fungating facial wound

[NC29mom]

I have a pt with a large, deep fungating wound which basically encompasses the entire right side of her face (eye swollen shut for months now). There is an area of tunneling which extends from beside her nose, probably into her sinus cavity, and draining into her oral cavity. Presently the trmt is silvidene impregnated guaze packing/adaptic dressing. Of course, presently we are just trying to maintain comfort, as its a nonhealing wound. Any better ideas for dressing material? And, the pt has severe pain anytime the dressing is changed .... even with morphine prior. I remember from a wound clinic, there being an aerosol spray you could spray to the wound bed to numb the area when changing the drag or debriding the wound bed. Anybody know what that spray is ... or another which would do the same job? Thanks in advance....

[leslie :-D]

isn't adaptic basically a vaseline-type guaze?

i have worked on many fungating wounds and no matter what product is used, it remains incredibly painful.

i have found that working as quickly as humanly possible, was the kindest thing we could do for these patients.

dang, i recall a cn who would take her sweet time when changing these dsgs.

the grimaces, clenched teeth, moaning was too much for ME to bear and i ended up snapping at her:

"can you pick up the pace, harriet?"

seriously, i do believe that knowing these wounds won't heal and that our goals are to prevent infection or secondary complications...

that just pretty much changing dsg at speed of light, will benefit pt the most...imo.

and yes, premedicating (with anxiolytic as well!) is critical, too.

leslie

[NC29mom, ASN, LPN, RN]

I did look into the Mepiel drsg..... I was just unsure if it would work....I will order and try....

I try to work as fast as possible but I end up stopping numerous times bc pt raises her hand. Today, I incorporated the hurricane spray. I sprayed the bottom layer of the packing in hopes it would numb for removal.....didn't see a real difference. ..

My pt has told me several times in the past, she feels god is punishing her for her sins, and this is why she suffers...breaks my heart.

I am going next week to get my wcei wound certification. ...hopefully I will learn something which will help her...

Thanks everybody!

[tewdles, RN]

We use lidocaine topically on painful wounds sometimes...or perhaps a topical morphine to the wound edges?

Who doesn't hate painful wounds in a hospice patient! So unfair it seems...

[SaoirseRN]

I did look into the Mepiel drsg..... I was just unsure if it would work....I will order and try....

!

I actually had a patient with a fungating facial tumor similar to what you described except it didn't require packing. However it had numerous "bleeders" whenever the dressings came off and I did use the mepitel. It did help keep some of the places from sticking. I hope it helps your patient.