And I need some ideas on what kind of dressing to use.
Patient in her 90's, very thin and bony; sits in WC or lies in bed. I did a recert visit on her last week--my first time to see her--and discovered this new wound on her ischial spine.
The wound is approximately 6x4x2cm; wound base is 30% red and "healthy" looking, 70% yellow, adherent "slough". Scant serous drainage, no malodor.
My first thought was to get rid of the slough, so we started daily wet to dry dressings with NS. After a week or so, it actually has developed more slough, so now I need some ideas. MD open to our suggestions, which is great.
Another RN suggested Aquacel AG, but I'm concerned that the wound isn't "wet" enough for that to be effective. She suggested that I wet the Aquacel with NS first, then cover with gauze. How does that sound?
If you're an MD, have you considered sharp debridement? Or referring patient to one that can debride it? This will quickly get rid of the slough instead of the very slow process of santyl or other dressings that allow for autolytic debridement. Less slough equals less food for bacteria. If you go the santyl route make sure you cross-hatch the slough to get better results. Above all, hope you can keep her out of pain...
I would get her a speciality mattress and a roho cushion if she doesn't already have them. Ask yourself, is it really necessary to send a pt in there 90's to a wound clinic for sharp debridement?? Please start with santyl, hydrofera blue or medihoney.
I would get her a speciality mattress and a roho cushion if she doesn't already have them. Ask yourself is it really necessary to send a pt in there 90's to a wound clinic for sharp debridement?? Please start with santyl, hydrofera blue or medihoney.[/quote']
What if she only required one trip? She deserves to have the chance for this wound to heal as quickly as possible. We see many patients in that age range and are by no means aggressive, requiring weekly visits for their care. This patient should be presented with all options. That being said, there are generally docs that will come to NHs and SNFs willing to perform bedside procedures.
We have a running joke about wet-to-dry. I swear that is the only dressing change MDs learn during residency. All our fellows come in and order wet-to-dry for every patient they see.
lorirn58
74 Posts
Ca Alginates do not "secrete" a gel. They become gel-like after they get wet.