Cleansing a necrotic toe/ischemic toe(s)

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Question:

If a patient has PVD and diabetes and has a necrotic/ischemic toe, do you cleanse with normal saline or just paint with povidone?

My preceptor told me that you should never cleanse with normal saline, but did not tell me the rationale. Why should I only paint with povidone?

Wound Care Nurses?? Please help? Thanks

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Specializes in LTC, Memory loss, PDN.

what does the order say?

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Specializes in Hospice, Geriatrics, Wounds.

The goal is to keep the toe as dry as possible bc the eschar serves as a barrier to bacteria, etc. DM causes delayed healing, and PVD results in poor circulation to the extremity. Our blood carries all the necessary qualities to heal (oxygen, etc)....ever heard" the healing is in the blood"? So anyone with compromised blood flow would be at a high risk to not heal.

Cleansing with saline (or any other irrigant) just adds moisture that we DONT want, as moisture compromises the barrier the eschar has created. Debreding this area would only cause a multitude of issues within an already compromised pt.

Remember. .....you don't just assess the wound......you assess the PATIENT. . To figure out what would cause issues with wound healing before EVER suggesting a wound plan of care. The pt should be taught to keep this area dry as well.

Good question! !!!

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