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Discussion

Palliative wound help

I'm back again, begging for help ...... I have a hospice patient with a deep facial wound r/t cancer (basically encompasses the entire R side of her face, eye swollen shut, tunneling depth near nare which tunnels into sinus/oral cavity). I need help, as far as what palliative wound treatment would be ideal. She has a lot of pain associated with the wound, of course, and already receives MS Contin ER BID, and IR PRN 30 min prior to dressing changes). Through allnurses.com I was able to learn about a wound numbing spray, Regenecare, which I definitely want to incorporate into her dressing change. They also make a Regenecare hydrogel. I was wondering if maybe the hydrogel could be impregnanted into guaze, and used as a packing material. I need something for pain, something for odor, and something which can help with the exudate. My thoughts were to get Flagyl gel, to mix with something...... Just brainstorming..... This is a very difficult area to dress. I have tried so many different things, none of which I thought were ideal. And, sadly, I must have ideas which are cost effective, as we are a bundled service, and my boss is not going to approve dressings which cost too much. My goals are: Odor control, exudate control, and first and foremost...PAIN control. ANY IDEAS????

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    We have used the regenecare hydrogel and mixed it with nugauze plain packing for tunneling. Have you tried any charcoal dressings as maybe a secondary? Maybe the regenecare hydrogel with a secondary absorptive charcoal (odor eliminating) dressing with an elastic dressing retainer like stockinette to hold it in place will work? It is difficult to tell without seeing the wound position. I'm sorry as I don't feel like I have been of much help.

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    Ok, so I can impregnate guaze with the regenecare hydrogel? Great! I'm thinking it will help considerably with pain. I have thought about using a charcoal foam dressing; however, due to the location\positioning of the wound....I wasn't sure how to place. There's just no way I could apply a stocking type dressing. The wound extends from temporal region (over r eye w/eye swollen completely shut), down near r nare, to corner of mouth, and back around near ear. So, basically encompasses the entire right region of my pts face. I use almost an entire ABD pad to cover. So, I'm going to suggest regenecare hydrogel impregnated guaze, adaptive drsg, and foam outer drsg...sound like a plan? Couldn't we add flagyl gel to mix for odor? Maybe use both regenecare hydrogel and flagyl gel to impregnate guaze? I will check and see if I can find a charcoal foam drsg.... thanks!!

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