of Health

More Related