Stasis ulcer dilemma

Traveler · Oct 17, 2004

It sounds like a challenging case for you! There are so many different products out there with different names but that do the same thing. I am not familiar with Multidex powder. It sounds like he could use some debridment. We use a product called Curasalt. This goes on the wounds under all other dressings. If there is lots of drainage I would use calcium alginate or Aquacel AG (again, what we use but there are many other names.) The silver impregnated dressings are good at preventing infection. We use two good dressings: Versiva and Combiderm. The second one is a little thicker and can tolerate a little more saturation. The adhesive is great and they are meant to and will stay on for up to a week. But I would put some skin prep where the adhesive goes to maintain skin integrity. Compression bandages are great if the patient is compliant in leaving them on until the next visit. I have used Unna boots in the past- calmine impregnated gauze covered with ace wrap or co-ban. Profore is also a good choice but I don't have too much experience with it. Since urine contamination is a problem, could the patient be taught to put on a fresh ace wrap every day and wash the soiled one? Or Ted hose? This would give some compression therapy to decrease the edema. The underlying dressing should not be compromised if the quality of it is good. Another totally different approach would be a WoundVac. Of course the patient is going to have to be compliant here as well but I have seen great things with these wound vacs. There are many great wound clinics out there. Some of our patients go once a week and they make further recommendations to us. After all of the slough is removed by chemical debridment, something like Regranex might be good to try to speed the healing. Also, since he is diabetic, the more he is compliant and has fsbs wnl would help also. I always tell my wound patients to increase proteins in their diet and take vitamin c and zinc supplements. Some labs may be indicated to see where he is nutritionally in order for the wounds to be able to heal. One other thing- Anodyne therapy. We are supposed to be getting one this month. It is basically light therapy that is used for diabetic neuropathy and for tissue stimulation in wounds. If it is found to work for the patient, they are eligible to get one that is covered by Medicare for their own home use. I have seen it work very well on a patient of ours for a traumatic wound. I don't know how much I helped. There are so many products out there but each situation is so different.

Ann

leslie :-D · Oct 19, 2004

i too agree that it needs enzymatic debridement of the yellow slough....panafil, accuzyme, santyl.

why are you using calcium alginate? is the drainage that heavy? if the drainage is not heavy, then calcium alginate or wound vac would not be indicated.

again, i would do the debridement with an occlusive dressing bid until drainage is controlled.

are his blood sugars stable? malnourished? zinc and vit c used to be a protocal at a former facility. also prevent pressure to those areas behind his calves.

good luck.

leslie

hoolahan, ASN, RN · Oct 24, 2004

Does the pt have a caregiver? I would think a Cath would be better since he is unstable on his feet, he could use a leg bag. Is he able to do anything for himself?

It sounds like the home situation isn't the best either if the dressings are always soaked with urine.

I agree if there is slough, debridement may be in order.

I recommend a wound nurse consult for this one.