Pressure ulcers in "sensitive" areas?

[ceebeeRN]

..hmm...second time this has happened so by now, I should known better lol. I posted a wound care issue in the wound care nursing section with no avail. Since I'm genuinely concerned and am seeking advice..I decided to repost here. I serve primarily as a wound care nurse on a rehab floor of a LTC facility and I have one resident who some how developed what was diagnosed as a decubitus on his scrotum/member (to me it actually looks more like a laceration from friction/force possibly from his foley cath). The resident is on quite obese and his stomach overhangs on his scrotum causing the wound environment to be really warm and humid and in turn quite smelly. Right now, the order is just for cleansing with normal saline, patting dry, and applying a dry dressing. The wound didn't get worse but it sure doesn't look like its getting better and the odor...phew! Any suggestion for a new treatment and/or some kind deodorizing cleanser since Dakins is probably out of the question due to the location? Ouch!

[kbrn2002, ADN, RN]

I agree open areas to this area are difficult to treat. Not many options for dressings that will stay in place other than tucking in abd pads or kerlix.

Have you ever used InterDry strips? They are quite effective at wicking moisture away. We have a couple ladies with chronic yeasty excoriations under their breasts and an obese gentleman with the same chronic yeast issue under his pannus and we have had great results using the InterDry either alone or in combination with antifungal powder. Never used it with a scrotum excoriation but I would imagine it might be effective.

Disclaimer, I am not a wound care nurse so if you are interested you may want to ask a wound nurse for more details.

[CapeCodMermaid, RN]

Dakins solution is bleach.....not a good idea to be putting bleach on any skin never mind a scrotum.

[Jensmom7, BSN, RN]

Dakins is used primarily to control odor-like our Hospice patients with large, non-healing Stage IV coccyx or sacral wounds.

Creams (like Silvadene or Metronidazole) in those warm, moist places can get messy.

Metronidazole tablets can be crushed and the powder sprinkled on the area. So can Gentamycin and Cipro tabs.

Again, I work Hospice, so we know most of the wounds we see have no chance of healing (although some of our patients have surprised us lol). Our interventions are geared primarily toward comfort and odor control. But they are still valid wound care modalities.

[Forever Sunshine, ASN, RN]

I agree open areas to this area are difficult to treat. Not many options for dressings that will stay in place other than tucking in abd pads or kerlix.

Have you ever used InterDry strips? They are quite effective at wicking moisture away. We have a couple ladies with chronic yeasty excoriations under their breasts and an obese gentleman with the same chronic yeast issue under his pannus and we have had great results using the InterDry either alone or in combination with antifungal powder. Never used it with a scrotum excoriation but I would imagine it might be effective.

Disclaimer, I am not a wound care nurse so if you are interested you may want to ask a wound nurse for more details.

Another vote for Interdry in this situation.

[morte, LPN, LVN]

if diabetic, better glucose control.

[ktwlpn, LPN]

Pull his pannus up with something like Montgomery straps if all else fails.Have seen this done with great success.....Those "dickie-do's" can be challenging

[CapeCodMermaid, RN]

We would get cited by the DPH for using Dakin's Solution, hospice or not.

[needlesmcgeeRN, ASN, RN]

We would get cited by the DPH for using Dakin's Solution, hospice or not.

So, I am confused, as Dakin's (or a diluted sodium hypochlorite) is a topical antimicrobial?

[litbitblack, ASN, RN]

Microbial powder may help