UNNA boot sticking to wounds........

[chenoaspirit, ASN, RN]

I also posted this in the wound nursing forum, but wanted to get as many responses as possible...so Im posting it here for all you homehealth nurses. Hopefully someone can give me some advice.

I have been applying unna boots to my patient twice weekly for about 3 weeks now. Its so painful for her because of the drainage that causes the boot to stick to the wounds. It takes me forever to get them off of her so I can reapply them. I know the boots have medi-paste in them to aide in wound healing so Ive been hesitant to apply any non-stick like adaptic over the wounds prior to applying the boot. If I apply such a dressing, wouldnt that keep the medi-paste from penetrating the wounds? I called the doc, but he is on vacation and the nurse didnt kinow if I should or not.

She was recently hospitalized and when she was d/c'ed home, I had to go and change them a few days later...to find adaptic over the wounds...which made it so easy to remove the boots. Thats how the d/c nurse had applied them (there was no order for that). Some people tell me to do so, some tell me not to. Ive been told to apply lotion to leg prior to applying, then Ive been told not to. Im so confused.

I just feel so bad for this woman...removing the unna boot is so painful and it literally pulls away skin with them. Ive soaked them in saline, Ive soaked them in water, which really doesnt help much to get them unstuck. Any advice would be very much appreciated. I have to change them again on Friday and Im hoping for it to be less painful/traumatic for her. She even cries, which makes me feel so bad for her.

I know I have to have an order for anything new I do, but I was just wondering if anyone here has learned a technique or tricks so that I could mention to the doc. Most wound care is up to us homehealth nurses. Thanks.

[annaedRN, RN]

could you switch to a 2 or 4 layer compression wrap system (such as Profore) so then you could use Adpatic or some other such non-stick dressing. If the ulcers are bad...you could use Iodosorb gel then Adaptic before wrapping. I've suggested that to docs and really had it heal up. I had a lady that the unna boots seemed to make it worse..switched and started improving fairly quickly. Hope that helps..

[chenoaspirit, ASN, RN]

Thank you so much. I dont know what profore is. I'll have to look that one up. It sounds like something great. Anything better than what Im doing now. Thanks so much for your advice. I appreciate it. I hate wound care.

[chenoaspirit, ASN, RN]

Now I know what it is! Thanks. I think thats what she needs. Im gonna discuss this with the md. thanks again!

[annaedRN, RN]

Good luck! Hope it works. Picking out wound care products gets a little easier the longer you do it. It's great when the docs are on board with us...since we do this day in and day out!! We frequently get the call to assess a wound and recommend what is best...love those ones!!