favorite wound products

Specialties Wound

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Say, hypothetically you have all the money in the world at your disposal.:chuckle

Patient is 90 yr old NIDDM patient with dementia and constant oozing of stool. Her status is palliative, and decision has been made to do no aggressive forms of treatment. Diet is tollerated very well, but is limited because of NIDDM status, swallowing difficulties and various other feeding complications. Has indwelling cathether and is bedbound with multiple contractures of the legs. Stage IV ulcer to coccyx has been present since 1999 (!). Multiple products have been used over the years, multiple clinical nurse speciallists and infection control specialist have been consulted. Pt had been on VAC therapy for 6 mo, but this lead to a deepening of the wound bed, and was d/c'd in 2001.

How do you propose to treat this client?:)

Originally posted by adrienurse

Does anyone use Allevyn products?

The Allevyn products are very popular here and I think they work well if used appropriately. :)

We have been using Regranex gel which we have been havig great results on diabetic neuropathic ulcers. Regranex is one of the first recombinant platelet derived growth factor for treatment of ulcers. The gel is applied in a thin layer and kept covered with a dampened gauze dressing. We do not let gauze dry out. In combination with the regranex we use LILT therapy (Low-Intensity Laser Therapy) once we change to a dry enviroment. It stimulates the production of the granulation tissue,.

Specializes in Home Health.

Regranex is good stuff, about $500 for a tiny tube too! Fortunately it only takes a teensy bit, that is a good idea though.

adir, have you seen the newer clinitron beds? I had a pt who had one in the home, I was doing a sub visit for his regular nurse, it was only clinitron-like in the center of the bed. Very cool, but still hard to keep HOB elevated. Gosh! I used to HATE those beds in the hospital!!! Esp if pt had enteral feeds.

Still though, it is really effective for those stage 4 decubs.

Did I already mention iodosorb? That stuff is great if the wound is draining a lot too. I absolutely swear by this stuff!!

You did say in the first post to imagine we had all the $$ we could want to treat this wound! ;)

originally posted by lpn,future, rn

panafil would have been my suggestion but since the wound does not need to be debrided, it defeats the purpose and panafil, for what i have seen, heals near the surface and keeps the wound from healing completly. cleansing with ns and applying santyl bid should do the "trick".

panafil also is being uses as a cleaner besides being a debriding agent!

Specializes in LTC, ER, ICU,.
originally posted by shygirl

panafil also is being uses as a cleaner besides being a debriding agent!

i would think because of its cost and depending on the wound which determines how often the treatment is done, this would not be the choice for a "cleaner per say". yet, we learn something new daily. school me, i love to learn. :)

Our facility had this person awhile ago and we used panafil on her Stage II ulcer. At first I questioned it also, but the MD was confident that he wanted to stay with the panafil. It worked! The wound was so clean.the dressing changes were only qd instead of , say BID and maybe the time that it was left on worked. The panafil has a stop action time associated with it. After so much time (I'm not sure of this) it allows the wounds to heal!

Specializes in MDS Coordinator, CWS.

If I understand you, this is all palliative right? Your main concern would be to keep the wound free of infection. You are not going to heal this wound, no matter what you try. You might want to put a gel overlay on her mattress, for treatment purposes only.(Gel overlay is of no help in prevention, and they are cheap) If you are dealing with little or no $$$, your best bet is to use 4 x 4 gauze moistened with regular old hydrogel. You want to pack this wound without traumatizing it. Loosely pack fluffed up moistened (real) gauze and fill in the wound. Don't overlap to margins, just cover wound bed. Cover with an ABD pad, it doesn't have to be taped on all sides, just enough to hold your gauze in. Change dressing everyday to keep from drying out. If you find it drying out with once a day changes, switch to BID. If you do have some dough and there is a chance of healing this wound, I highly recommend Silverlon packing. This is some amazing stuff, however, it is expensive. I deal with this sort of thing on a daily basis. I find this works well in palliative treatment. Good Luck!

