Pressure Ulcer?

PsychNurseWannaBe, BSN, RN · Nov 19, 2011

Pt. has what looks like blood blister that covers the entire heel of one foot. Kept wrapped to protect from breaking. Week later, the area is broken open around blood blister. Is it to be staged like a pressure ulcer? The dead skin is still attached around part of the area. Right now, we are just keeping it dry and wrapped to protect it. What is ideal TX for this type of wound?

Is this patient in bed a lot where pressure is a factor? If their leg is flat on the bed and the area is touching the mattress, it is more than likely pressure or possibly shearing forces from heels dragging across the bed when getting boosted. Heels should have been floated. So now the area is open. Continue to get them to float their heels. You know the "right way" and not with the heels touching the pillows. Ahhhgg, that irritates me when a CNA "floats" heels and they are not floated. OK I will get off my soap box. Hee hee.

How big is the area? How deep? Slough in the wound bed? Periwound intact? Drainage? Odor? Infection?

You actually do not want to keep the wound dry unless you mean it is from drainage. The wound needs a nice warm moist environment. What I normally would do is cleanse the area with a wound cleanser, skin prep the periwound, and apply tegaderm foam heel dressing. Change every 3 days and PRN. Nutrition is key as well. Does she eat well? If you are in a facility like LTC, PT can help with other modalities. Also have your dietitian look over her intakes. Arginaid is great for wound healing. Its a powder you mix with water and give BID. It is a tad expensive so if this wound is new... wait it out for a couple of weeks to see if the wound will improve with out it.

americanTrain · Nov 19, 2011

Pt. has what looks like blood blister that covers the entire heel of one foot. Kept wrapped to protect from breaking. Week later, the area is broken open around blood blister. Is it to be staged like a pressure ulcer? The dead skin is still attached around part of the area. Right now, we are just keeping it dry and wrapped to protect it. What is ideal TX for this type of wound?

Any fluid filled blister while intact is usually already considered a stage 2 ,( some might say unstageable, but our protocol is stage 2, unless there is eschar involved). The blister now open, stage 2 depending on depth, which is prob what you now have, as you describe. Now that it is open, you need to focus on preventing further tisue damage, and /or infection. Depending on the drainage, if scant, I would use a thin hydrocolloid dressing on the heel and offload, offload, offload. Change this dressing every 3 days and prn if drainage comes to borders of dressing or otherwise becomes compromised, ei... wet, soiled or peeling off. If no improvment at your next weekly assessment, or you see it progressivly getting worse, change your orders. You could also try hydrogel in wound bed, covered by foam gauze or other dressing of choice. But keep in mind, the type of dressing you use will depend on how frequently you change it.