Care of Pressure area to heels

[litbitblack]

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.

[RainMom]

That picture looks like you could use a cervical support or pillow (like people use to sleep sitting up) & modify to go around the ankle secured with a velcro strap.

[DidiRN]

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

I can still remember the smell of that stuff lol. I wondered too if it's still being used.

[cardiacfreak, ADN]

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

Yes, granulex is still available, I had a pt last week at the hospital who had it prescribed. Does anyone remember the pink solution they used to use and then we applied a heat lamp to dry the area, it worked well but sometimes people would get the heat source to close to the skin and it caused burns and this is why they stopped that practice.

[NRSKarenRN, BSN, RN]

Used that TONS in mid 70's in SNF and 80's in hospital:

[h=3]Granulex Top : Uses, Side Effects, Interactions, Pictures, Warnings ...[/h]Main ingredient Trypsin (a naturally occuring enzyme found in many food products), Balsam Peru and Castor Oil. Use with INTACT skin only.

[MunoRN, RN]

Friction and shear is almost never the cause of heal ulcers, and is never the cause of deep tissue injuries, it's always pressure, so dressings, skin protectants, etc won't be of much use. Heel lift support devices that relieve pressure without harming circulation are the primary treatment, along with nutrition optimization and activity where appropriate. Other barriers to healing should also be ruled out, such as poorly controlled diabetes or PAD/PVD.

[NRSKarenRN, BSN, RN]

Evidenced Based Practice:

Pressure Ulcers Best Practices & Evidence Based Practices for Prevention and Treatment

CEU Heel Pressure Ulcers Stand Guard - Nursing Center

[DedHedRN]

If the pt is really immobile, NOOOOOO!!! not these. I thought these were a good idea at one time too, until it caused a terrible pressure ulcer on the leg of the pt. Float on good old fashion pillows.

[BrandonLPN, LPN]

Yeah, those ankle ring thingies look like a good idea, but I can see them just becoming a tangled up hot mess. They look really uncomfortable, and I know my residents would thrash and kick until they ended up rubbing their heels all over the bed anyway.

[loriangel14, RN]

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[TD][h=1]We also use these.[/h][/TD]

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[amoLucia]

If the pt is really immobile, NOOOOOO!!! not these. I thought these were a good idea at one time too, until it caused a terrible pressure ulcer on the leg of the pt. Float on good old fashion pillows.

Thank you. I was going to say the same thing. Ulcerations under the blue ring would occur - on anterior & posterior surfaces of the leg. Haven't seen them used in years.

To tammiancrn - were you thinking mercurochrome (sp?) and Maalox (or MOM)?

[cardiacfreak, ADN]

Thank you. I was going to say the same thing. Ulcerations under the blue ring would occur - on anterior & posterior surfaces of the leg. Haven't seen them used in years.

To tammiancrn - were you thinking mercurochrome (sp?) and Maalox (or MOM)?

That's it