jennihardi

We use a lot of wound vacs in our burn unit, I'm still on the fence about their effectiveness. They are supposed to help w/vascularization and prepare the wound bed for grafting. I think our problem is we leave them on too long. The wounds are debrided in the OR, wound vacs placed in the OR and the whole process repeated every 5-10 days until the MD feels the wounds are ready for grafting. We also use Mepilex, a mildly adhesive silver impregnated drsg. Although we don't use it as it is intended (on donor sites), I've heard that it heals really well. We use Xeroform on our donor sites, which I hate. It doesn't seem like enough is used to properly cover the margins of the donor site, as well as not enough staples used to secure it. Then in the post-op period the patient becomes edematous and the drsg pulls away from the margins and exposes the wound. We then use the Bair Hugger unit to direct air onto the sites so the donor sites don't become soupy and wet. It seems a little ghetto if you ask me. There must be a better way. Also, for our partial thickness burns (2nd degree) we use Collagenase ointment, an enzymatic debridement ointment mixed with Polysporin power, spread it on xeroform and apply to the wounds, done BID. This works well but you also have to be able to scrub the wounds well to get off that pseudo-eschar or yellow slough. I'd like to know what other units do as well.

I too lost my mother in a house fire, while she was being taken off life support I vowed to become a nurse. I am now a burn ICU nurse. I think my personal experiences actually help me be a better nurse. I have more empathy and can therefore advocate for the best treatment of my patients. I look at my patients and say what if this was my mom, how could I do the best job for her health and recovery. I think it takes a little time to deal with your emotions and when they become distant enough you can pursue your career as a burn nurse. I still get emotional, but that's ok, patients sometimes need someone to be emotionally vested in their well-being. They might not have family or friends to advocate for them. Go for it!

Initial dressings are not a big deal. Once they get to a burn unit we are just going to take the dressings off anyway. Just do NOT use ice, this causes further tissue damage to already damaged burned skin.