Care of Pressure area to heels

[litbitblack, ASN, RN]

I have a resident who broke her hip, went to the hospital for a week for surgery ect and returned with pressure areas to bilat. heels. They are dark purple and one had a blister that resolved. It has been a month and they remain although the areas have gotten slightly smaller. Both heels now have small boggy centers with the surrounding area being hard. Tx consist of elevating heels and tegaderm to both areas changed every 5 days and prn. Is there something different I can do to facilitate the healing process. We have not done a nutrition consult yet or labwork ect. Thanks for any suggestions.

[chrisrn24]

We use those skin prep wipes BID on heel sores, maybe worth a try for you?

[nurseprnRN, BSN, RN]

What are you waiting for on the nutrition labs and wound care consult? Get those asap so you can be sure this poor woman has adequate protein levels to support healing and gets the best care for those heels. Sounds like they might need debridement and special dressing routine, not just Tegaderm . Relieving pressure is always a good idea but won't help in healing if the wounds aren't dealt with first. These aren't just "sores."

And you might also consider sending a pointed note to the hospital risk manager about this. This is completely unacceptable and the RM dept would want to know.

[BrandonLPN, LPN]

Sounds like there's bad stuff going on there, like undermining or something. A physician who specializes in wound care should be consulted.

[loriangel14, RN]

At my work place we don't cover heels like that. It makes them more boggy and mucky. We elevate and leave open to the air.

[amoLucia]

And we avoid shoes.

[SwansonRN]

Just learned today that if the patient is going to be immobile for more than 8 hrs the recommendation is to use a heel suspension device as opposed to just pillows for prevention.

You need a nutrition consult...like yesterday. Optimize her nutrition ASAP so her body has the fuel to heal (no pun intended). Also I can't think of anything therapeutic about putting tegaderms on PUs.

[Nascar nurse, ASN, RN]

Skin prep those heels, off load pressure, no shoes, multivitamin & nutritional supplements. DO NOT debrid a deep tissue wound on the heel that is not open. This will likely make the situation much worse!

[Nascar nurse, ASN, RN]

How To Handle Black Eschar Formation | Podiatry Today

Dr. Hadi adds that when eschar is solely caused by an area of pressure (such as a heel pressure ulcer), it is strictly due to focal pressure necrosis. She says you can often offload these areas and the eschar will slough in time, leaving behind an epithelialized region, which avoids the creation of an ulcer.

Ask the Wound Coach

[h=3]What do you all recommend for black heels if the wound is dry and intact?[/h] Treatment options for intact stable eschar:provide pressure reduction (elevate calves on pillows in bed) along with topical options: wrap the heel in dry gauze ,or paint with betadine or liquid barrier film (e.g. 3M Cavilon No Sting Barrier Film or Skin Prep Smith & Nephew ). Current standard of care guidelines, recommend that stable intact (dry, adherent, intact without erythema or fluctuance) eschar on the heels should not be removed. The reason: blood flow in the tissue under the eschar is virtually non-existent, therefore the wound is susceptible to infection with limited to no ability to fight off invading bacteria. The eschar acts as a natural barrier to infection, keeping the bacteria from entering the wound. However, should the eschar become unstable (wet, draining, loose, boggy, edematous, red) the eschar should be debrided.

**In my experience, skin prep will usually clear up the "boggyness" **

[amoLucia]

Anybody else remember the old standby - granulex spray? Is it still out there? Would something like this help?

[SubSippi]

Would SCDs help to promote circulation?

[Nurse Leigh]

Not sure how it works in LTC as far as purchasing resident specific equipment - (if Medicare won't cover even if rx from MD obtained) - maybe resident/family can outright purchase some items (also not sure if rx actually needed for something like this). Anyway, I found this product (pictured below) and my mother used it when she obtained a heel ulcer. I like it because it does not get as hot as an inflatable boot or those really pricey soft boots used in many hospitals. Also, resident can roll/be turned to side and not worry about foot falling off pillow. (If user c/o knee discomfort, a pillow under knee can help with that) Just a thought. Also agree with nutrition consult and idea of getting referral for wound care. Good luck to you and resident!