Specializes in LTC, ER, ICU,.
originally posted by shygirl

our facility had this person awhile ago and we used panafil on her stage ii ulcer. at first i questioned it also, but the md was confident that he wanted to stay with the panafil. it worked! the wound was so clean.the dressing changes were only qd instead of , say bid and maybe the time that it was left on worked. the panafil has a stop action time associated with it. after so much time (i'm not sure of this) it allows the wounds to heal!

thanks, shygirl. yes, i do remember that the panafil may be left intact if possbile to get the full effect.

have you thought of any other product/s that would help "this" client's wound to heal? i am thinking but haven't come up with anything as of yet.

Yes, look above at Bandaidexpert's opinion. I agree with this also

Specializes in LTC, ER, ICU,.
originally posted by shygirl

yes, look above at bandaidexpert's opinion. i agree with this also

yes, i read bandaidexpert's post. thanks! i appreciate you ladies for letting me join in on this thread. i will continue to "peep" and learn. :kiss

Thanks for all these opinions! It seems this field is growing so fast that it's hard to keep up. When I learned this in school 6 years ago it seems that all it was was duoderm and wet-to dry. I'm so interested in all this stuff!

Specializes in Home Health.

http://www.hill-rom.com/usa/products/prodlist1.asp?multcat=1,12

http://www.keomed.com/product.asp?dept_id=1800&pf_id=2296

Silverlon® Wound Packing Strips: To control local wound bleeding and nasal hemorrhage, for wicking fluids from a body cavity, infected area, abcess, etc.

Silverlon contact wound dressings are designed to be placed directly on the wound surface to reduce the potential disruption of the healing tissue during routine outer dressing changes. Silverlon contact dressings are indicated in the professional and veterinary market for local management of partial thickness burns, incisions, skin grafts, donor sites, lacerations, abrasions, and Stage I-IV dermal ulcers (vascular, venous, pressure, and diabetic).

Silverlon's advanced pure metallic silver technology for wound care provides a surface area of silver 25 times the surface area of the dressing. It is specially constructed with pure polyamide fibers circumferentially coated with 99.99% pure metallic silver. Pure metallic silver has been proven to eradicate more than 150 species of bacteria and fungi. The powerful antimicrobial activity of Silverlon has been proven to reduce the bacterial and fungi bioburden of the wound to the levels that promote healing of the wound.

Antimicrobial protection for a broad spectrum of wounds

Effective against antibiotic resistant MRSA and VRE bacteria

Restoration of normal transepithelial skin potential with reduction in pain and scarring

Hypoallergenic

Fewer dressing changes increases productivity

Reduces use of expensive wound packing dressings such as alginates, hydrocolloids, and hydrogels

All other wound management protocols not affected

FDA Approved

http://www.smith-nephew.com/businesses/W_Allevyn.html

Allevyn* Chronic Wound Dressings

Wounds produce exudate (they weep) as part of the natural cleansing and healing process. It is important for a wound dressing to absorb this exudate but manage it in a way that does not dry out the wound. It is clinically proven that wounds heal faster and better in a moist environment.

Smith & Nephew produces a whole family of Allevyn* dressings for chronic wounds such as venous leg ulcers and pressure ulcers (bed sores). These wounds can be large and difficult to heal and a very serious problem to the healthcare professionals and the patients affected.

The original Allevyn dressing was developed using the latest dressing technology. It has a trilaminate structure comprising:

a non-adherent wound contact layer,

a soft and highly absorbent central layer

an outer film layer which is waterproof, and helps prevent bacterial contamination, while allowing the skin to breathe.

Its non-adherent qualities ensure that the dressing does not stick to the wound, which minimises disruption to the healing tissue when dressings are changed.

The high absorbency of Allevyn's patented foam structure means that dressing changes can be kept to a minimum. This is better for the wound healing process, more comfortable for the patient and the reduced number of dressing changes make it more cost-effective solution to the healthcare provider.

