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.