Help with cleansing a necrotic/ischemic toe/foot?

[josephjohn87]

Question:

If a patient has PVD and diabetes and has a necrotic/ischemic toe, do you cleanse with normal saline or just paint with povidone?

My preceptor told me that you should never cleanse with normal saline, but did not tell me the rationale. Why? Why should I only pain with povidone?

Wound Care Nurses?? Please help? Thanks

[Morainey, BSN, RN]

In my experience (which has unfortunately included a large number of necrotic toes) yes. You want those babies to dry up and fall off. As yucky as a dry necrotic toe is a wet one is worse. It turns into a smelly, pulpy, shedding, bacteria factory and can lead to further infection in the foot.

In addition, there isn't much point in washing them. They are dead and beyond help. Loose debris will flake off into dressings and the toes themselves are fairly inoffensive provided you keep them dry.

So just a light coat of iodine (controls bacteria and aids in drying) and dry gauze dressings were the norm where I worked.

Innnnnteresting. I've had a couple of patients with necrotic toes and I'm so worried they're just going to, like, fall off.

Meanwhile, in the Yukon: The Sourtoe Cocktail | Atlas Obscura

[Anna Flaxis, BSN, RN]

If there is no blood supply, it's probably best for it to fall off.

[CodeteamB]

Innnnnteresting. I've had a couple of patients with necrotic toes and I'm so worried they're just going to, like, fall off.

Meanwhile, in the Yukon: The Sourtoe Cocktail | Atlas Obscura

The first time it happened I'm not gonna lie, there was a bit of sphincter clenching going on O.o

But really, there isn't a better outcome for a dead toe.

Also, may I just add BARF to those Dawson City freaks. Sheesh, Canadians....