Wound Care & Antiseptics

[lovelie_skittle]

Do you think the use of antiseptics such as hydrogen peroxide a practice issue in caring for patients with wound or ulcers?

[renerian, BSN, RN]

I have not seen an order for H202 for some time on wound care? Are you getting docs who are ordering that?

renerian

[Traveler]

Where I did hh before (until August) we routinely used h2o2 and w to d dressings. When I mentioned this to my new agency they were shocked. They don't even carry peroxide in the supply room. We have a WOCN who recommends dressings to us and does lots of inservices. We carry relatively few products but they all seem to be good with good results. Some of the docs will order h2o2, but we can usually get the order changed. The only thing I can think is that the products we were using at the old agency were much less expensive than these we use now and they were trying to save money.

[CoffeeRTC, BSN, RN]

I actually have a resident ordered half strengh wet to dry with that. Doc refused to change. Wound was healing, but I think it has a pocket in it from not being packed (surgical I&D of an old G tube site)

Also have a res geting acetic acid on a coccyx wound.

[Cherybaby]

We routinely do debridements of ulcerations and non healing chronic wounds. Never ever do we use peroxide on ANYTHING except perhaps to clean off blood from a trauma laceration. (And to get blood out of our scrubs! :chuckle ) We generally stick to a routine of cetacaine spray, silver nitrate sticks for cauterization and to promote epithiliazation...and then lastly, we will do a silverdene cream dressing or a wet to dry with sterile saline, depending on the patients allergies/tolerance.

Peroxide. That is sooooo archaic!!

[renerian, BSN, RN]

I have been so swamped at work I have not had time to do any research. I am sorry.

renerian

[NRSKarenRN, BSN, RN]

hydrogen peroxide in wound care.

action is the mechanical cleansing and debridement by effervescent action. considerations when using are:

1. [color=#336633]can cause ulceration of newly formed tissue
   
2. [color=#336633]toxic to fibroblasts
   
3. [color=#336633]should never be used to pack sinus tracts: can cause air embolism
   
4. [color=#336633]should not be used for forceful irrigation; can cause subcutaneous emphysema, which mimics gas gangrene
   

[color=#336633]data from cooper, d: fundamental; products and their usage. in guide to wound care, chicago, 1983

[color=#336633]many studies have documented that the use of hydrogen peroxide in open wounds is not only cytotoxic to bacteria, but also to white blood cells and vital wound healing cells such as fibroblasts. this is because their primary mechanism of action is to destroy cell walls regardless of the identity of the cell. the use of cytotoxic agents in wounds should be weighed in light of this. in addition to the absence of clinical benefit, antiseptics may also encourage the development of resistant organisms.

[color=#336633]doughty 1994 hellewell, et al, 1997: hess 1990; nwomeh, yager, and cohen 1998

from: http://www.hcaw.org/displaycommon.cfm?an=13

wound healing

[color=#336633]

[color=#336633]heeding outcomes--not just dressing costs--makes for the best care and the best use of wound care dollars

http://www.findarticles.com/p/articles/mi_m3830/is_4_50/ai_75180211

wounds: nursing care and product selection http://nsweb.nursingspectrum.com/ce/ce81.htm

includes great grid + ceu's: wound care products by objective

yes this is a practice issue. getting docs to change 100years of practice is difficult. arm them with articles from professional publications is the best way to make inroads---along with promises not to call then as much if they will allow newer wound care stratigies...most sucessful line with home care nurses.

[angel Ann]

we dont keep and use hydrogen peroxide in UK for cleaning wounds and ulcers.I think it is obsolete now.Some may use that or the povidone i. for pre op skin cleansing but we normally use the normasol liquid to clean all kinds of wounds,its effective and evidence-based.