margo533

You really need to go on to a RN program, Betty. Wound care isn't just changing dressings, it's assessing the wound AND the contributing factors, the patient's ability to manage their care and their support system for this--and then develping a treatment plan and teaching how to carry it out. After becoming a RN, there are programs accredited by the Wound, Ostomy, Continence Nurses Society which are the 'gold standard' for this field. There are other 'quickie' programs for non baccalaureate prepared nurses, some may accept a LPN. I just don't think this is the way to excellence, though it probably has a place in the dismal health care scene we work in. Margaret Jones RN, CWON (retired)

For a clean surgical wound, you want the wound bed to remain moist (not wet); if it dries out, it's not going to heal. Wet-to-dry drsgs mean just that--moist gauze that's allowed to dry out so that when it's removed, it takes the non-viable tissue with it; THIS IS NEVER, EVER DONE WITH A FRESH SURGICAL WOUND. NEVER! The surgeons obviously don't want the wound to dry out, so the best post op dressing order for a non-infected, uncomplicated surgical wound would be "continuous moist saline dressings- change daily". The simple addition of a wound gel applied to the wound bed, topped with moist gauze will provide a "continuous moist dressing" and keep the wound bed moist between daily drsg changes--which is the objective. (BID and TID dressings are completely unnecessary, indeed they are detrimental, since wound bed temperature influences rate of healing; dressing removal lowers temps for hours after dressing is changed.) The literature going back 15 years is loaded with studies validating the above. Your wound care nurse should be familiar with the literature and I'm surprised if she isn't working with nursing administration to bring physicians and nursing staff up to date and current with evidence-based practices. In addition, these BID and TID drsg changes take nursing time away from other duties, and contribute to nurse work overload, higher labor costs, and staffing problems. Administrators definitely are interested in containing costs, so I suggest you print this out and show it to your nurse Manager or Director. :) (My credentials: CWOCN 1995-2010; I retired in 2008 and my certification expired as of Jan 1, 2011)

Good for you, chrissylou! I'm more than happy for anyone to bounce ideas & questions off me. My one great message is that a wound is just a part of a whole person; all that person's physical characteristics, personal cognition, and his/her social support network form the background for treating a wound.

Emmjay, your professional background sounds excellent to proceed. Chrissy Lou, I know, I agree, the WOCN route is difficult, and I certainly agree, we need many more nurses knowledgable in wound care to care for our patients. Perhaps I'm too much of a "purist", wanting to add to the credentialed only those who can meet WOCN's (admittently) difficult standards; WOCN's standards are simply to have a baseline for assessment. Okay. I worked in home health (Indianapolis VNS and private home health agencies), hospital inpatient and hospital-based outpatient clinic over 15 yrs as a CWOCN; I have practiced in the entire scope of practice and am now retired (I'm 67yrs old). I urge you to proceed and learn in the educational setting you are able to progress in. If you have a BSN, by all means go the WOCN route; if you don't, then the most strenuous route will be the best. Believe me, one week will not make you an expert.

Slough tissue is that white-ish (or grey-ish) looking glunk you see adhering to an otherwise pink-to-red wound bed. After a week with a transparent dressing over eschar, you'll see it connecting the eschar to the (hopefully) granulating wound bed. It's necrotic tissue, the forerunner to eschar, if it dries out enough. That's the pure and simple way to characterize it. Epithelialization or epithelium is the top layer you see "crowding in" on a healing wound with sequential observations. --margo533, CWOCN since 1995

If the patient's nutritional status isn't adequate for healing, it is not going to heal. Period. Nutrition is that important. Don't beat yourself up, the "host" has to support healing, or it's not going to heal. --margo533, CWOCN since 1995

OMG, is this still going on??? I've been retired since 2008, and the wet to dry was being contested even when I went back to school and became a CWOCN in 1995! NO, NO, NO, NO--- NO WET TO DRY DRESSINGS!! This has been emperically validated time after time, go into the WOCN Journals for definitive statements on this issue. (Nowhappywoundnurse, you made my day!) ;->

Sorry to see I've discovered this forum until now, so my post will not be pertinent to that specific patient. However, the use of liquid adhesives is probably universal with experienced VAC practitioners. --margo533, CWOCN since 1995

Physicians have no concept of what allowed nursing practice is--yes, really! The physician must do this unless your personal/professional credentials along with your State board of nursing AND your employer's policy allows you to do this--even though it only involves inserting a sterile needle into the pustule and not contaminating the specimen. (Do State and employer "rules" need to be changed? D'uh. Become an activist!)

I retired two yrs ago, but had been a CWOCN since 1995. At my last position as a CWOCN at a community hospital in the Portland OR area, I was making $38+/hr. Keep in mind, wages/salaries are higher on both coasts than in the "heartland".

I've been a CWOCN since 1995, and while ostomies constituted only about 25% of my practice, I found that overall, that has given me the greatest professional satisfaction as far as making a really huge and positive difference in my patients' lives, and in their families' lives. As a Certified ostomy nurse, your job is to TEACH the patient/family to be independent in the management of their ostomy. You teach using demonstration and return demo above all, but not entirely. You trouble-shoot and determine the best pouching system. You teach how to obtain ostomy supplies and set them up with responsive vendors. You advocate with their surgeon and their suppliers. Surgeons have no idea how to manage ostomies; that's why ostomy certification came into being. You also do a HUGE amount of teaching to nursing staff and nursing students--that's key, since we aren't there 24 hrs/day.

Certification through WOCN educational endeavor is the Gold Standard. Period. But please consider: before doing ANY specialty course work, you first need to become an expert nursing generalist, which will require at least five years of med-surg staff nursing. Only then will you be prepared to BEGIN to become a board-certified specialist--in any nursing specialty. A wound is just one part of a whole person--whose individual characteristics will tell you how to proceed ONLY if you can correctly "read" the whole person. Margo533, CWOCN since 1995

You definitely need at least five years of med-surg practice before going for certification. This is because the CWON must consider age, prognosis, cognition, ALL body systems, comorbidities, nutritional & immune stutus, medications, psycho-social support system, etc etc when treating patients with wounds & ostomies. I think this is true of any nursing specialty--you must first be an expert generalist before you can specialize.

The whole point of a CA alginate dressing is absorption greater than gauze packing, so NO, don't moisten the alginate. Margo533, CWOCN

This is why certified wound specialists are needed. You need to look at the bigger picture: what's the patient's over-all condition and prognosis? The plan depends completely on that. For example, if this is am acutely terminal patient, I'd put on a dry dressing and relieve pressure. If it's a patient with the nutritional and immune status to heal, and moderately good prognosis, only then would I proceed with debridement. Soften it up with a transparent dressing, then sharp debride the eschar off. Then a chemical debrider will have the opportunity to work. Margo, CWOCN since 1995