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- Jul 25, '02 by adrienurseMepilex? Mepitel? All the brands from molynike (Í know spelling is very wrong) start with Me...
I 've seen Enterostomal Nurses use powders like that for a patient with a very challenging stoma with +++loose stool. Dried it up real fast into a gel. Maybe it was a product originally meant for that? Could be wrong.Last edit by adrienurse on Jul 25, '02
- Jul 27, '02 by hoolahanhttp://woundcare.org/newsvol2n2/pr1.htm
I found it!! It is multidex gel, and also comes in a powder form. This stuff looks like the ticket adri!! It was a lot to cut-n-paste, and had lots of pics that I didn't think would come out, but are worth a look-see, some amazing healing w this stuff. Check it out!!
- Jul 28, '02 by RandHi,
Nice discussion. I'm always so happy to find people who like to talk shop.
There's a lot of good advice here, but in a (hopefully) brief post, I'd like to add a few things.
First off to echo a few others comments... It might be best to focus less on the wound dressing and look to identify why this woman's wound isn't healing.
hemoglobin/hematocrit greater then, say.. 12/35
hemoglobin A1c less then ~ 7.5
albumin greater then 3.2
prealbumin greater than 20
weight gain versus loss
Consistent adequate pressure relief. Research (Ferrill/Osterweil) has shown that beds have little affect on healing stage IV wounds. Turning the individual side to side (24 hours a day) would ensure pressure relief to a sacral wound.
If bone is exposed, some would argue that there is osteomylitis. Infected bone will delay healing.
There has been significant research lately on the healing process and the wound enviroment. Things like biofilms, MMP's and prolonged inflammation are now leading to new treatment modalities.
Having said that, I agree with what's already been said. For a 90 year old requiring palliative care, keep it simple and comfortable. In the meantime, don't lose interest in curing, best though, find the cause.
Just like the old story about the person hiking along a riverbank... see's someone drowning, floating down the river. The hiker rescues the suffering individual by extending a tree branch into the water. The hiker then proceeds along then river until they spot someone else drowning! They quickly use another tree branch to rescue the person. This occurs one more time until FINALLY, the hiker decides to go upstream and find out why people are falling in the river.
All the best.
- Jul 28, '02 by adrienurseHad another CNS in to look at wound. Suggested trial of flagyl/hydrogel to wound base -- perhaps wound is bordering on infection verses being clean. Tunnelling seems to be getting deeper. Will update you on results.
- Aug 1, '02 by RandHope I didn't squelch the discussion...
- Aug 1, '02 by hoolahanNope, I don't think so, sometimes they just die off, but we'll wait and see what adri said is happening now....
Stick around Rand. The specialty forums wax and wane like this.
- Aug 2, '02 by adrienurseUPDATE!!!
Finished course of flagyl. Looking good. Allevyn did not seem to be agreeing with the periwound area. Have decided with my buddy CNS to return to the basics and try something low-tec. New regime. Pack wound base and undermining loosely with saline and hydrogel soaked guaze (4X4), cover with ABD pad. Fix in to place with 2, 10 X 28 opsites. Change OD PRN.
My little ladies wound is all cleaned up! It looks fabulous. Tunnelling is still present but wound base suddenly looks like its granulating. WooHoo!
Good, I'm really sick of having to justify the $$ spent on this poor little thing to my boss.
- Aug 2, '02 by adrienurseP.S. Sorry Rand, I wasn't ignoring you. I read your post and agree. I have been a big advocate (well that's not quite what they call me :P) for having this lady turned side-to-side q2h.
Although because of her status, we don't subject her to a lot of bloodwork. I am certain that her albumen level has really improved since adding a powdered protein supplement to her diet. She does love to eat and gets a lot of pleasure from it.
- Aug 11, '02 by adrienurseWound is granulating. Imagine! This is a wound that has been there since 1999. The most lo-tech solution is working. Did I ever mention that in my last job, we healed a stage IV ulcer using only guaze, hydrogel and hypafix.
- Aug 11, '02 by NRSKarenRNGood for you Adrienne!
Great comment Rand:
"It might be best to focus less on the wound dressing and look to identify why this woman's wound isn't healing".
Clear up infection, fungal growth, consistent approach, loosely pack, low tech--voila they are healed!
LOVE Hydrogel (if not draining a lot0!