Duoderm, Tegaderm, Wet Gauze

Nurses General Nursing

Published

Which or what else do you prefer for a sacral stage II in a very immobile, bed-bound patient? What do you suggest? Any treatments with which you have successful outcomes? I would really like this to heal.

Thanks.

http://www.healthpoint.com/divisions/tm/XenadermQuestionsAnswers.pdf

CMS won't pay for Xenaderm. The issue with leaving it open is 44 residents, 2 CNAs on night, 5 on days, 6 when and only when (HA!) we are fully staffed. He simply won't get enough cleansing.

I DO like the Allevyn. For a stubborn woman who won't keep her heels up, and sacral wounds. I'm going to run ordering those by by DON. The docs sign off on what we order unless they've had specific wound care done.

:no:

Such a sad ruling.

Specializes in Hospice, LTC, Rehab, Home Health.

I too dislike Duoderm. I've seen it crumple into a rock like mass that puts more pressure on the area than if it was unprotected. My favorite wound care product ever was called "Scott's Wound Care System" It was a line of Saline based products that were color coded to match the wound bed -- Red dot package for red wound beds, yellow for yellow(slough) wound bed, black dots for black (necrotic) wounds! Never any question when to change products and NO allergies! It was great! Haven't seen it in a while-- it worked great so they probably don't make it anymore lol

Specializes in PACU.

definately no wet gauze on this . . .i personally like allevyn, but my facility switched to duoderms instead. I find the duoderms do bunch up. I was always taught duoderms were to be changed every 3 days . . .but recently someone told me they saw 5-7 days. I have not had a chance to look up which is correct per the company.

I went to the COnvatec site (Duoderm manufacturer) and they say up to 7 days.

how about pulsing or gavaging the tube feed, so that the patient has time when he could be more nearly flat. And when hob is up make sure the knees are gatched to decrease "sliding" down the bed.

Specializes in PACU.
I went to the COnvatec site (Duoderm manufacturer) and they say up to 7 days.

Thanks!

how about pulsing or gavaging the tube feed, so that the patient has time when he could be more nearly flat. And when hob is up make sure the knees are gatched to decrease "sliding" down the bed.

I can ask about the former. The latter is already in place.

Thanks.

Specializes in Holistic and Aesthetic Medicine.

Don't forget good nutritional therapy...at one LTC I worked with, they start Vit A 16,000 IU po q day, Vit C 500mg bid, and Zinc Sulfate 220mg qd at the first sign of redness. After 1 month a Zn level is done. When healed, the Vit A is reduced to 8,000 IU, the vit C is continued and the Zn may or may not be discontinued depending on blood level. They had great success with speeding healing when they made that change. They also typically added a whey protein supplement like Beneprotein.

I like the remedy skin repair and calmazine line by medline for the surrounding skin and the allevyn ag dressings to help prevent infection and speed healing. http://www.medline.com/wound-skin-care/remedy.asp

May you be blessed for going the extra mile for your patient!

Specializes in LTC, Subacute Rehab.

We've had really good results with hydrogel and Permafoam (similar to Allevyn, I think). If the edges are a bit macerated, we do use skin prep.

I am going to ask about ordering some Allevyns. I was considering asking the doc about changing to a higher protein formula - he's on Jevity 1.2 now. I'll ask about the vitamins. And about upping the rate so he can lie flat for at least a portion of the day.

For now, it seems that my best bet is to continue with the Duoderms, change 2x week, skin prep to entire sacrum and coccyx, and lots of repositioning. LOTS of zinc oxide cream.

Thanks, all.

Before putting a new dsg on, cleanse the intact skin with ns, skin prep the intact skin that the adhesive will touch and LET DRY. I found that doing this may help with the bunching up of the duoderm. Xenaderm was great, while I was still in LTC I kept a stash of it because medicare stopped covering it. A little silverdene in the wound bed may help too.

+ Add a Comment