Treating an abscess

[Kathe519]

I am currently working with a patient that was admitted to my facility with an abscess to her left buttock. According to reports from her caregiver and the sending hospital, the patient has been receiving treatment for this abscess for a couple of months now. I was consulted by the infectious diease doctor for recommendations. On admission the patient presented with two small "scabbed" areas on her left buttock measuring approx 1 cm round. Honestly it looks like a vampire bit her behind. The next day, the scabbed areas opened up revealing two tunnels/tracts. The first time I was called to assess the area, I found two small openings spaced approximately 2cm apart. The top tunnel/tract is 0.5cm round and measures 3 cm deep. The bottom tunnel/tract is also 0.5cm round and 2 cm deep. They are draining a min/mod amount of almost serous, but slightly milky yellow tinged drainage. There is no odor present. The peri wound skin is intact, pink/red but blanchable. No warmth or edema noted upon assessment. The patient denies any pain during dressing changes. They have been cleaning/flushing the areas with NSS and packing them with iodoform strips, and then covering it with a dry dressing. The patient is being followed by ID and she is on oral anitbiotics. The patient has been and remains aefebrile. I should also add that she had an MRI done prior to her coming to us and it did show tunneling, but no involvement of bone.

I was a little stumped as to what more I could suggest. Right away I looked into her diet and appetite, which I found to be poor and lacking in protein. So I consulted the dietician to evaluate her for pro-stat or Juven. Something easy for her to get down but that would pack a powerful punch in the protein department. I then requested that she be given an air-mattress. She is good about turning and offloading pressure but I figured it couldn't hurt to have it in place. I recommeded that she continue to be seen by infectious diease to follow the course of anitbiotics. I also recommeded to continue the packing with iodoform once daily. Finally I suggested that she be seen by the wound care specialist at the previous hospital for a follow-up. I don't have much to compare the current state of her wound to as the records I received from the preivous hospital were seriously lacking.

I Don't know what else to do other than to monitor the area closely. Am I missing anything? I'm still pretty new at this whole wound care thing, and I hate to always jump to referring them to a wound care center, but what more can I do? Do you think they wound open it up and do some I&D on it? I'm so worried it will progress and we will be facing deeper tunnels and the possibility of oseto? Any advice would be helpful!

[mommy.19, MSN, RN, APRN]

I think referring to the wound center should be higher ranking on your plan of care. Just because, well, don't you want a wound specialist taking care of your wound? :) You were very right to do this. Was the antibiotic given empiric or one rx'd from a c&s taken by tissue culture from the wound? You sound like you're taking a pretty holistic approach, considering all facets that could be affecting healing: nutrition, bio burden, dead space, periwound condition, drainage, offloading, etc. How long has the current therapy been utilized? You may attempt a silver alginate rope or another antimicrobial or non-cytotoxic dressing to see if this supports wound healing efforts.

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