thoughts on the best protective seal

[bebop1]

we are having a debate on which is the best skin protectant to use. I was wanting the thoughts of other nurses too!

what is under everyone elses cases that you seem to get the best satisfaction from skin protectant? wether you are using it to just plain old proctect the skin from exudate, using it with an ostomy, or I am having trouble finding a good one to use under the drape of a wound vac. which is the best for a wound vac?

all and any advice would be great........

and what is the best one that medicare will cover for the ostomy also....

thanks!!!!

[RN1989]

Benzoin works well in the right conditions. For excoriated/yeasty skin under the drape, we've used nystatin powder on the bad skin, put a telfa on top of that, then put the drape on so that it covers a larger area and holds everything in place. Really hard to give a good one-thing-fixes-all since it really depends on what the problem is and how the pt's skin is reacting.

[bebop1]

Thanks. I have never done that. I have used cavilon under the drape with a wound vac on one patient. and it seems to works well. but the wound is right by the rectum. so by the time I go to change the wound vac again, the seal is almost broken because of the cleaning of the bowel movments the patient is having? any suggestions? on how to get a better seal here? or am I doing ok?

[annaedRN, RN]

I too have used the antifungal powder and sealed that with skin prep. Then placed the VAC drape - sometimes using a few smaller pieces works better than a larger piece. You can also then use skin prep on the drape, especially at the edges to help get a good seal. A wound in the gluteal fold area is never a fun one to get anything to stick to:banghead:

[bebop1]

so which fungul powder do you use? so you clean the area, put the powder, then the tegaderm, then the drap on top of all of that? and that doesn't cause any maceration under the drap from being too "hot" under all that tap because of the powder then?

thanks.

emily

[annaedRN, RN]

Cleanse skin, pat dry, apply Microguard antifungal powder, seal with skin prep (pads or spray), then place VAC drape around wound (window pane it) then place granu- or vers-foam in wound then cover with VAC drape to seal (you could use the skin prep at edges of "window pane" drape before applying this piece of drape if you needed it). Usually place hole (atleast 2cm round) over sponge in wound then often bridge atleast 4-5 cm away. Place trac pad on bridged sponge- making sure that sponge covers entire center of trac pad. Usually find that it seals better if a small piece of VAC drape then covers the trac pad too - just cover lightly though. If too much drape is applied it loses its permeability. No problems with maceration if both antifungal powder and skin prep is used. Hope this helps some!

[RN1989]

I have used pieces of Allevyn thin to cover the edge of the clear drape and go onto the skin. Duoderm thin would probably work as well. It's flexible, but it helps to protect that edge of the drape so that it isn't pulled up when they wipe against it. I also find that using the Allevyn helps when you can't seem to get a seal and you have one tiny airleak that is driving you nuts!

[bella2010]

We use Mastisol liquid adhesive and it has worked wonders. It is a skin barrier and adhesive in one. Our seals on our drapes never break