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- by NrsJena May 12, '06Homecare client has stage 4 on sacrum. Full coverage of thick yellow slough, with eschar at center. Current tx is Sivadine BID. Would like to recommend a chemical debrider- something along the lines of Panafil, Santayl or maybe Accuzyme? Looking for one that is Medicare reimbursable (if that's even possible anymore
- May 12, '06 by suebird3Panafil works well. Am using it right now.
- May 12, '06 by NrsJenaSue- do you know if Panafil is covered by medicare?
- May 12, '06 by suebird3Yes, it is. Public Aide is a different story, though (at least where I am....)
- May 12, '06 by bigtexHold up! If you are the only one using the debridment oint. then thats cool, but time after time I have gotten an order for chemical deb. (did not ask for it) and some yoyo has come behind me and screwed up what progress I have made. What Im trying to say is that if you can have it Surgicaly deb. it not only in the long run save money and time, but helps the pt recover alot faster. If you do decide to use chemical, I would use pan or santyl with a breathable dressing (not opsite or any other tegaderm dressing because no matter what they say it is not breathable and will cause drainage to pool and emacerate the healthy tissue causing the chemical to eat what used to be healthy skin causing your wound to be way larger than what it should be, and thats even with kalistat) and you will have to adjust frequently to dressing types with use of either of these products because sometime a really dry or moist wound will become saturated alot faster with these products. I would increase my visits to atleast qod for the first week to monitor drainage and wound depth. But you could also just go old school with a wet to moist/dry dressing. Well obvoisly I hate Product salesman, and no im no expert on any level, but having healed many wounds that other people have butchered in HH and LTC these are suggestions. PS if and when you get it debrided, you should push for a wound vac, they a freaks of nature and only trust the best which is kci, You get what you pay for and medicare/medicaid/insurance pays for it. We used a off brand once and no crap they showed up with a suction machined and tubing and told me to wrap the end of the tubing in a wet 4x4 stick it in the wound and cover it with opsite. I just about ****** myself i was laughing so hard. Anyways way to long winded good luck
- May 19, '06 by joycetikNrsJena, i'd use santyl. santyl works from the outer edges going inwards towards the base of the wound pulling that yellow slough plug out (and hopefully the black eschar in the middle, too). panafil works good with 30-40% slough and could be too mild for that kind of wound.
- May 19, '06 by wenbonmacUntil we have removed the cause of pressure, nothing works too well. But, Panafil we've seen the best results with.
- May 24, '06 by sharlynnI would never use Silvadene as a treatment for a Stage IV.
- May 25, '06 by Cing_angelsI just recently talked to a pharmacist about the same thing (medicaid reimbursment) and he told me it depends on what plan they have chosen-since their is so many now- maybe thats how medicare works too? Not sure.
- May 25, '06 by NrsJenaUpdate: Got the order for Santyl- two weeks in and the slough is down by about 40%. Eschar completely gone. In regard to payment: a total PIA! I ended up having to call the insurence company and down-load the formulary to actually look up what would be covered. The pharmacy apparently does not have an update formulary on site. But-alls well that ends well.
We have addressed the pressure- and given education to caregiver to limit time OOB and re-position q2 hrs.
As for the VAC- I have used it previously with mixed results. Once it's clean- we'll see what we have and go from there. I have worked with KCI many times- have the local consultant's number on my cell- won't dream of working with any other.
Thank you all for the wonderful advice!!