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Coccyx wound left open to air?

Posted
by lailadarling lailadarling (New) New Student

Hi everyone,

This is my first post here, I made an account specifically to post this question. I just finished my third year of RN school in Ontario and I have a Summer job in LTC as a PSW. On my third orientation shift I was doing HS care for an elderly woman who had a deep coccyx wound with no dressing (I couldn't see it because the patient was rolled on her side towards me, but my orienter described it for me). I asked my orienter why there was no dressing but she didn't know, and I could have asked the nurse but didn't get around to it.

I know in some cases wounds are left open to air if there is an infection. However leaving a coccyx wound open to air seems like terrible practice, especially if the resident is incontinent (which this one was). I'm not trying to be that young, naive nursing student who thinks she knows best but I'm just wondering if this is something that is done often, for my own knowledge.

Thanks!

It depends on how deep the wound is. Many shallow wounds can just have an ointment or cream. In fact, wound care companies are developing more of these dressing free therapies (Look up Triad cream). If it is a full thickness wound, then it probably should be covered.

vampiregirl, BSN, RN

Specializes in Hospice. Has 11 years experience.

Agree, with the previous poster. I've seen some great results with appropriate product selection in some patients!

Years ago I was a CNA at a facility that stopped using briefs at night except under specific conditions and with nurse approval. None of us CNA's thought this would be a good idea... we were wrong. Lots less skin issues and the healing of several superficial wounds occurred. As I recall we also did partial baths/ incontinence care on every patient at HS and applied barrier cream to almost everyone - so there were more pieces to this than just no briefs.

In regards to the OP questions... other considerations to in regards to this treatment being appropriate would be in the patient is continent or incontinent as well as their ability related to bed mobility (I saw you mentioned this patient was incontinent - I just threw that in to help with the thinking through the process). Positioning the patient to alleviate pressure to the affected area is also very important.

I encourage you to ask questions when you encounter things like this! This is how we continue learning even as a experienced nurse I still ask many questions and do a lot of research:)

Lovecaring, BSN, RN

Specializes in Infection Control & Wound Care. Has 19 years experience.

I use Triad or Calmoseptine paste for incontinent residents as prophylaxis and for stage 1 pressure injuries (intact skin with non-blanchable area), and stage 2 pressure injuries (shallow open ulcers). Apply to wound bed and periwound tissue daily and/or every brief change), leave it open to air. Turn res Q2H, add an air mattress when possible. Educate res in regards to nutrition, hydration and offloading if he/she is alert and oriented.

LISA25

Specializes in REGISTERED NURSING.

ELDERLY OBESE RES. THAT WILL NOT LIE IN BED SO AS TO BE REPOSITIONED. SHE STAYS IN R/C, AND REPEATEDLY URINATES ON PADS, SHE HAS ESBI AND NOW HAS A WOUND TO ENTIRE PERI AREA. WHAT DO WE DO TO MANAGE THIS PLEASE.

I BELIEVE WE NEED TO HAVE HER INCONT. PERI SITU CLEANED HOURLY, AND HAVE HER LIE IN BED FOR AN HOUR EVERY OTHER HOUR DURING THE DAY. USE CREAM AND OPEN TO AIR METHOD. HOPING TO KEEP ESBI OUT OF HER WOUND.

Lovecaring, BSN, RN

Specializes in Infection Control & Wound Care. Has 19 years experience.

Hi Lisa,

Since res has ESBL in urine, is incontinent, and has a wound to entire peri area and the focus would be to heal the wound and avoid ESBL in it, I would talk to res physician and discuss the possibility to use an indwelling urinary catheter until res finish ABX for ESBL in urine. I really don't like this approach because of the risk for UTI, but as you said, you hope to keep ESBL out of her wound, so this is a possibility to be discussed with res physician.

It is hard because she is in a recliner, and I am not sure what setting she is in, but you might consider if an external female catheter (like PureWick: https://www.purewickathome.com/) would helpful or be appropriate.

Edited by egg122 NP

LISA25

Specializes in REGISTERED NURSING.

Thank you so much for the suggestion. I have heard good things about pure wick before, but have not every used in practice. I will be looking into this, thank you!

LISA25

Specializes in REGISTERED NURSING.

On 8/9/2020 at 5:51 PM, egg122 NP said:

It is hard because she is in a recliner, and I am not sure what setting she is in, but you might consider if an external female catheter (like PureWick: https://www.purewickathome.com/) would helpful or be appropriate.

I checked into this and it is resident out of pocket 500.00 to get started, then 200.00 every two weeks thereafter. The company has applied to medicare reimbursement/ insurance, etc. but so far private pay only.

A deep coccyx pressure ulcer of an incontinent pt. definitely needs to be covered, leaving it open would put it at risk for an e coli infection.