Crazy for wounds...

PalmHarborMom · Apr 23, 2013

I am just a student but LOVE wounds! Before I started school, My hubby had a severe MRSA infection that due to surgical debridement left him with a doozy of a wound. At first, we had home health nurses coming to the house for IV's and dressing changes. It took less than 2 weeks for me to fire them. At first the doctor was concerned until I explained that they were not following Dr's orders for the dressings. Getting really involved in his care inspired me to be a nurse and has helped in nursing school.

My first day of Med Surg clinicals we had a patient with an abdominal wound large enough to fit a football in it. He needed a dressing change but my preceptor and I were dealing with an infiltrated IV first on another patient. Then I hear the sound of a wet towel hitting the ground. I go around the curtain to see that it is not a towel but the man's dressing (an packing) has fallen off as he tried to get up. Considering that we had all the dressing supplies right there, I offered to my preceptor to take care of it while she finished the IV. Afterwards, she said that she was surprised that I just jumped right in. Evidently, wounds that large give some people the willy's. Cases like these are wonderful! A wound that large is life threatening. I could see the abdominal mesh used to repair a hernia so if his infection were to come back... it would be devastating. Then we had the issue of him having a reaction to tape and his impressive girth. The size of the wound meant he needed lots of tape but we couldn't. Solution, minimal tape and the use of an abdominal binder. If loving wounds means that I might be known as the stinky nurse... then so be it. Heck, being the wound nurse in the hospital might be a great thing!

skylark, BSN, RN · Apr 23, 2013

I could see the abdominal mesh used to repair a hernia so if his infection were to come back... it would be devastating. Then we had the issue of him having a reaction to tape and his impressive girth. The size of the wound meant he needed lots of tape but we couldn't. Solution, minimal tape and the use of an abdominal binder. If loving wounds means that I might be known as the stinky nurse... then so be it. Heck, being the wound nurse in the hospital might be a great thing!

When you haven't got that available, what works great is a pair of those net undies they use with incontinence pads, and cut the middle gusset seam.

Voila, a large tubular elastic net bandage!

and those that can't tolerate tape can often cope with film dressings cut into wide strips and applied around the dressing.

PalmHarborMom · Apr 23, 2013

When you haven't got that available, what works great is a pair of those net undies they use with incontinence pads, and cut the middle gusset seam.
Voila, a large tubular elastic net bandage!
and those that can't tolerate tape can often cope with film dressings cut into wide strips and applied around the dressing.

I'll have to look for those net undies... not sure if the VA hospitals carry them. This patient required an abdominal binder that (before it was stretched) that was about 3 inches shorter than I am tall (5'8) Even then, it took everything me, another nurse and the patient had to get it closed. The wound was 21" long and about 6-8 inches deep depending on where you measured. The binder was helpful because when the patient rolled side to side or got out of bed, his girth shifted and would cause the wound to open up even wider. All that stress on the wound did not help. Keeping the wound stable when he moved was also much more comfortable for him.

Thanks! for the tips about those undies and the film dressings. Being creative when it comes to wounds is an asset.

skylark, BSN, RN · Apr 23, 2013

Just be careful that binder doesn't cause any blisters or pressure ulcers!!

If is tight then there will be restricted blood flow = ischemia = breakdown of tissue = pressure ulcer. :eek:

Is the wound suitable for vac?

redhead_NURSE98!, ADN, BSN · Apr 23, 2013

Gauze as a dressing??
Seriously??
Since when??
Gauze is for wound cleansing only. It is not a dressing. Can we have some sensible evidence based practice going on here please?
Yes I am a wound care nurse among other things, I have a qualification in it, and have worked with all wound care, from major burns to pressure ulcers. Show me one piece of evidence that gauze is therapeutic on a wound please.

Wow. Okay, it's official. You've established that you're WAY more educated than the OP, who is a STUDENT, who said "can't wait to see what's under all that gauze." I'm sure she meant it just as literally as you've taken it.

In short: Rude.

PalmHarborMom · Apr 24, 2013

Just be careful that binder doesn't cause any blisters or pressure ulcers!!
If is tight then there will be restricted blood flow = ischemia = breakdown of tissue = pressure ulcer.
Is the wound suitable for vac?

The abdominal binder was very snug; however, we removed it every 2-4 hours to check for irritation. It was already a XXXXL and the hospital did not have anything larger. I also asked the Woundcare Nurse to peek in when she was on the floor and she looked over everything. One issue getting the binder fastened was that the binder was incredibly long and wide and needed to be closed over a very curved abdomen. That combined with wanting to make sure that there were no wrinkles proved a daunting task.

The Wound Care nurse and the doctor were thinking about a wound vac after a scheduled surgical debridement. (there was a shelf of eschar that was to be removed) They were also checking on the availability of foam in large sizes so as to not have multiple pieces.

skylark, BSN, RN · Apr 24, 2013

Thanks!

I guess its a sign of the times that everything needs to be in XXXXL sizes now. Maybe if I think about it long enough, I can invent a new style bariatric binder and make my first million?! :woot: