sacral wound dressing help

[lpn1313]

I have a pt. who has a pressure ulcer perhaps 3-5 mm above the orifice. Anyone have suggestions as to how we can place a dressing here without it becoming full of stool? Pt. is inc. of both bowel and bladder. Any suggestions would be greatly appreciated as we are at our wit's end... We've tried comfeel in various shapes, blisterfilm over gauze, allevyn in different shapes.

[suebird3]

I was told that ANY eschar on the wound automatically made the wound "unstageable".

BTW, Allevyn is a good product.

Suebird

[ROSIEK]

If the wound is developing black eschar it has to be changed to stage 4, in our facility if resident has stage 3 or 4 we can put catheter in them to help keep urine out of wound. I like to use accuzyme on necrotic tissue, it helps to debride the eschar. also Panafil is great to promote granulation. we use optifoam dressings to cover these areas. The optifoam is by medline. Hope that this helps.

With the recent changes to F-Tag 315 it is not appropriate to use a urinary catheter unless medically indicated. A catheter to prevent contamination to a wound is considered a convenience and is a red flag to surveyors. Gladase and gladase c are less costly to the facility than accuzyme and panafil and have similar ingredients and same mode of action check the PI in the box for the ingredients. Also while the wound covered with eschar is unstagable for the MDS it is considered a stage IV. Your documentation in your NN or Progrss report should indicated that it is unstagable due to eschar.

[Angbabe]

this may sound verrrrry odd, but applying honey to the wound will keep infection from growing, and keep all the other icky stuff out! it worked wonders on my stage two wound after my wound doctor told me to do it. Also cleaning the wound two to three times a day with a combination of first bubbling it out three times with peroxide, a couple syringes full of bleach water and last but not least 3-4 syringes full of rubbing alcohol. My wound healed so fast with these procedures!

[mommy.19, MSN, RN, APRN]

Assessment of a wound should include many factors.

Addressing the etiology is very important in preventing regression, i.e. offloading of the area.

Moisture balance is also important, as is reduction of bioburden.

Colonization can place the wound back into the inflammatory cycle and prevent it from progressing. The wound should be cultured (not a drainage culture) but a tissue culture to see what may be causing pathogenic changes, if any.

What is the patient's pre-albumin? Juven is a good supplement to increase pre-albumin, it mixes with any beverage.

The wound, if covered in black eschar, needs to be sharps debrided by a physician if possible, or autolytic/enzymatic debridement utilized.

As for the difficulty in dressing the wound, for those wounds that are right on the edge of the orifice, I use an allevyn thin, or cut a strip of it if its that close, and place that between the wound and the orifice, the apply a mepilex border over it, after applying copious amounts of skin prep. We then place abd pad/tape over that so whenever the patient is soiled, it is mostly soiled over the abd pad/tape. I realize this is laborious but it is critical that the stool and urine stay out of the wound, for obvious reasons but also the wound requires a very specific moisture AND pH balance to begin building new tissue.

I would definitely suggest using an antimicrobial dressing, depending upon amount of exudate and also if the wound can be sharps debrided by a physician. The eschar can be covered with an autolytic debrider such as hypergel (although not antimicrobial, most bacteria except psudomonas have difficulty living in such hypertonic environments), as long as the periwound is protected with zinc oxide or other barrier. This would do best to be changed daily. Using anything such as dakins solution, bleach, peroxide, etc, is cytotoxic and will only serve to kill good tissue along with the bad. Hope this helps.