Necrotizing Fasciitis

[TigerGalLE, BSN, RN]

I have a pt that I am taking care of on my floor that has just been diagnosed with necrotizing fasciitis. He had abd surgery and it became infected, has now been debrided and his abd wound is huge, deep, and terrible looking. Has anyone every had a pt with necrotizing fasciitis in their wound that has survived? His dressing changes are almost scary they are so deep... well they are scary. I'm packing his abd so deep with NS soaked gauze. The smell and the drainage are enough to put me over the edge.... I'm just wondering if this pt actually has a change to live... His has other comorbitities as well....

Tiger

[Scrubby]

Hmmm yes we had a case in theatre not so long ago, thank goodness for tinc benz!

I found this very interesting case study, might be some help.

http://www.woundsresearch.com/article/4418#

[Conrad283, BSN, RN]

I've heard of patients having NF in/on a limb, the abd may have a different effect since it's close to some vital organs.

[racing-mom4, BSN, RN]

We had a patient last Spring come in with a terrible leg pain, she thought it was a charlie horse. Unable to bear weight, they admited her with the dx irretractalbe pain. 3 hours later, her leg was swelling and purple, you could litterally watch the purple move down her leg, when pedal pulses were attempted, it sounded like rice crispies. It was necrotizing fasciitis.

Immediate surgery to amputate, they had to amputate all the way to her abdomen, She lived about 2 weeks.

The day before she came in with the leg pain, she was shopping at the mall and then went out to dinner with her friends. Very scary. Come to find out she was a diabetic, and gave herself insulin in her thigh. So that had to be the entry spot. Sad to say, but I feel lucky I got to see it, not something one sees every day. I will never forget it.

[snowfreeze, BSN, RN]

I have cared for a few necrotizing fascitis patients, only one with extensive abdominal and thigh damage lived to walk back into the hospital and thank us for saving her life. The rest had co-morbid factors and didn't survive the daily debridements and all the antibiotics.

Once that nasty smell is gone the healing begins. Having appropriate acuity based nurse patient ratios, awesome intensivists, aggressive very involved surgeons and Infectious Disease on top of things makes a big difference. Maintaining range of motion in all joints plus turning hourly to avoid pressure ulcers makes for a bit more intact person for acute rehab after hospitalization.

[RN1989]

I have had some patients with it that survived, others did not. The quick spread of it is the problem. They rush them to surgery and cut away what they think is dead, only to find that they didn't get enough. Generally you need to make a wide excision with even "good" tissue" to try to contain it but sometimes that isn't possible.

One idea for heavy drainage is to use an ng tube in the wound. I've literally had patients where we coiled/layed ng tubes into their bellies to fit the shape of the wound. The multiple holes in an ngt helps to suck the crap out better. Then you can lightly put saline soaked gauze on top. If you're down to the peritoneum and worried about suction causing bleeding, laying down an unfolded kerlix/4x4 that is moistened, then putting the ngt on top, then covering with gauze will help decrease the suction being right next to vital parts.

Nasty stuff. Unfortunately most places I have been took these patients out of the unit and put them on the floors - bad idea. But it also depends on whether the doc has any experience with nec. fasc. or not.

[NurseCard, ADN]

I once helped care for a patient (I think I was still a tech at the time) who I believe had this... she had had what started out as just a small place and turned into a GIGANTIC hole in her abdomen. She ended up with a wound vac.

She did recover, and is still around as far as I know.

[Dan Morsette]

As a 10 yr survivor of NF, I first want to thank the nurses that helped me throu that horrible, scary 3 months. My debreded area goes from buttock to buttock, navel to groin, and up the right rib cage mid back to just in front of arm, as high up as my nipple, apx 25% of total skin, or about 4 sq ft. The wound was so deed and bandage changes so tough, it scared a nurse right out of the room. for good info on this disease go to Welcome to the National Necrotizing Fasciitis Foundation and if you want to see pic of my experiance, go to survivors stories, scroll down to Dan M. story. May seem like there is a lot of survivors on that site, but compare the survivovrs list to the tribute list and you will see just how deadly this disease is.

[All4NursingRN]

I remember a senior nurse telling me about a patient with NF. Guy came in c/o something on his skin, hours later he had to be intubated and had a lactate through the roof! This is one of those rare, freak disorders/stories you hear about. People going to the hospital for something simple then dying.

[xoemmylouox, ASN, RN]

When I was a student doing rounds in surgery I was able to see a newly dx case of NF. It was quite the experience. I couldn't believe how much flesh they removed. I do believe she survived. It started in her Abd.

[paddler]

I have seen/helped 3 patients with NF and they all survived. One lady worked in medical records and got a paper cut on her finger that erupted 3 weeks later as NF in her axilla. Crazy.

[footqueen]

You are truly a miracle, Dan! Thanks for sharing your story- very inspirational!