The family of Allevyn products addresses the needs of a wide variety of wounds. Deep wounds may be managed with a special 3 Dimensional dressing, Allevyn Cavity. Different shapes also provide effective application to difficult areas such as the heel. Allevyn Adhesive combines the exudate management of Allevyn with the adhesive properties of Op Site* film, thus offering a single product application where two were needed before.

The result is cleaner, easier management of those wounds which have traditionally proved difficult to care for, providing greater patient comfort and valuable savings in nursing time.

*Trademark of Smith & Nephew

http://www.healthpoint.com/content/tissue/tissue_panafil_prescrib.htm

Papain-Urea-Chlorophyllin Copper Complex Sodium

Description: Panafil® Ointment is an enzymatic debriding-healing ointment which contains standardized Papain, USP (not less than 521,700 USP units per gram of ointment), Urea USP 10% and Chlorophyllin Copper Complex Sodium 0.5% in a hydrophilic base composed of Purified Water, USP; Propylene Glycol, USP; White Petrolatum, USP; Stearyl Alcohol, NF; Polyoxyl 40 Stearate, NF; Sorbitan Monostearate, NF; Boric Acid, NF; Chlorobutanol (Anhydrous), NF as a preservative; Sodium Borate, NF.

Clinical Pharmacology: Papain, the proteolytic enzyme derived from the fruit of carica papaya, is a potent digestant of nonviable protein matter, but is harmless to viable tissue. It has the unique advantage of being active over a wide pH range, 3 to 12. Despite its recognized value as a digestive agent, papain is relatively ineffective when used alone as a debriding agent, primarily because it requires the presence of activators to exert its digestive function. Urea is combined with papain to provide two supplementary chemical actions: 1) to expose by solvent action the activators of papain (sulfhydryl groups) which are always present, but not necessarily accessible, in the nonviable tissue or debris of lesions, and 2) to denature the nonviable protein matter in lesions and thereby render it more susceptible to enzymatic digestion. In pharmacologic studies involving digestion of beef powder, Miller1 showed that the combination of papain and urea produced twice as much digestion as papain alone.

Chlorophyllin Copper Complex Sodium adds healing action to the cleansing action of the proteolytic papain-urea combination. The basic wound-healing properties of Chlorophyllin Copper Complex Sodium are promotion of healthy granulations, control of local inflammation and reduction of wound odors.2 Specifically, Chlorophyllin Copper Complex Sodium inhibits the hemagglutinating and inflammatory properties of protein degradation products in the wound, including the products of enzymatic digestion, thus providing an additional protective factor.1,3 The incorporation of Chlorophyllin Copper Complex Sodium in Panafil Ointment permits its continuous use for as long as desired to help produce and then maintain a clean wound base and to promote healing.

Indications and Uses: Panafil Ointment is suggested for treatment of acute and chronic lesions such as varicose, diabetic and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic or infected wounds.

Panafil Ointment is applied continuously throughout treatment of these conditions (1) for enzymatic debridement of necrotic tissue and liquefaction of fibrinous, purulent debris, (2) to keep the wound clean, and simultaneously (3) to promote normal healing.

Contraindications: None known.

Precautions: See Dosage and Administration. Not to be used in eyes.

Adverse Reactions: Panafil Ointment is generally well tolerated and nonirritating. A small percentage of patients may experience a transient "burning" sensation on application of the ointment. Occasionally, the profuse exudate resulting from enzymatic digestion may cause irritation. In such cases, more frequent changes of dressings until exudate diminishes will alleviate discomfort.

Dosage and Administration: Cleanse the wound with Allclenz® Wound Cleanser or saline. Avoid cleansing with hydrogen peroxide solution as it may inactivate the papain. Apply Panafil directly to the wound, cover with appropriate dressing, and secure into place. Note: Papain may also be inactivated by the salts of heavy metals such as lead, silver and mercury. Contact with medications containing these metals should be avoided. When practicable, daily or twice daily changes of dressings are preferred. Longer intervals between redressings (two or three days) have proved satisfactory, and Panafil Ointment may be applied under pressure dressings.

