Stalled wound

[bebop1]

I have a Young 28 y/o female living in a LTC due to an open abd wound. it tunnels over 15 cm from 8-11 oclock.....this wound l and w is getting smaller but not the tunnel. the "weekend" manager ordered the smith and nephew for her over two or three months ago. this tunnel or what ever you want to call it...has NOT gotten better. this manager used to be the DON, so its like they do not want to listen to anyone. and it really makes me mad. I finally got the doctor to order TLC and pre-albumin....the levels where horrible. so we are starting with supplements and increase in protein. no infection. she is obese. what would you do?

My facility wants to use the smith and nephew because it is cheaper. I have "fought" for KCI at times. I think smith and nephew works for some wounds...but not all...like for KCI works for some but not others....I am in school at the moment becoming a WOC, and they are finally listening to me, but there has been two times I order a KCI on like wednesday, and when i get back on monday this weekend nurse has changed it out to smith and nephew!!!!!!!!!!!!!!!

suggestions for this patients wound? should I try another dressing? would KCI work?...the other measurements are

8X5.8X1.2

granulation...but as I see with the S&N...It looks "slick"...not the bumpy like with the kci.......what should I do? or suggest?

[skinnurse66, LPN]

Is there alot of drainage from the wound? are you packing the wound? Have you done a pre-albumin level it is a more accurate test then just the albumin. Was this a surgical wound to start with?

[bebop1]

I have just asked for a pre-albumin, so i will see.....it is drainig a mod-large amount. it is a wound that dehisced from a gastric bypass. so yes we are packing the wound with the "wet 4x4's" from the smith and nephew NPWT system.

she has so much pain that does not make sense with her actions, ie...playing Wii in the rehab gym, walking down the street with family to the local mexican resturant...and such. yet no infection, just had a ct no evidence of abcess or anything seen.

anyideas?

[KCCC357]

Has the wound been cultured? Also, may not have infection, but may have bacterial load. Try a wick dressing that has silver in it. Also the Dr may consider opening up the wound if the opening gets too small.

[morte, LPN, LVN]

is she following her post surgical diet plan?.....going to the local mexican restl. doesnt sound like it, though it could be for the "socialization"...but if she is that mobile, why isnt she in home care? has she lost weight post surgery? is she diabetic? etc

[LPN-WCC]

You may have a smoldering infection. Get an order for either CT or MRI to find out if she's pocketing. I would also get a CRP and ESR. Non- compliance is standard issue with wound pts. all you can do is document, document, document. Make sure you include education in that.

Let a primary nurse switch one of my vacs. I would come *******' unglued. To me the KCI products are the gold standard, but expensive. I hate the S&N NPWT, they need ALOT of work.

Watch this pt. close, she's got something going on. Are you doing the measurements yourself?

What did your cultures show?