Open wonds covered with dry swabs?

[mandihere]

Have a patient that over the past 2 months has been suffering with water blisters on his legs. We are doing everything possible to keep his legs elevated at times when needed and changing his dressings. Twice a week a company come in to care for him. They bath him and check on his health... They are registered nurses within this company so they all have much more knowledge then me for I am not a registered nurse. Now we were told by our head nurse that this company will be Comming into change his dressing so we will no longer need to unless needed.

[mandihere]

Sorry for some reason it posted before I was done:

Any ways the past month this client has had these nurses to come in and change his dressings. But this is the 6th time I have had to rewrap his legs because of them falling off or him taking them off ECt. The problem is when I go to do this I have realized his legs are being wrapped in dry swabs! In the training I have I was told to always you non adherent bandages for open wounds. But every time I change his legs they don't use these. It takes a whole bottle of saline for me to get the dry bandages off because they are stuck to his open blisters! I have taken out the box of dry swabs twice and replace them with non adherent pads. I've even written on the box to please only use these an still dry ones get used. Is there a reason anyone would cover a open sore with something that is not non adherent?

[mandihere]

O my and wonds should say wounds. Sorry I work nights and get very tired by this time in the am:)

[tokebi]

Does he have necrotic tissues? The only thing I can think of is maybe the nurses are using "wet-to-dry" method. You apply wet gauze and let it dry. When you take it off, the dead tissue comes off together so that the wound can start to heal. If that's what they're doing, you should not re-wet the dressing before removal. But I haven't seen that done for a long long time, because now we have many good debriding products.

Have you looked in the chart and see if they wrote dressing change instructions for staff? Wound care nurses should either leave a written instruction or educate staff nurses so that the patient gets consistent wound care.

[mandihere]

No there is not instructions on his chart. This makes a lot of sense tho and should be written down!

Thanks for the advice

[catlvr]

The wound care nurse at my facility LOVES wet to dry dressings, and uses them for everything, even for stuff that isn't being debrided - breaks my heart since it causes the resident a good bit of pain to remove, and it isn't best practice anyway. Sigh.

OP - the next time the wound care nurse is in the facility changing dressings, perhaps you could discuss with her/him and let them know that the pt is removing the dressings; education may be in order, or perhaps a different type of dressing. I thought that wet to dry dressings are usually changed twice daily?

[serenidad2004]

I had a pt that also would get blisters r/t edema circulation etc we used viscopaste gauze and then wrapped with kerlix worked good for the pt we changed 3x wk