Question about dressing

[NurseDianne, ADN]

I have a patient that has venous leg ulcers that drain a lot!! The facility where is currently lives uses Optilock w/ Kling wrap. They change the dressing bid d/t the excessive drainage. I have spoke to the wound care nurse and she said that is the only thing they have found that works. Two things my nurse manager wants me to think about, 1) is it really necessary to change his dressings bid and 2) the cost incurred by use of the Optilock (8) per day. I have ask and researched, I just don't see anything else to use. They have tried abd pads but they don't stay in place. Someone suggested peri-pads or some type of "depends". However I find that degrading to the patient.

Any suggestions?

Thanks

[Kittypower123, BSN, RN]

We had a patient with a similar problem. We used zinc oxide applied daily (after cleaning the legs of course) covered with abd pads and wrapped with kerlix. We did the wound care daily and the wounds really improved. We were eventually able to reduce wound care to threedays a week.

[pfeliks]

I had a patient exactly like that and after a wound care consult(iWork for a national company). We used unna boot with zinc,fan folded so there was no circumfrential wrapping. Then wrapped with surepress padding and then wrapped the whole thing with kerlix. Only had to change it twice weekly and it worked like a charm.

[SuesquatchRN, BSN, RN]

What's the terminal diagnosis? Is your agency necessarily responsible for the dressing supplies?

[TammyG]

We often use elastic retention netting (try Curad size #5) and ABD pads on leg wounds that need frequent changes. Otherwise you'll spend a fortune on specialty dressing. If you have to change the optilock twice per day, they are not fulfilling their purpose. I'd go with the netting and ABDs.

[pfeliks]

What's the terminal diagnosis? Is your agency necessarily responsible for the dressing supplies?

Yes our agency had to pay for the supplies which were not cheap. But as they were recommended by our wound team, the bean counters couldn't deny the charges I also work for a company where most supplies are able to be ordered vendor to patient from any nurse's computer. Orders placed before 1 pm will arrive the next day. It makes life easier. I have a patient right now with lung ca and acute promylocitic leukemia who recently fell and denuded the top layer of skin on her anterior calf. I accompanied her to the ED where definitive wound closure was done. Today I visited her and saw that she would need a Daily DPD. 6 inch border gauze will do the trick.. I was able to pull 2 of them from my emergency carbox and order 28 which will arrive at the patient's house tomorrow It makes life easy as on call will need to make daily visits this weekend and all wound care supplies will be in place. Our office manager will replace the 2 I pulled from my carbox

[NC29mom, ASN, LPN, RN]

I would love to know of a wound that wouldn't be related to the diagnosis in which the hospice refused to provide supplies. Sounds like a cop out to me. We provide wound supplies regardless of etiology and dx. Its called "Good care"

That's like saying. "Well Mr x, we can't pay for your incontinence supplies because you were incontinent long before you were dx with cancer"

Just like our pts that require colostomy supplies. ...but we have for dementia (or whatever dx not related). We still provide those colostomy supplies.

[TammyG]

One example I have seen recently is a chronic scalp wound resulting from a craniotomy a few years back; hospice diagnosis is COPD. Another is an infection at surgical site following hip surgery; hospice diagnosis is dementia. I think that hospices vary in their willingness to consider these types of wounds as related to hospice diagnosis. The issue doesn't come up that much with supplies but more often with obligation to treat when these wounds require treatment by an infectious disease specialist or more sophisticated treatment.

My hospice does not pay for colostomy supplies unrelated to the hospice diagnosis.