Painful arterial wound

[Traveler]

I am at a loss on what to do and thought I'd see if anyone had any advice. I have a home health patient who has had a painful arterial wound for over four months. We initially tried some wound gel, Aquacell, and a hydrocolloid dressing but the patient couldn't tolerate it and would remove the dressing. No matter what kind of dressing we use on her she either removes it herself daily or has her daughter take it off. She can't tolerate po analgesics and we did get an order for Lidoderm patches near the site for the pain which have helped a little. At this point we are cleaning it, using wound gel, Telfa, wrap it once with an Unna boot (the patient states it is soothing), wrap with Kerlix and secure with tape. This is all she will let us do. I have told both the patient and the caregiver that this is not the treatment of choice and that some of the other products we have tried to use would serve her much better. The pain continues in the wound and I have consulted with our wound care nurse who has no further suggestions (she has also seen the patient about a month ago and knows that the non-compliance is a big issue) I think that if we could get the wound to stop hurting she might be more compliant. I have read about some compounded salves with morphine in them but haven't spoken the the pharmacist yet. Help me!!!!!!

Ann

[webblarsk]

I am at a loss on what to do and thought I'd see if anyone had any advice. I have a home health patient who has had a painful arterial wound for over four months. We initially tried some wound gel, Aquacell, and a hydrocolloid dressing but the patient couldn't tolerate it and would remove the dressing. No matter what kind of dressing we use on her she either removes it herself daily or has her daughter take it off. She can't tolerate po analgesics and we did get an order for Lidoderm patches near the site for the pain which have helped a little. At this point we are cleaning it, using wound gel, Telfa, wrap it once with an Unna boot (the patient states it is soothing), wrap with Kerlix and secure with tape. This is all she will let us do. I have told both the patient and the caregiver that this is not the treatment of choice and that some of the other products we have tried to use would serve her much better. The pain continues in the wound and I have consulted with our wound care nurse who has no further suggestions (she has also seen the patient about a month ago and knows that the non-compliance is a big issue) I think that if we could get the wound to stop hurting she might be more compliant. I have read about some compounded salves with morphine in them but haven't spoken the the pharmacist yet. Help me!!!!!!

Ann

I work for a hospice and we have used morphine spray for wounds before. I am not sure about the strength. But I am sure your pharmacist could help you out with that. My medical director did raise a question about how effective the morphine spray could be since it wouldn't be absorbed by the liver. So if anyone has a answer for that please let me know. I have seen good results with the morphine spray. Also I have heard about tea tree oil as a natural analgesic. There isn't any PO analgesics that she can tolerate?

[EricTAMUCC-BSN, BSN, RN]

In addition to WebBlarsk's suggestion you might try Lidocaine jelly to spread on the wound and/or Hydrocortisone cream.

[steelcityrn, RN]

Have You Tried The 4x4 Derma Gran B Gauze ,it Is Very Good. Have To Be Sure It Contains Zinc/vit. Applied Q3d,wash With Soap/h2o And Pat Dry. I Like To Cover With The Bordered 4x4 Telfa And Secure With Hyperflex Tape. This Of Course All Has To Have A Dr Order. I Stay Away From Kerlex Wrap With Non-compliant Chf'ers. I Really Have Had Success With The Unna Boot Also But I Do Not Put Anything Under It To Clean Skin. I Wrap With Coban Or Cling After Applying Then Ace Wrap After Its Dried If Required.