Skin Prep and Duoderm

[bshaw96]

Has anyone ever used the skin prep pads under a duoderm pad? I'm new to HH, but I went out with the HH nurse last week. There is a patient with a stage 2 on her sacrum. They are having problems with the duoderm peeling off. She is bedridden, and is not moving around a lot, so it's not from that. In my opinion, it is from the wound drainage. Not much, but enough in my opinion to keep the duoderm from staying on for the time needed. In essence, it's getting pulled off everyday, and is making things worse. I suggested some sort of absorbent dressing. But HH nurse used skin prep to try to keep the duoderm in place. I've used skin prep with dry dressings to keep them in place, but never seen it done under a duoderm. Will this help or should we try a diff. course of action? I was merely observing that day, so didn't want to step on her toes. But to me the duoderm just didn't seem to be doing the trick.

[mommy.19, MSN, RN, APRN]

If the drainage is more than small to none, your are correct in feeling another product is more appropriate. Duoderm is a hydrocolloid, you'd likely need something more absorbent like a foam or an alginate. Also, it's not likely a stage II if it's having that much drainage, thought I can't see the wound so my opinion is not very valuable. Also, if the pt is incontinent and the skin is often very moist (i.e. pt not being cleaned or turned properly), you will be hard pressed to find a dressing to stay. Maybe a tegaderm foam? Just my 2cents.

[coupb8222]

How did the saran wrap work? Didn't it trap moisture to the area promoting further breakdown or did you get it to heal?

[hawthornernkelly]

What about using mepiplex border after skin prep?

[mommy.19, MSN, RN, APRN]

a mepilex border would be appropriate for moderate to large draining full thickness wounds, but requires a primary dressing as well (mepilex borders are secondaries unless you're using mepilex border Ag).