Help Needed to treat wounds effectively

[KimRN41514]

We are seeing more and more venous stasis ulcers and diabetic ulcers at our rural hospital. Unfortunately, we don't have a Wound Care nurse. We have protocols for decubitus ulcer treatments. Does anyone have any wound care protocols that they would share? Thank you!

[cookie102]

UNNA boots tend to work really well on venous stasis ulcer, just make sure with MD that is ok to use some compression.

[EHRN]

We are seeing more and more venous stasis ulcers and diabetic ulcers at our rural hospital. Unfortunately, we don't have a Wound Care nurse. We have protocols for decubitus ulcer treatments. Does anyone have any wound care protocols that they would share? Thank you!

I agree, Unna boots are very effective, but if not applied correctly, can cause more damage. For venous ulcers, try Silvadene to wounds daily, cover with 4x4's and secure with Kerlix or rolled gauze. Encourage pt to keep legs elevated at or above level of heart as much as possible. If the wounds have heavy drainage, try using Aquacel over the silvadene and before the 4x4's. You can also use Silvadene on diabetic ulcers, but Iodasorb can be more effective. Hope this helps...

[KimRN41514]

We have used Unna boots in the past. Should be no problem getting them stocked again. We currently use Convatec products for wound care and have seen good results with pressure ulcers. Thank you so much for your suggestions :)

[loveawound]

Ive Used Unna Boots In The Past And Loved Them, But A Bad Experience Has Me Very Cautious Now. A Unna Boot Was Applied To A Pt With Stasis Ulcers And Weeping Edema, When I Removed The Unna Boot The Pt Skin Peeled Off As Well

[oldiebutgoodie, RN]

I just went to a seminar by 3M, who have developed a short-stretch bandage system to provide compression:

http://solutions.3m.com/wps/portal/3M/en_US/SH/SkinHealth/solutions/skin-wound-care/venous-ulcers/coban2/

It is 2 layer Coban, and apparently, the Coban is the brand name, not the same as the stuff we use as a self adherent wrap. It apparently stays up really well, is easy to apply.

Oldiebutgoodie

[RN1989]

The staff needs to be fully educated and checked off on competencies to use unnas boots and compression wraps such as Profore. The doctors also need to be fully educated on their use. It is dangerous to use compression without someone who knows what they are doing. It does not sound like your facility is set up for that kind of responsibility.

Unnas boots and profores are also quite expensive. Using them as part of a "protocol" without oversight from someone is not only dangerous but you will likely rack up a large expense that the facility will not be reimbursed for.

Stasis and diabetic ulcers need specialized care for safety as well as reimbursement. There is so much more that goes into wound care besides slapping a particular dressing on.

I would suggest that you work with your facility to get an experienced wound care doc or WOCN to do per diem work to ensure that things are done safely and efficiently.

[FranNHRN]

Patients need to have their circulation checked in their lower extremities prior to applying unna boots. Applying unna boots on someone with poor circulation could be dangerous.

[Codypatody, BSN, RN]

Also, Unna boots should only be used on patients who are ambulatory. If they are not ambulatory, then compression should be used. You should also check a patient's ABI prior to applying any sort of compression.

I agree with a previous post to refer to a wound care nurse or wound care clinic.

[lsyorke, RN]

I just went to a seminar by 3M, who have developed a short-stretch bandage system to provide compression:

http://solutions.3m.com/wps/portal/3M/en_US/SH/SkinHealth/solutions/skin-wound-care/venous-ulcers/coban2/

It is 2 layer Coban, and apparently, the Coban is the brand name, not the same as the stuff we use as a self adherent wrap. It apparently stays up really well, is easy to apply.

Oldiebutgoodie

We use ALOT of these....awesome product! The part patients like the best is that the first layer doesn't cover the heel, so they can get shoes on.

[JDunno]

Their site is ugly, but check out OJMedtech.com. They specialize in lymphedema treatement and woundcare . They work with hospitals and Dr's to supply the patients with everything needed to treat the patients wounds. Call them and ask about it.

[sonjamontg]

We too use the Coban 2 layer wraps if the patients ABI is good. (greater than 0.8). We have the patient come back in two days after their first application to make sure things are going well and there are no new problems. We cut the 2 layer off and reapply. Very easy to apply. Might tell the patient to keep a pair of nylons handy at night to keep the sheets from sticking to the coban layer.