[doodlemom]

Originally Posted by RN4hospice

Our hospice has had several similar wounds. As the disease progresses, it is a possibility that the patient could "bleed out". Placing dark towels in the home is less frightening to families when there is bleeding. We have used Monsel's solution (Ferric Subsulfate) directly on the bandages that touches the wounds (leave in place). This prevents or greatly minimizes bleeding. I feel it is much better than the silver nitrate sticks because if helps prevent the bleeding. The solution is a stypic or haemostatic agent. Your hospice pharmacist should have more information on it. Our pharmacy keeps it in stock. We were actually introduced to it by an OB/GYN physician when we had a pt. who had vaginal bleed outs. Saturate a tampon in the solution and insert it for several hours....stops the bleeding! Works great!I think it is great that this forum is available...so we can get ideas from others to treat our patients. Good luck!

Wow! I've not heard of this product before. I am going to file that away in my brain for the next time I come into this situation. Thanks!

[Wildbriar]

Me too, thanks everyone for the great insights!

[breezes1cna]

Originally Posted by BeExcellent

An "old school" hospice nurse turned me on to a product called Icthammol 20% ointment. I have never seen a wound product work better including the silver impregnated products and the granulation promoters. This is an ointment that has antimicrobial and antifungal properties. It is thick, dark and sticky and made from shale oil! But I have used it on HUGE wounds that have granulated and healed. It is also very cheap. I used 1/2 strength Dakins to decrease bacterial load, then alginate with Icthammol liberally in the wound. It is amazing stuff. It has healed wounds that others declared unhealable. It is too cheap for anyone to make any money on at about $3.00 a tube.

Hello everyone. I just found this site, and it is sooooo cool. I was Dx'd with stage 3 Breast Cancer in 2005, I did the chemo cocktails , and 33 rads treatments. Then in 2007, I was Dx'd with Breast Cancer again, this time on the other side. I decided to do the Bi-lateral mas. Now I have an open wound that will not heal. we have tried the Wound Vac, And the Aliginate treatment. And it's been a year tomorrow, that I had the surgery. The wound is on the side that had the rads treatment, in 2005. The Dr. says that could very well be the problem. A skin graft is not an option right now.. As the surgeon will not take my case until I quit smoking. ( I'm presently on Chantix and down to 2 smokes a day)So, I was surprised to hear about the Icthammol 20%. Does anyone else have any other ideas? Thanks in advanced.

[Em1995]

I had a patient with a similar wound and close to the same scenario.She was insistent on staying home.
She did bleed out from this wound, but it was peaceful and painless for she and the family. I encouraged them to get a red or maroon flannel sheet set. They were able to get several! We also made sure we had red towels. I got a "bleed-out" kit/orders in place asap and kept this in the home. We use IM morphine and valium (and you can also use SL ativan) as part of the bleed-out kit. I can tell you from my experience with several of these kinds of wounds that they go rapidly.So you need to be ready in a split second.
Unfortunately, my next door neighbor(and one of my best friends) is looking at the same. She has fought a very long battle with breast cancer and it is now all over her chest wall and rapidly spreading. I am going to have a difficult time handling this. She has not yet decided upon hospice. But, it's only a matter of time. I'll certainly be there for my friend to help her walk over the veil.

[interleukin]

Em1995,

You are, indeed, an excellent and compassionate friend.

We'd all be blessed to have a neighbor like you.

[Second]

We have had two patients with this type of wound in the last month or so. While superficial bleeding can be stopped in a variety of ways, it seems that nothing can prevent a bleed out if the tumor reaches a major vessel. I agree that it is helpful to prepare the patient and family for this possibilty. It is in fact quick and painless and the one's who suffer most are people caring for the patient who are unprepared for this. For bleeding from superficial vessels we sometimes spray Afrin directly on the bleeding areas with very good results. THis is something the patient can have at bedside. My patient also had a large deep wound which she prefered to keep open to air, partly because dressing changes were painful and the dressings she was using were sticking. Also wrapping the wound was awkward. WE ended up cleansing the wound with saline, spraying with Afrin, applying calcium alginate and ABD's. The patient came up with the idea of wearing a sleevless men's tee shirt instead of wrapping, THis held the dressing in place. The difficult aspect of these wounds is that they really don't seem to heal, just grow worse with the tumor's growth. We also administered morphine prior to dressing changes, and this helped the patient very much.