Pressure Ulcer Dressings

[NurseHotFlash]

I would like to know more about pressure ulcer dressings. I have purchased 2 books, but they are not here yet. Besides, I love to read "real world" answers from you guys. I am relatively new to nursing and have had several different answers on when to use DuoDerm, or non-sitck dressings. Also, when should you use Aquacel? We get orders like "change dressings daily" but the specifics are often missing. Are there some simple guidelines to follow? Thanks for your help!

[Sunnysidegirl]

Where I work we have a wound nurse that does a wound consult.She then writes a note about her findings and gives specific instructions on what to dress a wound with.If the wound is deep we usually clean the wound with NS and pack it with gauze soaked in saline or Dakins solution.then cover with a nonoclusive dressing then dry gauze on top.Other open wounds like an abscess we usually use nonocclusive dressings some even have antibacterial properties other times is just a basic wet to dry dressing.We usually put duoderms on pressure ulcers that we try to keep clean and dry.Air beds if your facility has them are also great for healing of wounds.

[K+MgSO4, BSN]

Oh NOOOOOO! Wet to dry dressings went out with the ark!!!! The wet saline will dry out and when you go to remove it even if you re-wet it you will remove the delicate new cells that the body is producing as part of the healing process.

If you have a moist cavity wound or a large area wound that is not very sloughy get it VAC'd. Seems expensive but shortens recovery time and only has to be dressed every 2/3day. If a wound is sloughy dont VAC it till you remove the slough. Aquacell or Aquacell AG (if infected) work well as long it is not putting out a lot of exudate and you can leave the wound intact for a day at 2 at a time.

Mepilex or mepilex boarder are good choices for grade 1 pressure area as they supply some padding and dont bunch up like duoderm and are less traumatic to remove than duodem. regular pressure area care and chair cushions and proper shoes are essential tools in pressure sore recovery.

Also as nurses in my ward we are given a pretty free regien with dressing choices as the surgeons are aware that we know more than they do about them. still get in the notes for a haemoserous oozing wound to put Kaldostat on it.........are they mad?? Only use kaldostat for bleeding wounds. Also often on the AM rounds the surgeons will whip the bed clothes off a pt and find a Drainage bag over the oozing wound and remark "what a good idea"!!! DUH!! Protecting the skin effectively and monitoring the output.

Also check your pt albumin levels cause if there levels are in their boots then they will have serious issues healing wounds. Get the dietican involved and start a food record chart. Ensure that your diabetics are well controlled also.

[laina chow]

That really help!! I am currently a second year BSN student, and is going to my very first meg-surg class in Sept. your information would really help me out!! we learn several different kind of dressing but I always not sure what to use and what is the best for the patient. thank you!!

[kayern]

See what products your institution has. ANCC has a great pressure ulcer continuing education module as does Medline. We have a Wound/Ostomy Nurse who acts as a consultation and recommends to our nurses dressings if they are unsure. Each institution has its own line of products for prevention and treatment then you can always research.