i really need help!! i am a nurse in a ltc facility that is responsible for measuring, documentating and caring for all of the wounds in the facility. i have this patient that was admitted about 3y ago. when he was admitted he had x 2 stage iv pu, one to l ischium and one to r ischium. he is approx 50 y/o, and has no use of his ble. well, we eventually were able to heal the pu to the l ischium by using a combo of e-stim (by pt) and hydrogel moistened guaze packing. it took awhile to heal, but it eventually did about 7 months ago. however; the pu to the r ischium remains. currently the trmt is to pack tunneling depth with hydrogel moistened guaze and cover with dry guaze qday. when comparing the measurements from jan 2009 to measurements from jan 2010, there was very little improvement. the wound measures 1.5 x 0.5 x 2.0cm. the tunneling depth measures 2.0cm and is to the lateral aspect of the wound. the wound base that is visible is a pale pink color. no exudate, no odor, no slough noted. 100% pink. i am at a standstill with this wound. i approached my don about possibly performing a wound culture and her response was, "oh they don't even recommend doing that anymore. all wounds will have bacteria". i also requested that the patient be sent to the wound clinic (about 45 min away, and we have used them before for other non-healing wounds. this pt has never been). but her response was, "oh his insurance won't pay for him to go (or transport)" - and the facility is unwilling to pick up the costs. the patient has the very best mattress & cushion for his scooter, is on a strick turning schedule, only gets up oob three times a week for 4h at the time, has a foley catheter, has had pt work with the wound on 2 separate occasions, takes supplements, labs drawn and all wnl r/t wound healing. i just don't know what else to do for this wound!!! other trmts we have tried are: wet to dry and silvercel. neither were successful. to all the wound professionals, your opinion/knowledge would be greatly appreciated!!! please help me with some ideas as to why this wound won't heal (and keep in mind, my don won't let me culture wound) and what other kinds of interventions or trmts could be successful. all knowledge is greatly appreciated!
post questions if you need to and i will answer if you need more information. i will check back often.