sacral wound dressing help

  1. 0
    I have a pt. who has a pressure ulcer perhaps 3-5 mm above the anus. Anyone have suggestions as to how we can place a dressing here without it becoming full of stool? Pt. is inc. of both bowel and bladder. Any suggestions would be greatly appreciated as we are at our wit's end... We've tried comfeel in various shapes, blisterfilm over gauze, allevyn in different shapes.

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  2. 15 Comments...

  3. 0
    What is the stage, tissue type, length, width, depth, and status of the periulcer? More suggestions might come if we have some more specifics especially since this is such a hard sight to deal with a dressing. As you already know. Look forward from hearing from you.
  4. 0
    As bird2 said, its hard to answer that without knowing much about the bed sore itself. Does your facility have a wound care team?

    Many times it just comes down to frequent dressing checks/changes. You may try using a rectal bag to corral the poop (heh) and keep the wound dry...although the bags don't usually stick all that well, and if the patient is alert, the bags can be pretty embarrassing and uncomfortable. We use duoderms very frequently, and we reinforce the edges (esp the one that is next to the anus) with tegaderms as needed. It probably wouldn't be a bad idea to use a protective barrier cream around the dressing to help prevent additional breakdown. The best thing to do though is to turn turn turn and check it often. Keep it clean and keep it dry!! It gets tedious, esp when you end up having to do it hourly. Ugh!! But it's the best thing that can be done.

    Pressure ulcers are a pain in the butt!! Literally!
  5. 0
    It's about 3.5 cm round, stage 2 about .3 cm depth. We've got some new tissue growth around the edges, but the center has developed an area of black eschar. The idea of a collection bag has been tossed around, but there's no place to attach it, the wound is literally right next to the anal opening.
  6. 0
    Quote from lpn1313
    It's about 3.5 cm round, stage 2 about .3 cm depth. We've got some new tissue growth around the edges, but the center has developed an area of black eschar. The idea of a collection bag has been tossed around, but there's no place to attach it, the wound is literally right next to the anal opening.
    Do you have access to a certified wound care nurse? That alone would be very helpful. It sounds like the eschar needs debridement. Maybe Accuzyme to the eschar and a zinc based ointment on the periulcer to keep drainage off of the area. Since it wound need to be changed so often maybe you should think about just gauze for now.. Once the wound bed is fully granulated then I would consider Xenaderm. BUT my gut feeling is this ulcer really, really needs a certified wound care specialist involved. The way you describe the ulcer it could be fast approaching a stage 3. Check with you local hospital (I'm assuming that you work in LTC??) they usually have nurses that specialize in this area. Good luck.
  7. 0
    Quote from lpn1313
    I have a pt. who has a pressure ulcer perhaps 3-5 mm above the anus. Anyone have suggestions as to how we can place a dressing here without it becoming full of stool? Pt. is inc. of both bowel and bladder. Any suggestions would be greatly appreciated as we are at our wit's end... We've tried comfeel in various shapes, blisterfilm over gauze, allevyn in different shapes.
    The fact that it has developed eschar probably means that you are not keeping it as moist as would be best. Which simply means that the dressing is not occlusive enough or not staying in place, no news there!

    MOST IMPORTANT!!!!! is are you relieving the pressure? Nothing you do will help if you don't. Either keep her off her side or get her an air mattress...and if you have her on an air mattress, don't use the cloth incontinent pads. Use a single layer of sheet and either a diaper or chux under her. We did a study in my hospital and those cloth pads (which I loved when I was on the floor) caused pressure ulcers even on an air mattress. Once we got rid of them, our p/u incidence went way down.
    As for the wound treatment, duoderm is good and the eschar will debride if you can keep it covered. The thin duoderm conforms better than the thick. I like to seal the bottom end with a clear film dressing. The trick is to be sure the skin near the anus is ABSOLUTELY DRY and to stretch the skin while you are applying the dressing so that the dressing sort of folds into the crease when you release it. Another trick that may work for you is to edge the thin duoderm with papertape rather than plastic film. Then wipe it with alcohol and let it dry before releasing your hold on the skin, kind of stroking it into the skin while it dries. I think it is the 3M product (?microderm?) that is formulated especially for adhesion in moist areas.
    However, if the wound has very much drainage, duoderm will not work well by itself. Try a Calcium Alginate dressing under it for increased absorption or retry the Allevyn with the adhesive edge but use the technique of being sure the skin is dry and stretching it while applying the dressing.
    Another option is to just try to keep the area moist and protected with a thick ointment..especially if she wears a diaper. Just cleanse the area and reapply the ointment with each diaper change. Ilex is one that is very sticky (although it also sticks to the diaper). Calmoseptine is another, or Desitin. What you want is an occlusive moisture barrier ointment.
    Unless your patient is immunocompromised, I would not worry too much about contamination of the wound, odd as that sounds. If you can truly get the pressure off and keep the wound moist, that alone will go a long way to letting the wound heal. If the wound edges are starting to show signs of healing, your patient obviously can heal and those two steps may be enough.
    Good Luck
  8. 0
    Quote from lpn1313
    I have a pt. who has a pressure ulcer perhaps 3-5 mm above the anus. Anyone have suggestions as to how we can place a dressing here without it becoming full of stool? Pt. is inc. of both bowel and bladder. Any suggestions would be greatly appreciated as we are at our wit's end... We've tried comfeel in various shapes, blisterfilm over gauze, allevyn in different shapes.
    Rereading my reply I said "keeping her off her side." I meant "keeping her off her coccyx!') Sorry.
  9. 0
    I remember using an ointment called Ilex that worked wonders for a clean stage II. It was a thick barrier that you could apply zinc oxide over it as a top coat. Anyone use this?
  10. 0
    Quote from lpn1313
    I have a pt. who has a pressure ulcer perhaps 3-5 mm above the anus. Anyone have suggestions as to how we can place a dressing here without it becoming full of stool? Pt. is inc. of both bowel and bladder. Any suggestions would be greatly appreciated as we are at our wit's end... We've tried comfeel in various shapes, blisterfilm over gauze, allevyn in different shapes.
    I would suggest revisiting the allevyn sacrum, being sure to use skin prep making sure it is dry before applying the bordered allevyn. Start at the bottom to ensure you do not have gaps near the anus. Fold and smooth from the center of the dressing. Allevyn can be cleaned from the surface and not changed unless breached. Have you considered using acticoat as an antimicrobial barrier. It will help to prevent further contamination to the wound and allow for an enviorment conducive to healing.
  11. 0
    Hi, it sounds like one of those difficult spots to keep covered.

    We use Friars balsam around (not on) the wound. It is so sticky that the duoderm sticks so much better.

    One thing that seems to get missed... is there adequate protien in their diet?


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