Weeping legs and wounds

[rnkalee]

I have a patient with breast cancer with mets to the liver. She was also born with cerebal palsy so she's wheelchair bound. She has edema in her lower legs and feet. Within the past month she has developed blisters on her calves that leak clear fluid. The largest blister is about 3 inches in diameter, the smallest is probably 0.5 cm. Originally her MD had her in bilateral unna boots which we changed twice a week. She covered the unna boots with kerlix but had to change it frequently because it would be soaked. Now we have discontinued the unna boots because they don't seem to be helping but she continues to have these blisters and extreme weeping. I've tried silver-impregnated products, I cleanse with wound cleanser every time. Now they are wrapped with ABD pads and changed frequently. The weeping is very odorous and the patient is miserable. It doens't seem to be getting better, only worse. Please help! I'm a hospice newbie (only 5 months) and am tapping into the resources of other nurses with more experience but we've not been able to really help this woman. Any ideas you have would be great!!

thanks

karen,

[psychshadow]

I had some problems with the weeping leg syndrome. I found using baby diapers on my legs for the moisture was much more comfortable than Kerlex. Just put the diaper on the leg sideways and use the tapes as you would on a baby. :redbeathe:nurse:

[Leda1st]

Unfortunately, I am a newbie as well, so I don't have any good suggestions. I just wanted to say how creatively COOL the poise pad and diaper suggestions were! I would NEVER have thought of those! To the OP: I hope some of these ideas have helped.

[tewdles, RN]

As we all know, this type of problem with dependent edema is all to common in our patients. I recently read an article describing an approach to management of the edema and discomfort which included intentionally creating needle tracts in the tissue and allowing the fluid to passively drain. They inserted and removed large bore needles (with local anesthetic) in a caudal to cephalo direction. The tracts drained fluid and provided measurable weight loss and symptom reduction for the patients.

Mostly in my area we trial a diuretic, wrap and elevate as the patient will tolerate or allow.