Wound Care Question

Specialties Wound

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A little background first: My hubby had a pilonidal sinus and cyst excised in mid Feb. A few weeks ago was his last visit to the surgeon and he was healed to the point that it didn't require packing at all! Well, during the last week the wound has re-opened itself! We paid the surgeon a visit yesterday and he had to slice some tissue that was growing over the top.. he said it was already a reoccurance! Now we're back to packing BID. :rolleyes:

Anyways, we won't have the homecare nurse visit for another week and they sent me home with as many supplies as possible.. but while packing his wound this morning I noticed some things were missing. Main question is, is rubbing alcohol the same thing that's on those alcohol pads? I am just wiping the tips of tweezers.

For the packing before, we were using all kinds of stuff. First saline soaked gauze, then aquacel for a few weeks, then acticoat silver. The surgeon's nurse said to use saline soaked gauze but to wring it out really well, so that it was just damp. Our homecare nurse was really persistent on using the other things, which I told the surgeon's nurse about and she said not to. So if we get the same nurse and she is persistent about using the other stuff, is there a way I can politely tell her perhaps not?

Also, do you have any tips you can share about packing a wound like this? That would be great! Nursing school is only 3 years off in the future :chuckle

He doesn't mind the tape gwenith :) There actually is not much drainage. It doesn't even drain onto the folded 4x4.

Lysa what is a VAC system? Thanks!

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We use the VAC system often where I work but now that I look at the pictures, I realize that the wound isn't really that big and the VAC system in this case wouldn't be used. If you want to learn about vacumn assisted closure, go to http://www.kci1.com. By the way, we use maggots alot too for debridement. We have them sent to us from California. I remember the first time we used them, they all got loose out of the dressing that was on the knee...let's just say they made their way "up hill"!! Gross!!

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He doesn't mind the tape gwenith :) There actually is not much drainage. It doesn't even drain onto the folded 4x4.

Lysa what is a VAC system? Thanks!

As you have already noticed :rolleyes: , the aquacel turns into a gel after absorbing wound exudate - it is very absorbant and used for draining wounds. If you can tape the lower edge of the dressing and make an occlusive dressing, you could try leaving the dressing 2 or 3 days (if the aquacel is dry when you change the dressing, soak it off gently and consider another dressing type at that point).

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saline soaked gauze is really only appropriate if the goal is to apply a wet-to-dry dressing to debride a wound - rarely used nowadays since we have access to a plethora of superior dressings...

i agree with gwenith, your home-care nurse seems to know what she's doing; let her continue to evaluate the wound and change the treatment to suit the characteristics of the wound as the wound progresses. sounds if she is up-to-date on wound care practice (can't say the same for the surgeon's nurse) :imbar

also, do you have any tips you can share about packing a wound like this? that would be great! nursing school is only 3 years off in the future :chuckle

...never force a packing tightly into a wound, pack loosely.... :p

the latest research shows that normal saline dsgs. maintained in a moist clean environment is encouraged on pink viable wounds. antimicrobials are not even indicated if there are no signs of infection. saline should never be soaked. and yes, it is used as a w-d dsg for debridement, but we weren't talking about w-d in this case. again, if there is no slough/yellow tissue then maintaining a saline dsg in a moist environment (if there's not any copious amt of drainage) will definitely granulate and facilitate healing.

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saline should NEVER be soaked.

What exactly does that mean?

Thank you!! :)

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What exactly does that mean?

Thank you!! :)

sorry nat....saline should never be soaked then packed or applied. it should always be wrung out first, especially if it's going to be applied on a wound rather than in a wound. you don't want wound margins to get macerated.

leslie

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Aha! Okay I get it. Thanks very much! Yep I am wringing it out and it's being packed into the wound. I cover it with a dry 4x4 folded in half and then tape that to his butt. :chuckle

Also the inner packing has been sticking to the wound pretty badly, and I have been flushing it with saline before I pull it out with the forceps, but the other morning it was terrible! I flushed and pulled, flushed and pulled and it bled pretty bad after I got it off for a few mins. So because of that I have started using DuoDERM Hydroactive Gel inside the wound first, then I put the packing in. It seems to be helping with the sticking a lot but I wonder if it can hinder healing at all, anyone know?

Thanks for all the help everyone! His wound is getting smaller every day and we go back to the surgeon Tues.

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Specializes in LTC,Hospice/palliative care,acute care.
Aha! Okay I get it. Thanks very much! Yep I am wringing it out and it's being packed into the wound. I cover it with a dry 4x4 folded in half and then tape that to his butt. :chuckle

Also the inner packing has been sticking to the wound pretty badly, and I have been flushing it with saline before I pull it out with the forceps, but the other morning it was terrible! I flushed and pulled, flushed and pulled and it bled pretty bad after I got it off for a few mins. So because of that I have started using DuoDERM Hydroactive Gel inside the wound first, then I put the packing in. It seems to be helping with the sticking a lot but I wonder if it can hinder healing at all, anyone know?

Thanks for all the help everyone! His wound is getting smaller every day and we go back to the surgeon Tues.

http://www.pilonidal.org/ This is a great informative site-you will learn what causes the cyst,how best to prevent it from recurring and how wounds actually heal.....But always contact your doctor with any questions.....
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great photos

im a community nurse in england our patients have a shower before we arrive to remove the old dressing, we then lightly pack wounds with aquacel or aquacel ag, if it is deap we would use a gel like intrasite to help granulation, to protect the surrounding skin we would use something like cavilon which gives a barrier. then cover the wound with a waterproof dressing that is comto the patient. if the wound starts to look like it is over granulating then we would use a foam to flatten it. we never use gauze to pack wounds

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