Treatment of Sacral Pressure Sore With Possible Underlying Sinus

[delbry]

Hi everyone,

I work in an aged care facility in Australia. I am currently working in High Care and I have a problem with a dependant patient.

She developed a bed sore on her coccyz approximatly 2cm above her orifice. She is in her 60's and is approx 130kg (286lbs) The pressure sore is currently 3cm long with a width of 1cm, there is no depth as yet. The sore excrites fluids & puss and has an extremly strong odour which is actually enough to turn my stomach (hard to do!!)

The surface of the sore is shiny, red and inflamed and is starting to break down. The sore appears to have an underlying sinus that is yet to break through the surface of the wound.

The skin surface is extremly sore to touch and causes the resident allot of pain & discomfort. We use an air flow matress on her bed at all times on a medium setting & we reposition every 2hrs.

She wears continence pads at all times although we do toilet her throughout the day. She is often incontinent of urine & faeces and often has light anal leakage between changes if she passes wind or coughs. Her stools are dark green/black in colour and have a loose, tar like consistency. She is an inculine dependant diabetic.

We have used alginate directly over the wound and have packed combine secured with micropore between the cheeks of her buttocks in an attempt to keep the area as clean as possible however we are not having any sucess as the wound continues to break down. We have also tried other methods like solosite gel but have had no sucess.

We are at the point now where we need some seroious action to be taken. We dont have time for a trial and error period as this wound has developed in less than 3 weeks.

Any ideas, sugestions or advice would be appreciated.

ETA: Just realised I wrote Sacral in the title- woops!

[nightmare, RN]

My first thought would be ,get rid of the incontinence pads and use flat 60x60 incontinence sheets instead to keep the urine and faeces away from the wound.Does she have sugar in her urine?This would provide a great food source for bacteria.Let the area dry if possible,again natural drying can kill off some bacterias.It's probably considered old-fashioned but I have stopped more that one serious pressure sore by doing this.Could she be catheterised for a short term until the wound is under control?

Why are her stools green/black BTW? presumably an underlying condition which is probably compromising her healing ability as well.

[delbry]

My first thought would be ,get rid of the incontinence pads and use flat 60x60 incontinence sheets instead to keep the urine and faeces away from the wound.Does she have sugar in her urine?This would provide a great food source for bacteria.Let the area dry if possible,again natural drying can kill off some bacterias.It's probably considered old-fashioned but I have stopped more that one serious pressure sore by doing this.Could she be catheterised for a short term until the wound is under control?

Why are her stools green/black BTW? presumably an underlying condition which is probably compromising her healing ability as well.

Some very good sugestions, thanks! I will put them to my co-workers on my next shift.

In regards to her stools, Im not exactly sure why they are green/black..... To be perfectly honest, Im not even sure that they have looked into it.

I work for a very large company that owns hundreds of facility's through out Australia and we have major staffing and funding issues to deal with. Its frustrating to say the least.

[nightmare, RN]

Green/black tarry stools sounds like blood in the stools or it could just be iron tablets but if she is at all debilitated then this will slow down any healing process.

[oldiebutgoodie, RN]

Could she have an abscess there? In which case, the wound won't heal until the abscess is drained.

Does she sit in a chair a lot? I see coccyx wounds when patients are stuck in a chair and stay there all day long. A seat cushion, such as the EHOB Waffle Cushion, could be helpful for this lady.

Can you get a surgical consult for the wound? If it is draining, with purulent discharge, and possible sinus tract, this indicates abscess or other infection. If it continued, pt could get osteo in the underlying bone.

Good luck,

Oldiebutgoodie

[gettingupthere]

Had a patient like that years back, ended up with a fissure into the rectum. Not nice, after many months of fooling with it, she ended up with a colostomy! Actually sounds very similar as I recall it!