pain with mesalt - advice, alternatives?

[nursekelly217]

I am a HHN with a pt with non healing wounds on both feet. Long history with the wounds and wound care has been changed to and from every product I can possibly think of. Aquacel, prisma, promogran, iodoform, accuzyme, mesalt, foam dressings, the works. Wounds drain copiously (saturate dressing and socks daily no matter how bulky the dressing) and aside from when they were surgically debrided look terrible and consistently have a shiny gray/opaque wound bed... however they are shallow and not a candidate for the wound vac either. Current tx is daily mesalt (this is the ONLY product that has remotely debrided the wounds and semi-contained the drainage) but the patient barely tolerates the dressing change. As soon as the mesaul is placed in the wound beds, he is in excrutiating pain, pulls away, kicks out and screams. It takes 5-15 min for him to be able to tolerate completing the tx and he continues to appear to be in severe distress through the entire visit. The man is nonverbal, old CVA and very proud and stubborn. Very often refuses pain meds before tx, even tylenol. I'm wondering if anyone has any other suggestions for wound care and/or pain management with the mesalt. I'm at a total loss for what else to do and this poor man is in so much pain... Thanks!

[spectral_ev]

i just used mesalt for the first time on a patient and she says it stings very much. that makes sense since it's salt. she's going to make sure to take pain med before the next dsg change, but i would like to hear if anyone has a way to make it less painful.

[BronsonRN]

How about paint viscous xylocaine/lidocaine in the wound for ~5 min. cleansing with NS then packing the wound. I have seen this used on a few pts and it works.

[kwillitspathassist]

I am a 59yr old diabetic who is s/p I&D of an MRSA abscess which developed in a tma site Wound care included Mesalt which I found painful as it initiated stabbing pains. I tried 25mg of Benedryl to no avail and followed it with a Percocet. I finally dropped off to sleep. The next application of Mesalt was covered with Multidex which did not completely alleviate the discomfort but reduced it to a tolerable level.

KW

PS Has anyone noted increased edema with Mesalt use?:

[Seaton CWCN]

Mesalt should not be painful if used correctly, it is only for wounds with yellow moist slough in the wound bed, if there is healthy tissue the mesalt will hurt since it is a salt product. It is for debridement only. If it burns or hurts your patient it should be discontinued. I have had a lot of success with debridement with the product and love it. It will clean up a wound quickly, much faster than the enzymatics, put it on dry and change it daily, works great, but don't put it on a clean wound.

[Melina]

Have you ever considered a wound vac? I didn't see it in your list. You can even instill lidocaine into the dressing prior to removal to ease the pain of dressing changes.

Mel

[Melina]

Oops, sorry. You did mention the vac. Is it only because they are shallow that you are ruling it out? There are dressings for shallow wounds available.

[Heather.leah]

You stated that each time the wounds are debrided they get worse. This can be a sign that the patient doesn't have good blood flow to the area. Without good blood flow, no wound treatment will work. I would check with his physician to see if he has sufficient arterial flow. If he doesn't, then he needs to be revascularized. Another sign of infection is copious amounts of drainage. Has the wound been cultured to check for infection. I have used mesalt on many patients that their wounds were had slough and also on wounds that had healthy wound beds, both types of wounds did experience minimal pain with mesalt. Moistening the mesalt prior to placing it into the wound bed can decrease the pain, but if patient still experiences severe pain and you are unable to manage it appropriately then a different dressing needs to be used. Pain is our fifth vital sign and we cannot ignore it.

[NursSherri]

My concern here is that so many products have been used with no success! A wound can not heal if the etiology is not addressed. If this pt has copious drng, then it is likely a venous stasis ulcer. You should get an ABI (ankle brachial index) which can be checked at home first. This will clue you into whether this is venous, arterial or mixed. It sounds as though compression wraps would be indicated. If you relieve the fluid pressure, then you could likely do simple wound care that would encourage autolytic debridement of the wound. I agree that it would be helpful to get a culture as well. You may want to try IODOSORB gel, which is antimicrobial, and also has been shown to penetrate biofilm. Forcing this pain to have a painful wound care is not the solution!! If you don't treat the cause, all will fail!