Question: Dakins Tx of Pressure Ulcer

[RPN_2006]

Looking for your opinion.

Several pressure ulcers are being debrided of slough OD c sterile gauze soaked in Dakins 1:4, wet to moist. Peri-wound protected c petroleum jelly. Wounds are debriding quickly and granulating nicely. I have been careful to avoid packing on new granulation.

In one of these ulcers the last piece of slough came out of the base and a tendon was revealed. Wound base is now moist pink granulation and a tendon, no slough or necrosis.

It was my understanding that this solution would destroy healthy tissue, therefore I attempted to update physician (this is homecare), however he was unavailable. I held the Dakins and packed the affected ulcer with sterile NS soaked gauze instead.

I did this for two days (several phone calls, a fax later) and the wound looks good.

Day three I recieve a written response to continue tx c Dakins.

So I guess I am wondering if this is typical use of the product. I have referred cl to our ET who will assess next week. Is it safe to continue tx in the interm? All info I have found suggests protecting peri-wound...but a tendon?

[sharlynn]

You are correct and the doctor is very outdated! I personally have not seen Dakins ordered since the 70's! I'm surprised you have had such good results.

I'm not sure what to tell you, since you have a direct doctor's order and I don't know the exact circumstances. For instance, does the doctor ever actually look at the wound, and is he the "Dr God" type who will raise a big stink because you didn't follow orders?

Personally, I would continue with the NS until your ET could look at the wound. But I worked with a great bunch of doctors who admitted that I knew more than they did about Wound Care and pretty much did whatever I suggested.

Sorry I can't be of more help!

[RPN_2006]

Thanks for your reply.

It is presicely because we never see this tx anymore that I am unsure.

"Dr. God" is a vascular surgeon and sees the cl q 4 weeks, which is another two weeks from now. Our ET may have better luck than I did (I hope).

[oldiebutgoodie, RN]

At my facility, we have used Dakin's for a limited time, such as a week, on a wound which is malodorous. Then we switch to a different treatment. once the odor is gone (and we presume there is now a reduced bioburden in the wound).

Oldiebutgoodie

[Codypatody, BSN, RN]

Dakins is appropriate to use on wounds infected with Strep or staph. The dressing is done TID for two weeks max. I don't know of Dakins being effective on debridement but if used with a wet to dry dressing, I am sure that will happen.

[NurseyBaby'05, BSN, RN]

We use it too for infected wounds that don't respond well to other newer tx. Definitely not for long term either.

Like another person said, the new healthy tissue is probably secondary to the fact that its'a wet->dry dressing as opposed to what the solution is.

Maybe continue the Dakin's until the ET consult unless there is noticible skin damage. A few more days won't make or break anything.

[treatwounds]

Dakins can still be used to treat pseudomonas. Used as a wet to damp so that you don't tear up the granulation tissue.

Anyway, it works.

[Codypatody, BSN, RN]

Acetic Acid is a good alternative for pseudomonas as well. TID for two weeks.