TAS for wet-to-dry dressings used for everything!

[ceecel.dee, MSN, RN]

Our facility is in a real rut! All of our GP's defer to our General Surgeon for wound care orders, but he orders the same thing for any and all types of wounds! Triple Antibiotic Solution (TAS), wet-to-dry, dressing changes BID. This may be appropriate for his surgical patient who is left with an open incision, but for pressure ulcers in need of debridment, or venous stasis ulcers?

Can the TAS actually be harmful to some wounds?

The other facility I pick up some hours at (and the same surgeon has priviliges at) is in the same rut, although they do not believe in irrigating the wound well with saline at each dressing change. When asked, the surgeon really has no preference about how this is done!

With all the great products out there, there must be better ways to be treating these wounds, but he thinks there is just really good marketing by the product reps for expensive dressings, when all that is needed is 4x4's and TAS (not cheap either!).

What say you experts? Help!

[Destinystar]

The surgeon can order whatever his little heart desires. But afterward we have to monitor the response to treatment. If the wound appears to be healing without s/s of infection I see no reason to change the tx. However if the wound appears to have s/s infection you need to culture the drainage and do a C & S. If there is an infection sometimes the pts. has to have more aggessive therapy like PO or IV ATB. If the wound has MRSA cant use bacitracin need to use muciporin. If the wound needs debridement it is best to ask the MD for a consult from a WOCN:p

Our facility is in a real rut! All of our GP's defer to our General Surgeon for wound care orders, but he orders the same thing for any and all types of wounds! Triple Antibiotic Solution (TAS), wet-to-dry, dressing changes BID. This may be appropriate for his surgical patient who is left with an open incision, but for pressure ulcers in need of debridment, or venous stasis ulcers?

Can the TAS actually be harmful to some wounds?

The other facility I pick up some hours at (and the same surgeon has priviliges at) is in the same rut, although they do not believe in irrigating the wound well with saline at each dressing change. When asked, the surgeon really has no preference about how this is done!

With all the great products out there, there must be better ways to be treating these wounds, but he thinks there is just really good marketing by the product reps for expensive dressings, when all that is needed is 4x4's and TAS (not cheap either!).

What say you experts? Help!

[sharlynn]

Most surgeons are hopelessly out of date when it comes to wound care. My husband recently had a lap chole and one incision was infected. I used Polymem and he said to clean it with peroxide! Needless to say, I didn't follow his instructions.

My facility has a Wound Care & Prevention Team. It consists of nursing from acute care, LTC and Home Health, dietary, OT, PT and Infection Control. There is a standing order for WC&PT as needed. We make recommendations for treatment and the doctors just okay them. It is working out very well.

[Jay-Jay, RN]

For diabetics, wet/dry dressings can turn dry gangrene into wet gangrene, which is the LAST thing you want to do.

Someone needs to get this dinosaur...er, doctor to update his skills!

[Traveler]

I think reasons for the continued high usage of w/d dressings is either from ignorance about other options and cost. It is much less costly to do a w/d dressing. The last HHA I worked for used this a lot. Now I am at a job where they never use these. The initial cost is higher but the overall outcome is lower because they work much better.