I am a PROUD hospice nurse with a Pt I need to desperatly help! I have conversed with so many knowledgable wound nurses on this forum, I just had to post a thread to see if anyone could help. Here's the scoop:
Mr. J is a hospice Pt, admitted for esophageal cancer. He has a large tumor related wound to his L lateral neck. Measures approximately 9 x 7cm with some tunneling depth to the center of the wound which measures approx 3cm. The tunneling depth comes and goes, as it is usually covered with a clot. HOWEVER, recently we have had some major issues with this area. Because of the location of the wound, the Pt and his CG's have to be extremly careful when providing care. We have had 2 epsiodes in the last week where the dressing was "snatched" off, causing the Pt to hemorrhage. Saying it made a bloody mess is an understatment. Currently we are using a calcium alignate dressing, covered by an ABD pad. Just a few days ago, I instructed the family to moisten the alignate before applying to the wound bed. I did this because, although this wound is a heavily exudating wound, the dressing seems to be getting snatched off before the alignate can gel, causing the Pt to hemorrhage. I just don't know how many more epsiodes of hemorrhaging my Pt can take. He is already very weak. I have done some research on my own, and was wondering about a haemostatic dressing. Has anybody ever had any experience with a wound such as the one my dear Pt has had to suffer with? Of course, he is a hospice Pt, and comfort measures are our priority. But, at the same time, if there is ANYTHING I could do (dressing) to reduce these hemorrhaging epsiodes, I would be delighted. Anothor problem is the Pt does not like having tape over his trachea. Of course, he cannot swallow. He has a peg tube, and has oral suctioning equipment on his bed so he can suction all oral secretions. We had some issues with his tongue swelling, but I finally got that under control with some good ole' Decadron. I was wondering if there was an alternative to securing the dressing.....
I appreciate ANY and ALL feedback................Thanks in advance........
Oct 15, '11
I am going to bump myself, hope nobody minds.....
Oct 15, '11
Ca Alginate is definitely a good hemostatic dressing, but I understand what you mean by the dressing being torn off before it alginate gels. One thing that may help is using a silver alginate or putting silvergel on plain ca alg (I've found this to have a hemostatic effect). Additionally, after debridement in clinic if a pt continues to bleed I'll soak ca alg with lumicain and that typically works very well. I'm not sure what you have access to as far as secondary dressings, but you may try a dressing like a plain bordered foam dressing (edges usually are tegaderm-like and stick well to articulating areas such as the neck/arm/hips, and be sure to use plenty of skin prep---hope that helps.
Oct 17, '11
very gently pack with iodoform, cover wound with medihoney then wipe around area with a skin prep and cover with an opsite
Oct 22, '11
can you put some vaseline gauze over the base of the wound, then pack with the calcium alginate?