EHRN

1/2 strength Dakins is an excellent choice. Are you able to probe to bone? If so, you will need to get a bone biopsy for pathology to rule out osteo, if osteo +, they will need a 6-10 week course of IV Vancomycin. You don't want to do Dakins for too long. You can paint 1/4 inch or 1/2 inch plain packing with Iodasorb, and place it to depth of wound (do not pack), and then apply Iodasorb to remainder of wound bed. (This works better than using the Iodaform packing strips, it absorbs better). Place a piece of Aquacel over the wound, then skin prep the periwound and place a combiderm over the site. Iodasorb can stay in a wound for up to 3 days, depending on the drainage. The most important thing will be to offload the wound at all times. Hope this helps...

I agree, Unna boots are very effective, but if not applied correctly, can cause more damage. For venous ulcers, try Silvadene to wounds daily, cover with 4x4's and secure with Kerlix or rolled gauze. Encourage pt to keep legs elevated at or above level of heart as much as possible. If the wounds have heavy drainage, try using Aquacel over the silvadene and before the 4x4's. You can also use Silvadene on diabetic ulcers, but Iodasorb can be more effective. Hope this helps...

PICC lines are central lines, the tip is usually in the lower third of the SVC. A midline is a peripheral line, with its tip distal to the shoulder. Since the tip of the midline is not in the central circulation, our hospital does not require a chest x-ray for confirmation of placement. Hope this helps...

We don't have an NICU, but I'll share what we do. We have pre-written standing orders for our PICC lines that includes an initial dressing change 24 hours post insertion. At this 1st drsg change, a biopatch is placed. Then, our protocol/standing orders states that the dressing should be changed every 7 days (with biopatch) and PRN. We use Statlock about 95% of the time, and these get changed out with the dressing changes as well.

Not sure when this was posted, but maybe I can help. At our Wound Care Center, we frequently use Apligraf. If a VAC was ordered, we would place Mepitel over the graft, and depending on the amount of drainage, use either white or black granufoam. If using white foam, you may have to increase the suction. Hope this helps.

We are a fairly new PICC team, and would love to get some input from other teams out there. What works and what doesn't? Do you get any specialty pay? Do you get paid by insertion? What do you do if the MD refuses to read the chest x-ray and the radiologist has gone home? What hours do you take call? Do your floor nurses administer Cathflo or is it just your PICC team? Do you routinely use Statlocks or do you suture? Any advice is welcome

It depends on the situation. If the patient is obese or if there is a pacemaker or other hardware present, leaving the stylet in the PICC can make for easier viewing on the xray. Also, if there is a chance that the radiologist or MD will be looking at xray from home computer, leaving the stylet in can help them see the position of the tip more clearly. Personally, I prefer removing the stylet prior to the xray. Hope this helps.