Wound Care--"It itches!" Patient scratches around wound - page 2

Oh help! Patient came to us with a stasis ulcer on the shin, about the size and depth of a penny, non-draining, yellow wound bed. There's not much skin there, and the entire wound doesn't look... Read More

  1. by   gr8rnpjt
    If she is a frequent flyer she may be developing a latex allergy (different from a glue allergy which was previously suggested) --Unless the tape that was used is latex free. Just a thought, may want to consider latex free tape.
  2. by   UM Review RN
    UPDATE:

    Just wanted to let you all know that the patient's wound looked LOTS better after a few doses of benadryl and wet-to-dry dressing changes (doc insisted on those until Wound Nurse got to see it). It's shallower and appears to be healing. In addition, the edges are healing and pink, not red and macerated any more.


    Thank you all!
  3. by   Marie_LPN, RN
    Quote from Angie O'Plasty, RN
    UPDATE:

    Just wanted to let you all know that the patient's wound looked LOTS better after a few doses of benadryl and wet-to-dry dressing changes (doc insisted on those until Wound Nurse got to see it). It's shallower and appears to be healing. In addition, the edges are healing and pink, not red and macerated any more.


    Thank you all!

    Good!

    My leg hurt just reading about that situation.
  4. by   broadstreet
    i agree w/ topical benadryl or hydrocortisone as long as the surrounding tissues isn't too wet already.

    based on what i've read about the wound itself, i would recommend stopping the wet to dry. stasis ulcers tend to be rather wet, and adding moisture to the already wet wound bed and border will promote maceration and breakdown of surrounding tissues. also, wet to dry dressings are non selective debriders. meaning when they and pull off gunk, they also pull off good granulation buds.

    i'd recommend enzymatic debrider for short term use to get rid of initial slough (if it won't come off on its own), and cover with something absorbent to soak up sloughy drainage. once you've got a good wound bed, i'd recommend something to soak up excess moisture without drying out to provide the best healing environment. foam dressings like mepilex work great for this stage of stasis ulcer healing.

    also, once the wound isn't so gunky and wet, the dressings don't have to be changed daily. every other day is often sufficient.

    i used to work with a lot of old fashioned docs that wanted to throw wet to dry dressings on everything. in 13 years of doing wound care (wound team), i've found that wet to dry dressings are appropriate about 10% of the time they are ordered, and that's probably a stretch. a lot of the newer docs and surgeons are much better about the plethora of other dressing options out there.

    another option for the itching/scratching would be lo-stretch wraps. they provide more compression than an ACE wrap, but not as much as an UNNA boot or compression garment. wrap her from her met heads to her popliteal fossa (over the kling, kerlix or whatever) and she won't have anything to scratch. this could also help with wound healing, as these folks prone to stasis ulcers usually have terrible venous return, and a little compression would certainly help with that, as long as her heart and kidneys can handle a little extra fluid return.

    just my two cents. not gospel by any means, but probably what i would do based on the info you've given.

    good luck!
  5. by   broadstreet
    Quote from zhlk1
    I work in home health and we love unna boots and use them often for venous stasis ulcers. We usually put a debrider like aquacel to the wound bed and then wrap the leg with an unna boot and cover with coban and then sometimes an ace wrap over this. Another plus is that it is a form of compression. They have calamine unna boots which would help with the itching. We also use sensicare ointment (basically zinc oxide and petroleum) around the wound bed to help protect the skin.
    just read this after posting my reply. good suggestions. great minds think alike.

    one last thing... with these wet stasis ulcers, it's also a good idea to coat the peri wound area with something like 3M no-sting barrier. it's basically a water seal to keep drainage from macerating surrounding tissue.

    i looooove me some wound care.
  6. by   prmenrs
    I'm very glad! That did sound miserable.
  7. by   WV_heart_RN
    Please tell your WOC nurse about this when he/she gets back. I am glad that the leg is healing but wet-to-dry dressings are no longer accepted practice. It can damage the newly forming tissue in the wound bed. It can be hard to get a doc to go along with this cause we all know how set in their ways they can be.
  8. by   shellsincanada
    Sometimes with a tape allergy I have found success with bordering the area with tegasorb or duoderm then the tape can stick to that instead
  9. by   nici1978
    Quote from zhlk1
    I work in home health and we love unna boots and use them often for venous stasis ulcers. We usually put a debrider like aquacel to the wound bed and then wrap the leg with an unna boot and cover with coban and then sometimes an ace wrap over this. Another plus is that it is a form of compression. They have calamine unna boots which would help with the itching. We also use sensicare ointment (basically zinc oxide and petroleum) around the wound bed to help protect the skin.

    just to let you knoe aquacel is not a debrider it is in fact a dressing with silver in it, it is a collagen
    a debrider would be your panafil or you accuzyme

    for itchy skin around wounds use chloderm it reliefs the itch

    ( i am working in wound care right now )

    nici
  10. by   asoonernurse
    Have you spoken to the doctor about ordering a honey-based (Leptospermum scoparium) dressing for the wound in combination with Panafil?

    Good luck,

    Michael

    Quote from Angie O'Plasty, RN
    Yes, you did. I noticed that. Never heard of Vicks but I will try it for other patients who have intact skin. Hers, at this point, is quite macerated around the wound from all that scratching. I have no idea if she's been scratching the wound itself, but I think the dressing has been protecting it so far, and she probably has tried.
  11. by   mc3
    I have used Calmoseptine ointment for itchy areas - has calomine, zinc and a cooling agent in it. I recommend it highly!!!
    mc3
  12. by   UM Review RN
    This thread is a bit old, but I thank you for your latest responses. I'm sure that this is not the only patient I'll ever have who itches.

    BTW, this patient wound up getting some benadryl in addition to the wound care ordered by the WC nurse, which did seem to help the problem.

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