Stoma powder for bed sores?

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I had a patient last night where wound care ordered “crusting”, he had a very large stage 3 pressure ulcer on his coccyx that was moderately bleeding. Wound care ordered stoma powder to be applied to the area, said that the powder would dry and form a crust. However when I turned the patient for dressing change it was moist and sloughed off on the pads.
Day shift nurse said I wasn’t suppose to remove the “crust” layer, I said I didn’t, it came off with turning. 
I have never heard of this technique, is this a new technique?!

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I don't think it's necessarily a new technique, there is a reference from 2006, Efficacy of a skin-protection powder for use as a dressing for intractable ulcers, that can be found in Pubmed. I don't know what the utility of this method would be over calcium alginate which is a more traditional wound dressing that absorbs moisure and creates a gel type barrier. It is my understanding that you want to maintain some level of moisture so the "crusting" technique is not one I have seen personally. But I'm far from a wound/ostomy expert. 

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Specializes in Med-Surg, Geriatrics, Wound Care.

For the crusting method I am familiar with, you would apply the stoma powder, and then a skin sealant over it, such as a No-Sting barrier (one brand being Cavilon, but there are other brands, also). The stoma powder absorbs the drainage, the skin sealant provides a barrier to keep the powder next to the skin, and the incontinence out. Some of the skin protectants say they are good for several days!

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Specializes in Vents, Telemetry, Home Care, Home infusion.

I've done this years ago prior to calcium alginate dressings.

Stoma powder helps to decrease bleeding by absorbing moisture from raw/broken skin; it needs to be covered with another product like barrier spray/wipes - will be wet then you air dry prior to dressings.  See:

https://www.veganostomy.ca/guide-to-ostomy-stoma-powder/

 

Bleeding Fungating wound care:

https://enclarapharmacia.com/palliative-pearls/managing-bleeding-fungating-woundstumors

Wound care advice:

https://www.woundsource.com/blog/maintaining-wound-bed

https://www.hopkinsmedicine.org/gec/series/wound_care.html

 

Today, I would not use crusting technique.  I've used gentle saline cleanse, apply gauze dressing to absorb /blot bleeding  prior to wound care: Peri wound use skin prep, then collegen powder to bleeding area, apply calcium alginate dressings/rope etc for moisture absorption.

https://www.woundsource.com/product-category/dressings/alginates

A Wound Care consult indicated for more current treatment plan.  Best wishes in getting effective wound care for this patient.

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1 hour ago, NRSKarenRN said:

I've done this years ago prior to calcium alginate dressings.

Stoma powder helps to decrease bleeding by absorbing moisture from raw/broken skin; it needs to be covered with another product like barrier spray/wipes - will be wet then you air dry prior to dressings.  See:

https://www.veganostomy.ca/guide-to-ostomy-stoma-powder/

 

Bleeding Fungating wound care:

https://enclarapharmacia.com/palliative-pearls/managing-bleeding-fungating-woundstumors

Wound care advice:

https://www.woundsource.com/blog/maintaining-wound-bed

https://www.hopkinsmedicine.org/gec/series/wound_care.html

 

Today, I would not use crusting technique.  I've used gentle saline cleanse, apply gauze dressing to absorb /blot bleeding  prior to wound care: Peri wound use skin prep, then collegen powder to bleeding area, apply calcium alginate dressings/rope etc for moisture absorption.

https://www.woundsource.com/product-category/dressings/alginates

A Wound Care consult indicated for more current treatment plan.  Best wishes in getting effective wound care for this patient.

 

 

 

 

 

Thank you!!! Very helpful

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Specializes in Justice ⚖️ Nursing.
On 8/28/2022 at 3:49 PM, Aloe_sky said:

I had a patient last night where wound care ordered “crusting”, he had a very large stage 3 pressure ulcer on his coccyx that was moderately bleeding. Wound care ordered stoma powder to be applied to the area, said that the powder would dry and form a crust. However when I turned the patient for dressing change it was moist and sloughed off on the pads.
Day shift nurse said I wasn’t suppose to remove the “crust” layer, I said I didn’t, it came off with turning. 
I have never heard of this technique, is this a new technique?!

I have never either and I worked on med surg unit with colorectal post ops and a mixed bag of wounds. Of course, this was 9 yrs ago so could be a new side trick to make debridement easier, but all.I think of is clumpy wet powder. ? 

Edit: just googled...so wounds with min exudate, can use for moisture control. Seems she was wrong about using it to form a crust though. The opposite would happen, I'd think. Unless it's covered it's not gonna stay on long enough to get crusty. I don't like the idea of it, myself. 

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Specializes in Geriatrics, Dialysis.

I've used it in the past for pressure wounds in the LTC setting with decidedly mixed results. The only times I have seen any measurable improvement to a coccyx/sacral ulcer was when that dressing order was combined with strict side to side repositioning and the resident only up in a chair for meals and limited activities. The pressure reduction from the strict reposition schedule was likely a much larger contributing factor to the wound healing than the stoma powder dressing change was.

There are in my opinion much better options.   A collagen powder dusting covered with a calcium alginate dressing would likely give much better results. However some of those more effective dressings can also be quite expensive. I can see some facilities just not being willing to order those expensive dressings.

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Specializes in been around the block.

I have a patient that has sacral and coccyx pressure ulcers complicated by frequent fecal incontinence.  staff, patient, and family have been doing great with pressure relief efforts- turning and bridging, but progress is very slow.  now it looks like another spot has opened up.

dressings are not helpful because they would only hold the feces against the skin.  we used a skin barrier ointment for the first few days, because that is our first line treatment.  I changed it to skin prep bid, then tid which improved for a while.  

nutrition is OK.  pt eats (is fed) during the day and has tube feeding overnight.  but this also means poop is frequent.

today I am going to try the stoma powder+adhesive spray combo to crust the open wounds.  I don't have access to Coloplast Triad cream-what I would rather use, so this may be my best option.  wish me luck.

search for "Efficacy of a skin-protection powder for use as a dressing for intractable ulcers | Journal of Wound Care (magonlinelibrary.com)"

BTW:  when I was learning the crusting technique, I made the mistake of using too much powder a few times.  this makes the crust too thick and fragile, and won't stay.  the original poster of this thread was not necessarily in that situation, but I mention it for anyone else going through the learning process.  OP may have been dealing with a wound with too much exudate that a crust will just keep washing off from underneath.

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