Something I've never seen!

[doodlemom]

I have a new patient that has leiomyosarcoma in her shoulder and it has metastasized as dime shaped fungating tumors all over her back. I covered her whole back with antibiotic ointment and ABD pads. It's very painful for her and very sad

[introspectiveRN]

Although I have yet to see wounds like the OP is describing, I have been dealing with patients who have terrible, malodorous breakdown wounds that never heal. With the pharm that we used previously, we were able to order flagyl powder; now (HP) we can only get flagyl caplets and crush them ourselves and then apply :icon_roll . Much more awkward to use than being able to "squirt" the powder directly on and around the wound(s). I have not really noticed the flagyl powder really helping that much with the smell of necrotic tissue. The idea of a pan of charcoal under the bed seems interesting. Where can I find this? Is it like the charcoal used for aquarium supplies?

I find dealing with these wounds discouraging. It seems like nothing I do really makes a big difference in the smell and by the time the pt has declined to the point of having these types of wounds...nothing seems to be able to heal them or stop them from progressing. Here is what I have been doing: crush flagyl caps and apply after cleaning wound with spray wound cleanser (the vinegar solution sounds like a great idea BTW...had not thought of that) than apply algesite, then charcoal pad over that and tegaderm on top (with skin prep around edges). On some wounds I apply flagyl powder into the bed of the wound and then hydrocolloid dsg over. For stage 1 I usually try wound gel and border gauze.

Any additional suggestions are so appreciated.

Although I did some wound care in the hospital, the pt population was so different and so were the methods used to treat wounds. We also had a special wound care nurse that floated from pt to pt doing the care (Wound vacs etc.). I really appreciate any and all advice I can get that will help me with wound care for my hospice pts. :nuke:

[cisco]

another product that works well to reduce odors is liquid chlorophyll. It comes in 8 oz bottles at most health food stores. Once the wounds are dressed, you can apply some of the chlorophyll to a 4x4 and place over part of the dressing and cover.

[jerseyRN]

Jessica, charcoal under the bed? What kind of charcoal?

[leslie :-D]

Jessica, charcoal under the bed? What kind of charcoal?

activated charcoal.

it comes in different forms, i.e., sponge, citrus scented odor remover, etc.

you can purchase it in pet supplies, appliance stores, gen'l merchandise.

i try not to get the 'scented' ones since any noxious stimuli can wreak havoc on the pts systems.

they work well.

leslie

[a21chdchic]

I have used baking soda on the outside of wound bandages for odor control many times, this usually works very well. Be careful to not get the soda on the skin. For fungating wounds, I usually use Hydrogel for moisture to keep bandages from sticking, Xeroform (The vaseline gauze), and ABD's for wounds that I know we cannot heal. These wounds are very painful, and we don't want to make the pain worse by peeling off dressings and causing bleeding, etc. Accuzyme works well, just for the debriding of eschar, then switch back to the hydrogel, and I have aslo used the Metrogel for wounds with infection/odors.

Ana