Necrotic ulcer and Surgeon

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  1. This is a discussion on Necrotic ulcer and Surgeon in Wound / Ostomy / Continence Nursing, part of Nursing Specialties ... A pt was transferred to us with ulcers on both heels. One is a Stage Two with a lot of slough. The...

    by Sep 13, '10
    A pt was transferred to us with ulcers on both heels. One is a Stage Two with a lot of slough. The other has a hard eschar covering it. We asked the surgeon to r/v it as we thought it needed surgical debridement. His instructions were to use chlorhexidine/alcohol hand rub on both ulcers to dry them out.
    The nursing staff aren't comfortable with following these directions but worry about not doing so being a possible future reason for litigation.
    We don't have specialist wound care nurses.
    Thoughts?
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    by Darknights Sep 13, '10 8:00 pm
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  3. 2 Comments so far...

  4. Sep 15, '10 by
    It is best practice to leave hard, dry eschar on the heel alone. Because the heel bone is so close to the skin, opening up the eschar makes the heel more prone to osteomyelitis. It is of utmost importance to off-load the heels. The heel with the slough is another story, as it is already open.
    Chrissy Lou and annaedRN like this.
  5. Nov 21, '10 by
    I agree with the above post. Surgeon's orders were just "busy work", not going to make any difference whatsoever, just covering his ***. If this patient is a GOMER (sorry!), I would not open up a stable dry eschar.
    Chrissy Lou likes this.