Help with dressing choice

[bell104]

I am a new wound care nurse and am in need of some help with a new patient. 100 yr old lady with unstageable ulcer on sacrum, measures about 4x2x2. Wound bed is 80% slough. She has undermining of 6cm from 5:00 to 9:00. No infection. Copious drainage. I was doing santyl to slough and packing it with aquacel. The undermining is just getting larger. Wound vac not an option. Any ideas on dressing choices? FYI, she doesn't take in much orally and feeding tube not an option for nutrition. I can order just about any wound dressing. I'm just having a hard time deciding the best way to pack this wound. Any help would be appreciated!

[nukefx007, RN]

I got to ask, since she's 100 and she's not eating well, is she a hospice candidate?

In addition, i am just throwing this idea out there, is it a sudden onset wound and pear in shape? if so it might be a Kennedy terminal ulcer. if it is there is really nothing you could do to heal the wound because her body is shutting down.

I would suggest have that wound sharp debrided by PT, if possible.

As far as dressing, aquacel ag is a good choice, probably use a foam dressing as a secondary dressing to add more absorbency. You could also try using alginates, they are good in absorbing wounds too. Another idea is using Hydrofera Blue, it could absorb large amount of drainage and it is also an antimicrobial. Hope this helps..

[dmdrn73]

I also question if it is a Kennedy Terminal Ulcer. But in any case the alginates are good for the drainage:Kaltostat, algisite, aquacel, Sorbsan, etc. The Ag would be better if infected. Can use an Allevyn adhesive foam dressing, it comes in a sacral shape but the square ones work nicely too. The Allevyn Gentle border is good too, doesn't adhere as much, sometimes the regular one will tear fragile skin when removed.