How Supplied: 30g tube

http://www.regranex.com/about/about_index.htm

REGRANEX is a prescription drug for the treatment of diabetic foot ulcers. It contains a factor normally found in the body (referred to as a platelet-derived growth factor), which is part of the body's natural healing process. Some wounds take a long time to heal and others may not heal at all. REGRANEX can help this problem in many patients by delivering the growth factor directly to the ulcer in a simple-to-use gel.

In order for REGRANEX to be effective, good wound care must be followed. Good wound care should include your doctor or healthcare provider removing dead skin from the wound, and keeping weight off your wound.

REGRANEX has not been studied in superficial diabetic foot ulcers. REGRANEX is contraindicated in patients with known neoplasms at the site of application. REGRANEX should not be used on wounds that are stitched or stapled. A small percentage of patients treated with REGRANEX or placebo gel experienced a rash near the wound. REGRANEX should not be used by patients sensitive to any components of this product.

Using REGRANEX the proper way, every day

Like all medication, REGRANEX must be used correctly for maximum effect. Follow this step-by-step guide to get the most from treatment with REGRANEX.

Wash hands thoroughly before applying REGRANEX

Before you apply REGRANEX, remove the dressing from the wound and rinse the wound gently with saline solution or water

Do not touch the tip of the tube to any surface. Use an application aid such as a cotton swab or a tongue depressor to apply it to the wound.

Apply a carefully measured quantity of REGRANEX to cover the wound in a thin, continuous layer (enough to cover the surface) as instructed by your doctor or healthcare professional. Do not apply a thick layer-it will not increase the effect of REGRANEX

After applying REGRANEX, dress the wound as instructed by your doctor or healthcare professional

Place a suitable size saline-moistened gauze on the wound. The moistened gauze should cover only the open wound and not come in direct contact with the surrounding intact skin. Only plain gauze should be used.

A small, dry pad dressing may be placed over the moistened gauze to prevent moisture in socks or shoes. Wrap a soft, dry gauze bandage over the pad to hold it in place and secure it with adhesive tape. Make sure that the adhesive side of the tape is secured onto the gauze and not to your skin

After bandaging, check to make sure that the bandage is secure enough so that it doesn't slip off, but not so tight as to be uncomfortable or hinder your circulation.

After 12 hours, remove the dressing and gently rinse the wound with saline solution or water. DO NOT APPLY ANY REGRANEX AT THIS TIME. Apply a new, moist dressing on the wound.

It is important that REGRANEX be correctly applied to the wound every day, until the wound has completely healed or your healthcare professional tells you to stop.

REGRANEX Gel contains becaplermin, a recombinant human platelet-derived growth factor (rhPDGF-BB) for topical administration.

REGRANEX Gel is a non-sterile, low bioburden, preserved, sodium carboxymethylcellulose-based (CMC) topical gel, containing the active ingredient becaplermin and the following inactive ingredients: sodium chloride, sodium acetate trihydrate, glacial acetic acid, water for injection, and methylparaben, propylparaben, and m-cresol as preservatives and l-lysine hydrochloride as a stabilizer. Each gram of REGRANEX Gel contains 100 µg of becaplermin.

REGRANEX Gel is indicated for the treatment of lower extremity diabetic neuropathic ulcers that extend into the subcutaneous tissue or beyond and have an adequate blood supply. When used as an adjunct to, and not a substitute for, good ulcer care practices including initial sharp debridement, pressure relief and infection control, REGRANEX Gel increases the incidence of complete healing of diabetic ulcers.

The efficacy of REGRANEX Gel for the treatment of diabetic neuropathic ulcers that do not extend through the dermis into subcutaneous tissue (Stage I or II, IAET staging classification) or ischemic diabetic ulcers has not been evaluated.

REGRANEX Gel is contraindicated in patients with:

known hypersensitivity to any component of this product (e.g., parabens)

known neoplasm(s) at the site(s) of application

Just thought I would collect some info on the products mentioned, some I know, some I don't. Enjoy.

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