venous stasis dsg problem

[terrapin]

I'm a home care nurse who could use some advice from you wound specs...my pt has bilateral venous stasis ulcers to lower legs. Very edematous, weepy, bumpy skin---The order is for Aquacell AG to weepy areas, cover with 4x4s, wrap with Kerlix, then with ACE. (3x/wk) The problem is the Ace wraps never stay on between visits. My wound care nurse says I have to wrap with a spiral. I think a figure-8 would stay better, but she says that's "too much compression." (Unna's boot already ruled out by doc)--any ideas?

[nurselearner]

one hint - after applying the ace - it should be snug but able to get your fingers under it - aplly tape length wise. It keeps it from raveling down. we used this in ortho for kids with success. Is the dressing staying dry? For my patient before putting the kerlix on we used sanitary napkins ..then the kerlix - they absorbed all the excess fluid and kept her dry.

[RN1989]

Use knee socks to help the ace stay on. If needed, cut the feet out of them and pull them up till the cut off part is at the ankle. It is very hard to get ace wraps to stay without some tightness to them. And sometimes it doesn't matter what you do, especially with larger legs, they just don't stay on well. If they are being used as light compression, when the edema decrerases any at all, the warps are going to fall. Profores do the same thing when the edema decreases, that is why you have to have several dressings changes a week.

[RPN_2006]

On larger legs I will sometimes use a tubular stretch net...we call it burn net..over the wrap to help all stay in place. It can be ordered in different sizes so as to avoid causing compression and generally stays in place fairly well.

[jnette, ASN, EMT-I]

On larger legs I will sometimes use a tubular stretch net...we call it burn net..over the wrap to help all stay in place. It can be ordered in different sizes so as to avoid causing compression and generally stays in place fairly well.

I agree.. I've found this to work best.. we call it "surginet". Great for holding many types of dressings in place!

I also like the idea of the socks/kneesox with the feet cut out! :)

I had a lady who pulled nylon kneehighs over hers. Not sure that was the best thing since nylon doesn't "breathe", but she was adament.. and it did keep those acewraps in place.