UNNA boot sticking to wounds...

[chenoaspirit, ASN, RN]

I have been applying unna boots to my patient twice weekly for about 3 weeks now. Its so painful for her because of the drainage that causes the boot to stick to the wounds. It takes me forever to get them off of her so I can reapply them. I know the boots have medi-paste in them to aide in wound healing so Ive been hesitant to apply any non-stick like adaptic over the wounds prior to applying the boot. If I apply such a dressing, wouldnt that keep the medi-paste from penetrating the wounds? I called the doc, but he is on vacation and the nurse didnt kinow if I should or not.

She was recently hospitalized and when she was d/c'ed home, I had to go and change them a few days later...to find adaptic over the wounds...which made it so easy to remove the boots. Thats how the d/c nurse had applied them (there was no order for that). Some people tell me to do so, some tell me not to. Ive been told to apply lotion to leg prior to applying, then Ive been told not to. Im so confused.

I just feel so bad for this woman...removing the unna boot is so painful and it literally pulls away skin with them. Ive soaked them in saline, Ive soaked them in water, which really doesnt help much to get them unstuck. Any advice would be very much appreciated. I have to change them again on Friday and Im hoping for it to be less painful/traumatic for her. She even cries, which makes me feel so bad for her.

I know I have to have an order for anything new I do, but I was just wondering if anyone here has learned a technique or tricks so that I could mention to the doc. Most wound care is up to us homehealth nurses. Thanks.

[groovy jeff, RN]

I am a rookie & I didn't know what a UNNA's boot was, so I did a little research. There is another thread here that may be helpful: https://allnurses.com/wound-ostomy-continence/unna-boot-171783.html

[chenoaspirit, ASN, RN]

thank you! :)

[vrily]

What I have learned about Unna's boot is that it does several things including, compression, and debridement of necrotic tissue. However, prior to applying the Unna's boot one need to apply a primary dressing to the wound itself, depending on whether or not the wound is clean, has necrotic tissue, is draining etc... example would be Calcium alginate with or without silver, or sponge dressing with or without silver. These dressing must be indicated to stay on for up to days since the unna's boot must be changed at least weekly or more if you have a weeping wound. You must obtain a MD's order for this primary dressing.

[nurselt_1317]

A better choice than using Adaptic would be to use Mepitel--it is great for preventing the unna boot from sticking to wound, but since it has several "pores" in the dressing it allows the secondary dressing over it (such as calcium alginate) to absorb the drainage.

Here is some more info: http://www.dressings.org/Dressings/mepitel.html

[sorlando]

I think Adaptic is great to use if the Unna boot is sticking to the wound. If there is a lot of drainage along with the sticking you could use Mepilex AG or Mepilex lite.

[SuesquatchRN, BSN, RN]

Can't she get a pain med prior to the change?

[WCC Nurse]

Unnas boots: I've put many of these on! Foremost, if wound continues to drain heavily or drainage increases, need to culture it. (treat the cause) As for the sticking, I recommend putting adaptic or mepitil over the wound unless it has large to copious amounts of drainage. If wound is drier, then the mepitil, otherwise oil emulsion or adaptic are less expensive dressings appropriate for that. And I always use silverlon for antimicrobial protection. If heavy drainage, use silver foam. Silvercell is a great dressing. Can change Unnas boot q 7 days as silver provides that many days of coverage. Of course if dressing is occluded/saturated with drainage, change it! Also important to consider: elevation of limb, use of whirlpool (if not contraindicated - no whirlpool with foley catheters or active infections present due to risk of cross-contamination). When removing the Unnas boot if it is still sticking, saturate area that's adhering with normal saline to loosen, should remove with less trauma. Hope that helps!