Duoderm on blisters?

[kate1114]

I am fairly new to the adult world, and in my NICU experience, we used duoderm mostly for beginning stages of skin breakdown or for facial protection to anchor OG tubes and such.

Recently I've seen a few patients come to the ICU with duoderm on heel blisters. When the duoderm is removed, typically the blister has burst at some point, leaving the moisture trapped in the duoderm causing greater skin breakdown with macerated skin.

Typically I try to just keep the extremity elevated with no pressure on the heel? What else do you do for heel blisters?

Thanks!

[LDJRN]

We typically just put some heel lift/suspension boots on the pt and just monitor the blister. Or we apply a foam dressing, so that if it bursts, all the yick is absorbed.

[GingerSue]

this is one example of a suggestion to keep pressure off the heels that another member posted in a thread when I had asked about the use of sheepskin

and this is another example that was described

there were several other good ideas described in that thread

[Ann RN]

I am fairly new to the adult world, and in my NICU experience, we used duoderm mostly for beginning stages of skin breakdown or for facial protection to anchor OG tubes and such.

Recently I've seen a few patients come to the ICU with duoderm on heel blisters. When the duoderm is removed, typically the blister has burst at some point, leaving the moisture trapped in the duoderm causing greater skin breakdown with macerated skin.

Typically I try to just keep the extremity elevated with no pressure on the heel? What else do you do for heel blisters?

Thanks!

Never, NEVER put duoderm on a blister!!!!! Never force a blister to open. The skin is the best protective covering. If it opens naturally, keep it clean & open to air.

[leslie :-D]

i've never heard of putting a duoderm on a blister.

as ann stated, the skin of the blister itself is protective in nature.

keep it suspended in air and monitor.

if it opens, then it needs some sort of warm, moist environment to regranulate.

a simple saline gel with dsd should suffice.

or even a duoderm once the skin has erupted.

just keep in mind that duoderms need to be changed q 3-4 days.

i've seen areas become necrotic because someone thought duoderms seldom needed changing.

leslie

[GardenDove]

Someone told me that duoderm is falling out a favor. I rarely see it used in my hospital, other than occasional people coming in from LTC with it. I've always found that the usual application of being put on the coccyx is ineffective because it always get crumbled up and/or forgotten. I don't like it!

[Antikigirl, ASN, RN]

I too am a believer in letting some skin issues heal naturally! And I have met my share of people that cover EVERYTHING from small cuts to blisters to even rashes (eek!).

Blisters I like to keep exposed to this stuff called AIR! LOL! If you are able, if not...like in the case of coccyx, good ol turning and asking the patient to keep that area free from any shear. Air does wonders, and keeps that mean old anerobic bacteria out of the mix! Even when I have had some folks with thigh or groinal blisters, I have had them take a naked nap to expose those to air.

When they have popped, then the work begins on judging to cover or not. Typically it is based on where it is. Coccyx is dreaded because I don't see many products that will stick and stay...and you wind up doing dressing changes a few times a shift...and causing more damage by shear and removal. Those are the times I will use a protective skin barrier cream and lots of time making sure the pt is clean at all times.

Heals...oh man I hate it when I see products on heals so darn much. Unless it is weeping, I float heals..keep them clean...and keep them exposed to air. I have seen the damage duoderm has caused with trapping anerobic bacteria in...and with diabetic heals...oh man I have seen actual losses of the foot due to it! If things are that bad...then perhaps treatment with a wound vac and constant care with wound care is appropriate!

Blisters or raw skin on ostomy sites should surely be handled by a wound care professional because of what is at risk. Typcially I keep all adhesives away from the area if possible and have a consultation. If I can't get that right away (our hospital has a good staffing of wound care specialists), I will clean the area well but gently with water (another one of natures wonderful cleaners that we tend to overlook) no soap and have put a piece of tegraderm on the spot then apply the appliance. Watch that area carefully especially if it is under the appliance because that is no guarentee that will help form a seal...but nor does a wound!

I remember one time in ALF when a man paniced and went from room to room trying to find me (innapropriate!) because he had a blister on his toe. I got him back to his apt with his wife and sat them down and said. "Guys, I adore you, and am going to help you...let me ask you this...with your 7 children, if one had a blister on their foot...what did you do?" the wife responded "but a bandaid on it for protection and told them to lay off wearing shoes for a while when they could.". I said "Exactly! Now, instead of having the facility charge you 50 buck for me to put a bandaid on it...how about I give you a bandaid. Keep an eye on it and let me know if it starts to look 'angry' (old wordage for red, weepy, warm)." They got the hint and that spread...and I wound up doing a lot less 2200 emergency calls for minor cuts or blisters! LOL!!!!!!

[fultzymom]

Our skin nurse like us to pad blisters on the heels with an ABD pad and wrap with kerlix. We change the dressing Q shower day et PRN. We had a patient come from the hospital with duoderm et when we had to take it off, the blister opened up and we had a mess. Took a long time to heal. I felt sorry for the patient.

Leslie

[Anagray, BSN]

I hate duoderms in general. I feel like the skin gets no oxygen and just is bathing in it's own juice instead of healing. As for blisters, the previous suggestions are excellent.

[mandykal, ADN, RN]

I have seen duoderms used many times, and i too disagree with its usage..... We use skin-prep when skin is intact, if it ruptures, then we use old fashion tx with bacitracin and telf wrap with comforming or kerlix........ Preventive measures is always heel protectors or a change of foot wear.....

[annmariern]

Skin prep to intact skin to toughen it up, keep it intact, Off load pressure. Duoderm is guaranteed to break it. I hate the stuff too.

[AlbertaBlue]

Duoderm can be very useful in certain instances...they are great overtop of the bridge of patients' noses who are on BiPAP machines...all that pressure from the BiPAP mask is then absorbed by the duoderm and not the patients sensitive skin. But I do agree that it can be misused and has caused, on occasion, the most horrendous wounds. OUCH!!