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Discussion

Skin breakdown...not sure what to do for it

I am a home health nurse. I have a patient who is bed bound. Her caregiver is wonderful to her. takes great care of the patient, but at the same time calls for every little thing. This patient has a feeding tube, and everything is great with that. We change her cath once a month.....we try...but it seems we do it every 3weeks. It "leaks" she will call at 3am. We have to tell her...that the patient is having spasams and that it will happen, this patient has had a cath now for over 1.5 years. chronic UTIs, so the dr has ordered that we change the cath every month....but can every 3 weeks...but no less.... Pt of course cannot use bed pan or commode. has at least 3-4 BM's a day. Caregive is usually pretty good in cleaning her up when she has them. But these last few weeks the patient has gotten these...I guess I call the pimples...on her buttocks. The caregiver says Boils? did I even spell that right ?? anyways....he buttocks is not really red at all...a little pink if anything. but they just all the sudden appear...with a white raised head, and "pop" and the caregiver squeezes them and white pus comes out, and it seems to bother the patient? what kind of care do I do to these things? what do you call them? they are any where from 3cm from her rectum to middle of her buttocks. I have her clean them and keep them dry. At times the caregive had applied ultra thin duoderm. Due to she had them from a previous pressure ulcer.

Any suggestions? She uses the barrier cream/ keeps her turned...I am not sure what they really are? and they have just started maybe this last month. No new meds, no new infections. I have had this patient for a year and a half. this is new.....and weird! any information would be great!!!!!

thanks!

confused! in louisiana! :rolleyes:

Featured Replies

  • Expert

For a starters what size catheter are you using?? There was some research in the spinal unit when I trained (Okay that was YEARS ago) on leaking catheters - they found that if you used a smaller cath it stops the spasm and the leaks. The other trick is to re-inflate the bladder - just by fity mls or so - an hours worth of clamping a couple of times a day and this should help stop the spasms. Have you got this patient on cranberry capsules?? This might also help.

Next question (boy I am nosey today:D) What underpadding do you have this patient on?

  • Author

she has a 16fr 5cc balloon...we install 10cc of fluid. her caregive gives her the cranberry supp, and she is on the blue pads....or the chux...I am not sure what brand we use...but they have been the same ones the whole time...we have not switched them.

  • Expert

It does sound as if she has a folliculitis. I might leave this next bit to one of the home care nurses though as I am ICU and not as familiar with what might be available in the home.

she has a 16fr 5cc balloon...we install 10cc of fluid. her caregive gives her the cranberry supp, and she is on the blue pads....or the chux...I am not sure what brand we use...but they have been the same ones the whole time...we have not switched them.

Blue chux will cause the moisture to sit on the skin. If she has a foley and they are only worried about proctection from BM you might consider a clothe pad or a better product that will wick the moisture away from the skin. They can usually be purchased at a Home Health Care store. What is being used as a protective barrier? I have never tried the new foleys that are coated with silver but they are suppose to be great for frequent UTI's. Pricing I suppose could be and issue depending on payor source. What bug does she grow when the urine is cultured? E-coli could be imprpoer cleaning.

Blue chux will cause the moisture to sit on the skin. If she has a foley and they are only worried about proctection from BM you might consider a clothe pad or a better product that will wick the moisture away from the skin. They can usually be purchased at a Home Health Care store. What is being used as a protective barrier? I have never tried the new foleys that are coated with silver but they are suppose to be great for frequent UTI's. Pricing I suppose could be and issue depending on payor source. What bug does she grow when the urine is cultured? E-coli could be imprpoer cleaning.

I need to reply to my own response since my AM coffee just kicked in and I now realize fully what I typed. When I suggessted the clothe pad I was not thinking of the inconvience for the family. So, probably not the best choice for a home setting. My concern was that any moisture on the skin could cause the outbreak or at least hinder the healing time.

  • Expert

sounds like folliculitis..see this article + pictures.

folliculitis. dermnet nz authoritative facts about the skin from the new zealand dermatological society.

dermnetnz.org/acne/folliculitis.html

suspect either of these two things.

1. with fecal incontince, pt being washed then barrier reapplied---not thouroughly getting clean and reapplication of ointment sealing in germs either bacterial or fungal

2. too much barrier cream being applied and clogging pores.

if basin being used to wash patinet, clean it thouroughly with mild bleach to disinfect it then rinse well with water.

any change in soap or type of barrier ointment used? might have contaminated product if hands not clean when recaping.

treatments:

clean with gentle antibacterial liquid soap using baby wipes. pat area dry with clean wash cloth/hand towel. apply otc triple antibiotic ointment. if that does seem to be working after 3-5 days, switch to antifungal ointment (used for athelete's feet). if no improvment in 10 days, might need rx med.

(don't forget doctors orders)

hollihan turned me onto baza® cream antifungal barrier as skin protectant and seen that work wonders sometimes it's a matter of trial and error.

weekly visit to prevent further skin infection/breakdown.

good luck and keep us updated.

  • Author

thank you so much! I will take in all this information and try it out this week. if I can get the dr ok. out drs around the area are great...when we call them with any kind of a 'new' tx they usually say yes...try it! so I will give it a try and tell ya all if anything works! thanks! :)

  • Expert

P.S.:

might try backing off on amount of water in balloon--try 8CC instead of 10.

Silastic silicone coated catheters work well in long term clients too.

  • Author

I know at first the order was just for 10cc in the balloon...then went to only 5cc for what eve the dr wanted..then back to 10....it leaks all the time. Her urine gets very thick...a lot of sediment. So a lot of times when we do take the cath out...the cath is plugged with a lot of 'crud' even flushing the cath doesn't help out.

whatever other suggestions ya all have would be great.....I do not know if there is really anything else we can do for this patient in the leaking cath part.

I am going to try this wound care stuff as soon as I can get some orders approved form the md....

Thanks! :yeah:

Have you thought that this may be a yeast infection. If she has frequent uti's she is probably on lots of ABT.

  • Author
Have you thought that this may be a yeast infection. If she has frequent uti's she is probably on lots of ABT.

The no ABT.......right now...last time she was on them was like 2-3 months ago. She always seems to have a yeast infection.....but I had never noticed these bumps....to me I say they look like "pimples" but they are so close to her rectum. I got information to the dr about everyones above suggestions...and he will call back monday with what he wants to do! so I hope we can do something to help this poor lady out!

Hi. sorry you're having so much trouble with this patient. I would like to suggest culturing these "boils" to rule out MRSA. If positive, antibiotics would help heal the current ones and prevent new sores. By your description, I would suggest iodasorb or accuzyme (as indicated) to open areas, cover with polymem, skin prep, and secure with mefix. Hope things settle down soon. Good luck.

Kat

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