wound care

Rand · May 30, 2002

Hi Gilda,

No, I don't think changing a dressing twice or three times daily is beneficial to a wound. I prefer extended wear dressings for the benefits of occlusion that I described in an earlier post. And again, I don't want chronic wounds that I am treating to dry out.

Diabetic neuropathy is not, in my opinion an etiology of a wound, rather it is a co-factor. Neuropathy doesn't directly cause ulcers. Generally, it is the lack of sensation that causes the individual to lose the protective mechanism from tissue injury. A diabetic who can't feel their foot might wear poorly fitting shoes or possibly step on a sharp object and not know it. If the feet aren't examined daily, then a sore can develop without the person knowing it.

Are you sure this amputee isn't putting pressure on the affected part of the foot? Whether while in bed or in a wheelchair? Perhaps they have poorly fitting footwear. If so, then pressure relief (off loading) is absolutely necessary for wound resolution.

By the way. There are numerous web sites available for good information on wound care. I created one 2 years ago that I am planning a redesign for in the coming months. Have a look at this "links page" of WoundTx.com.

Regards,

Rand

shygirl · May 30, 2002

Hello Rand,

I know for a fact that this resident does not put pressure on the affected area, nor does she wear ill fitting shoes. She is my patient in a nursing home. Maybe diabetic neuropathy is not the only "co-factor", maybe it's that she is immunocompromised. She is hyperglycemic and hyperglycemia impairs the ability of specialized leukocytes to destroy bacteria. Thus, maybe it is an ongoing infection. It somehow must not be trackable as her labs are not off. Thanks for all the advise! I checked out your site, it is really awesome. Now I don't have to waste allnurses.com's space to find answers to wound care......Gilda

bandaidexpert, BSN, RN · May 30, 2002

Hi gilda. have you tried Biafine WDE? I have incorporated this in our wound protocols, this is great stuff. Change the dressing daily and ensure complete pressure relief. The directions for applying want you to cover wound with moist gauze, however, I have found it is more effective if you cover with dry dressing.

Rand · May 30, 2002

Hi Gilda,

Thanks for having a look at my site, but I'd encourage you to continue posting here at allnurses.com. We all want traffic and interesting folks like yourself talking shop (discussing wound care), but I don't want to reduce participation on this forum. In fact, I plan on coming back here as well. If you spend some time searching my site or a general search on the web, you'll find other wound care discussions on several web sites.

So, not to belabor this little nursing home resident's wound on her foot, but since there isn't a pressure component influencing the lack of healing, what do you think was the initial cause of the injury?

Regards,

Rand

PS Don't mean to keep you on this topic. I'll happily drop the discussion if you've had enough :)

Rand · May 30, 2002

Hi Bandaid,

Have the makers of Biafine ever produced any explaination as to their product's efficacy? A while ago I heard it had something to do with onions. I also remember a rep telling me they didn't know why it worked... Not really what I wanted to hear in the current climate of evidenced based medicine.

Still, if it's relatively safe and cost effective, might be worth a try and evaluate for a clinical response. I know the plastics folks liked using it on burns. Radiation exposure isn't it?

Regards,

Rand

shygirl · May 31, 2002

Hey bandaidexpert,

I have never heard of Biafine WDE. What is it?

shygirl · May 31, 2002

Hello Rand,

I do not know the initial cause of the wound. She came to us 3 years ago with the one leg remaining. I will still come here to discuss "stuff", but I need to learn more on wound care in general....so I am also going to go to your site! Thanks, Gilda

P.S. I am never tired of talking:nurse:

Are you an MD? You are very intelligent!

shygirl · May 31, 2002

:chair: I have to add to that in case anyone else is reading this. Sorry, I know that MD's are not the only intelligent people out there. But Rand knows alot of info....

Rand · May 31, 2002

Hi Gilda,

It seems like I know what I'm talking about huh?!

Fooled ya.

Kidding...

I've been an RN since the 80's. Lived awhile before that... love to tell people about learning to wrap legs, (ie, venous compression wraps) on a (thoroughbred race) horse farm. Went to nursing school to be able to apply to a PA program. Finished physician assistant training in '95. Certified in surgery and primary care. Worked in family medicine, ER, did some research (cardiology) then decided I wanted to specialize. Always loved wound care. Began as a nurse in acute rehab, saw some wounds... then a lot more in home health.

As a PA, studied with Barbara Bates-Jensen at USC in California and went to work for a Curative managed outpatient center associated with a well respected burn center. Been "on my own" as much as a PA can... Working primarily in SNF's. Now that NP's, CNS's and PA's can bill Medicare, there are excellent opportunities for us in wound care.

Hey, thanks for indulging me... probably more of an answer then you were expecting. Actually, growing up my friends would call it Randling when I'd go on and on and on... like on answering machines or even in conversation... guess I even do it here.

All the best!

Rand

bandaidexpert, BSN, RN · Jun 1, 2002

gilda, it is amazing stuff, I have healed Stage III pressure areas on heels and butts in less than 2 weeks. It is a wound dressing emulsion(WDE). It is a water base. And to Rand: I don't care if it has rutabegas in it, it works. Yes, there are 2 types of Biafine, one for radiation burns as well. It is FDA approved, unlike Amerigel, which works well too. Medix Pharmaceuticals makes it. The main ingredient in Biafine is liquid paraffin. It seals the wound providing the moist healing environment needed to promote healing. I have been in wound care for 15 years and I am a firm believer in this product. It is cost effective too, our facility spends about 3 bucks a day on a QD treatment. Try it!!!!!

shygirl · Jun 1, 2002

Hey Bandaidexpert,

How much does it cost? if it is resonable, I might get our wound care specialist to go for it? You never know.

Thanks,Gilda

shygirl · Jun 1, 2002

Rand,

How cute is that? Randling? As in Randling on and on.....

P.S. You do know what you're talking about!

Gilda