Pressure Ulcer Care (Stage IV)

Specialties Hospice

Published

Specializes in School Nursing.

Hi everyone. I was wondering if y'all have any successful treatment protocols for full thickness decubitus wounds? I know curing the wound isn't the goal in EOL, but I would like to keep it from getting worse, if at all possible. Current treatment is cleaning, packing with calcium alginate, covering with sterile dressing 3x weekly. It's on the lateral foot. The CG are good about floating the site to keep pressure off, but pt is completely bed bound w/ severe bilateral contractions to upper and lower extremities, has an intake of

Have any of y'all found a treatment regimen that you feel works?

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Hi everyone. I was wondering if y'all have any successful treatment protocols for full thickness decubitus wounds? I know curing the wound isn't the goal in EOL, but I would like to keep it from getting worse, if at all possible. Current treatment is cleaning, packing with calcium alginate, covering with sterile dressing 3x weekly. It's on the lateral foot. The CG are good about floating the site to keep pressure off, but pt is completely bed bound w/ severe bilateral contractions to upper and lower extremities, has an intake of

Have any of y'all found a treatment regimen that you feel works?

Has the wound shown any signs of improvement or worsening over the past month?

Is there a lot of slough? If so, 2 weeks of santyl might be a good treatment to suggest to the MD? Also if it isn't a wound with a lot of drainage the alginate might no longer be the correct treatment. A consult with the wound clinic might also be a good thing to suggest.

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Sorry I was browsing the site under "what is new" with my ipad and didn't notice this was in a hospice forum. I tried to edit the post but couldn't figure out how.

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Specializes in School Nursing.

Thank you for your suggestions. The wound went from I-IV really quickly, matter of a week or two and does have a lot of drainage still. No odor and it seems to have stopped getting worse, but it's definitely not getting better.

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It sounds like your protocol is appropriate. The problem with Santyl is (1) many hospices won't pay the $200 for it and (2) it requires daily dressings, which may be difficult for some caregivers. We always tell families that the best to hope for is the wound will not get worse. With patients being very physiologically stressed and having poor nutrition, there is often no protein in the body to devote to wound healing.

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Specializes in School Nursing.
It sounds like your protocol is appropriate. The problem with Santyl is (1) many hospices won't pay the $200 for it and (2) it requires daily dressings, which may be difficult for some caregivers. We always tell families that the best to hope for is the wound will not get worse. With patients being very physiologically stressed and having poor nutrition, there is often no protein in the body to devote to wound healing.

Wow, that is an expensive treatment, and daily dressing changes I think will cause more distress than help to the patient. Thank you for your input. :)

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It sounds like your protocol is appropriate. The problem with Santyl is (1) many hospices won't pay the $200 for it and (2) it requires daily dressings, which may be difficult for some caregivers. We always tell families that the best to hope for is the wound will not get worse. With patients being very physiologically stressed and having poor nutrition, there is often no protein in the body to devote to wound healing.

I know. I posted my suggestion prior to noticing it was a hospice forum. I was not able to edit the post from my ipad.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

If the wound is painful for the patient you can add a topical med for comfort...morphine gel or lidocaine gel might help and are fairly inexpensive.

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