Triamcinolone/Miconazole on an open wound!?!

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    Hey y'all. I'm new to the site, but I need some advice so bad. I'm currently a student, so please bare with me. At my clinical site I was doing wound care. The order called for a mix of triamcinalone acetonide and miconazole to be applied to the buttock, and covered with an ABD pad. When I pulled aside the patient's brief, I found that she had an open wound measuring about 2x2 cm, and there was also a skin tear about 2 cm below it. There appeared to be no sign of yeast or a fungal infection at all. Forgive me if I'm rambling or say something wrong. I'm frustrated. I would not put it on the wound. I could not bring myself to do it, and told the nurse that I didn't feel comfortable doing it.

    So my question: Can you even put triamcinalone and miconazole on an open wound? I've been looking online, and I found that you can't put nystatin and triamcinalone on an open wound. (which nystatin is in the same category as miconazole).

    It just doesn't make any sense to me. I would do one of three things. Please tell me what you think. (of course I would clean it first)
    1) Use a generous amount of calmoseptine on the affected area, and cover with a non-adhesive pad/gauze.
    2) Apply silvasorb to the wound, cover with telfa, and tape.
    or 3) cut out hydrocolloid that extends 1 cm beyond the wound, and cover with a transparent film/tape.

    Oh yeah, if you saw the wound, you would immediately think it was a stage two pressure ulcer, which it may have developed into due to skin friction. The peri-wound is blanchable though. So all of this info is my humble opinion. I'm just really concerned about her wound, and the tx that they're doing. Thanks in advance for any advice that y'all have.
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  3. 4 Comments so far...

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    Nevermind. I talked to the nurse about it. Turns out that they tried everything with the individual in the past, and for whatever reason, this treatment works. I'm still blown away.
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    I have seen in wound care that there are alot of things you would not expect to be used..I have even heard of bismuth and bourbon? go figure, never question MD unless you have MSN beside your name....you will be eaten..by them
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    Yeah. I'm figuring that out pretty fast. I wouldn't question the MD. It was a nurse that wrote the orders, and had them signed off.
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    if the patient is incontinent of b&b it could be dermatitis, that can look like a pressure sore. you need to treat the cause of the "wound" before it can heal. if it is a deep seated fungal infection it can take time to resolve. putting an occlusive dressing like a hydrocolloid/ tegaderm over the area keeps it warm, moist and dark, things that fungal/yeasts love to thrive in. usually using an antifungal cream 2 times a day rubbed in good till you cant feel the ointment or cream, followed by a barrier ointment works well in healing the "wound"


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