venous stasis ulcer...it doesnt look like its healing

[chenoaspirit, ASN, RN]

I also posted this in Home Health, but thought the wound experts may have some advice.

I accepted this patient in the middle of her treatment. She has refused UNNA boots and the nurse had been applying polymem, changing q 5-7 days. Well, it had drainage when I first started seeing her, now its a hard/dry scab. Im still applying the polymem, but I am wondering now if its the correct treatment. Should the wound have this scab? Is that a good thing? It has gotten smaller, but the last measurement showed that it had gotten .1 cm longer, but had gotten narrower. What type of treatments are there for venous stasis ulcers, besides compression. This patient refuses compression. I plan to call the doc, but he is the type who depends on us nurses to decide the wound care. Any advice would be greatly appreciated, before I call the doc. Thanks in advance.

[morte, LPN, LVN]

why is the patient refusing compression?

[chenoaspirit, ASN, RN]

I dont know. The only thing she says is "it hurts and I dont like it". I tried to convince her, but it was a no go.

[morte, LPN, LVN]

perhaps some one wrapped too tightly at one time?......hope she likes the amp. better......

[LPN-WCC]

Is it a scab or eschar?

[certwndnrs]

Are you sure this wound doesn't have an arterial component?

[chenoaspirit, ASN, RN]

I dont know. I called the doc who wants her to go to the vascular md. she refuses this also. I just dont know what type of dressing to apply to this. The polymem is drying it out. It worked great with the drainage, but now she has no drainage.

Any advice would be great. It isnt eschar, it is a scab. I called the wound specialist for advice, but all she would tell me is "I need to see it" but this isnt an option. She wont do it. She expects me to just do what needs to be done.

[certwndnrs]

Ok, Stop the foam dressing. Try an old school duoderm so the scab can gel up. You may see some maceration for a little while but that'll have to be ok for now.

[chenoaspirit, ASN, RN]

Thank you so much. Maybe I can "border" the edges with a transparent? to keep from macerating it? I will try the duoderm.

[tencat]

As to your wound expert needing to see it....could you take a photo of it on your cell phone and send it to him/her?

[chenoaspirit, ASN, RN]

hey, thats an idea! I never thought of that! Great idea!!!!!!!! Thanks!!!!!!