ulcer dressing won't stick

[mickeymouse123]

I have a resident that has an ulcer on her coccyx and have tried many different dressings and techiniques to get the dressing to stick. The ulcer is right above the beginning of the butt crack and that is where it will not stick.

Any advice would be well appreciated

Thanks

[infectionRN]

opsite works well in this area, keeps soilage off the dressing as well. Good luck.

[CapeCodMermaid, RN]

You could try an Allevyn Adhesive, a duoderm or comfeel. Just make sure you keep your hand over the dressing for at least a minute. I've found many dressings won't stick if you 'slap' it on and walk away. The heat from your hand helps melt the adhesive so it stays stuck.

[mc3, ASN, RN]

I like Mepilex border sacrum. It comes in a heart shape :redbeathe, with the bottom of the heart right on the split of the buttocks. I take a pair of scissors and cut just the outer portion of the dressing to lay it against the inner buttock area. They stay pretty good, even in this area that gets easily soiled. Plus the silicone dressing part is tender on the skin (I like MUCH better than tegaderm!)JMHO:nurse:

mc3

[hottiemom04, BSN, RN]

Applying skin prep to the peri-wound allows great adhesion to the actual dressing and will also toughen the fragile skin at the same time.

[TopazLover, BSN, RN]

I the wound is bad, get a consult for a wound care specialist. This can be covered by Medicare, I think, and then the dsgs would be covered expense so you could get exactly what she needs. Many facilities do not carry enough of a variety of dsgs to get the exact one.

If it is not bad, try any or all of the other suggestions. You might want to get some samples from some companies to evaluate the product on her.

[CapeCodMermaid, RN]

I don't think Medicare will pay for a wound care specialist...and wound supplies are billed under med b

[TeresaB930, BSN, RN]

I agree with you hottiemom......I'm the wound care nurse at our facility. Wash the wound and peri wound, then dry it well. Apply a barrier like No Sting. It provides a barrier peri the wound, providing better adhesion for the Tegasorb or whatever you're putting on, but it sounds like there is some increased moisture in this area. The No Sting, by providing a barrier of adhesion, also provides a barrier to the skin so moisture doesn't sit on the skin.

No Sting comes in little packets like a 1"x1" sponge.

Good luck!

[achot chavi]

We have an adhesive spray that is intended for stoma bags that could work, you didn't describe the wound so I dont know what stage it is etc, but what works well with wounds in this area is

1. showers every day with extra time spraying water on the wound and if you cant, do this:

spray water through a 20 or 60 cc syringe and a 21g needle to loosen debris ( if exists) or without the needle if the area is clean. pat dry with a (sterile) gauze pad

2. wet (saline or ringers lactate) dressings covered with a nylon glove and tape over the area In Israel they are called Tenderwet- dont know what its called in the US advantage of this dsg is that its good for 24 hours, enough time so body temp remains stable but allows the nurse to see how its progressing. It absorbs the exudite and any wetness and nourishes the wound. a moist environment is also good for cell growth.

with this dsg you have to cover the "healthy" skin around the wound with a zinc oxide cream or vaseline

Please give more details about the wound, so we can help- wonder if we could add pictures to this?

[nerdtonurse?, BSN, RN]

If you don't have the specialty dressings (we carry them, but the odds of finding what you need at 3 in the morning are not great), take a rectangular shaped dressing, cut one point like the underside of a "W" with the orifice going into the middle point of the W and the "wings" going toward the buttocks. Cover the edges with opsite tape.

And it'll last until the first time the pt stools....

[CoffeeRTC, BSN, RN]

Does it need a dressing or can you use a ointment or thick barrier. Yrs ago I remember using Ilex cream on perianal wounds that were hard to dress...It worked.