Seeking expert advice on macerated area RLE

[PANYNP]

Seeking expert wound care advice, as my home health agency neither employs nor consults with a WOCN.

Patient was referred by PCP. Patient is a 62 yo well-nourished community-dwelling semi-retired moderately active non-smoking non-diabetic female with known venous insufficiency. No history of lymphedema. ABIs are 0.9 bilaterally.

Pt presents with a 3-week history of a 10 cm x 5 cm area containing approximately 12 punctuate weeping lesions on her R posterior calf. She states this area of skin irritation with weeping began during a Prednisone taper following severe bronchitis.

Pt was evaluated in Wound Clinic and was treated with Aquacel Ag and application of an Unna boot. Due to severe sensitivity to the zinc oxide component of the Unna boot, a recommendation was made to discontinue the Unna boot and continue with application of Aquacel Ag to affected area q other day, cover with ABDs, apply Eucerin to non-affected area, cover with one layer of Tubigrip foot to knee, and elevate extremity as much as possible.

Pt states that Aquacel Ag and dressings become saturated with serous fluid within 3 hours of dressing change, with accompanying maceration and circumferential skin irritation at ankle.

Pt is capable and compliant with carrying out her own dressing changes, but is concerned with lack of wound healing progress and required frequency of dressing changes, as well as cost of supplies.

Looking for suggestions on alternative to Aquacel Ag or any other ideas to promote healing.

[PANYNP]

Intended to say "punctate lesions", rather than "punctuate" lesions. Spellcheck, ugh.

[FallingInPlace, ADN, BSN, RN]

With weeping venous ulcers, you do need an absorbent layer over the Aquacel Ag, such as an ABD pad (which she was using). Some people find maxi pads work as well and are a bit cheaper. If she can tolerate compression, a 2 layer light compression wrap over the ABDs, such as 3M Coban Lite might be helpful because it should reduce the number of dressing changes. Triad cream can also be very helpful in preventing maceration of the periwound. Unfortunately, these wounds can be slow to heal, but she's not diabetic and has good ABIs. Reinforce the importance of no smoking if she is a smoker, good nutrition, and leg elevation.

[rkitty198, BSN, RN]

I like cavilon skin barrier spray as a base before any products to start.

I would also take into consideration her albumin-pre-albumin. I might even look into her bp, renal function. Sometimes in acute care we have done a few doses of lasix to help the diuresis which will give the extremity a day or two to start drying out which does help a lot.

[sallyrnrrt, ADN, RN]

These wounds respond to hyperbaric oxygen tx.........if that is an option in your area

I'm a big fan of therapeutics of hydrogel Ag.....

[Nursern06]

I would paint the periwound area with gentian violet. Then apply aquacel ag and drawtex. Then a two layer wrap to help it heal faster.

[Wound Nurse - Sales]

Here is a product that I have used on HEAVY draining wounds. not cheap but very effective.

http://www.elastogel.com/product-catalog/wound-care/gold-dust-wound-filler#products

Be very careful not to overdry the wound.

[versican]

For heavy weeping, have you tried transfer (mepilex transfer) which can last up to a week, covered with abd pad (or diaper)? Secured with roll gauze/tape. Large nylon to hold it-tubigrip for compression over all that. Elevate.

The abd pad (or diaper) can be changed daily and prn. Transfer stays in place up to a week.

[carrie276]

Aquacel to wound bed followed by Drawtex, abds, kerlix and 2 layer compression system. Elevate! Tell patients to watch TV through there feet lol