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Stage III not responding to hydrogel


Hi everyone!

I have a pt with a stage III to her sacrum. When she was admitted, it was 2.5x2.5x2, mostly pink. Hydrogel drsg was ordered. When I did my weekly reassessment, the wound was not responding well. It was larger, had no granulation tissue, and had macerated edges (no necrotic tissue was present but there was dark red pigmentation in some areas).

I am relatively new to wound care and have only seen positive things from hydrogel so far. I know the maceration is most likely from floor nurses not cutting the drsg to fit the wound, but in general, our pt's are well cared for and on a turning schedule.

Soooo, my question is, can someone recommend a different dressing for this wound?

Sorry if this sounds novice but I'd appreciate the help.


CarreBarreLPN, ASN, RN

Specializes in Sub Acute and Wound Care. Has 3 years experience.

Well there are a lot of factors consider in order to come up with a proper dressing. Here are a few more questions I'd ask myself before changing the dressing:

1. How long has this particular dressing been ordered?

2. Has the dressing been working (ie have the numbers been changing the tissue bed improving etc)?

3. How much drainage is there?

4. What am I covering it with?

5. Is there an odor?

6. What does the wound bed look like? Is it pink, anemic, sloughy?

7. Is the pt continent or incontinent and have they had loose stool lately?

8. Is the dressing being changed properly, on time, too often, or not enough?

9. What are their labs and nutrtional status like? Are supplements needed?

10. Are they actually being turned?

mommy.19, MSN, RN, APRN

Has 7 years experience.

Well, hydrogel is for wounds that are small to NO exudate, and is amorphous so it can (and likely will) macerate healthy periwound even if used on a wound with a dry bed. So, it is not likely the person changing the dressing that is causing this maceration. The wound needs something that is appropriate for it's specific level of exudate. CarreBarre listed very pertinent questions and I would definitely address these. I would discontinue the hydrogel immediately if it were my pt. Just my 2 cents!


Has 10 years experience.

How much depth does the wound have? How much drainage? For maceration I use Sure prep to the periwound. I would also consider using calcium alginate or Puracol depending on drainage amount.

I hope you eventually got an order for WoundVac.

mommy.19, MSN, RN, APRN

Has 7 years experience.

I have never seen the wound, but don't feel that based on its dimensions that a wound vac would be appropriate.

Drainage drives the dressing.

What type of dressing are you using? The brand.

I would change to something with more absorption that will fill dead space too.

From what you are describing the wound is more exudative and the hydrogel impregnated dressing is not appropriate.

It all depends on the products you have on hand.

List the alternative dressings you have available in your formulary so we can help you a little better.