venous stasis ulcer. treatments?

[chenoaspirit, ASN, RN]

I accepted this patient in the middle of her treatment. She has refused UNNA boots and the nurse had been applying polymem, changing q 5-7 days. Well, it had drainage when I first started seeing her, now its a hard/dry scab. Im still applying the polymem, but I am wondering now if its the correct treatment. Should the wound have this scab? Is that a good thing? It has gotten smaller, but the last measurement showed that it had gotten .1 cm longer, but had gotten narrower. What type of treatments are there for venous stasis ulcers, besides compression. This patient refuses compression. I plan to call the doc, but he is the type who depends on us nurses to decide the wound care. Any advice would be greatly appreciated, before I call the doc. Thanks in advance.

[NRSKarenRN, BSN, RN]

etiology + surgical options:

chronic venous insufficiency: emedicine vascular surgery

stasis dermatitis: emedicine dermatology

venous ulcers are treated with compression of the leg to minimize edema or swelling. compression treatments include wearing compression stockings, multilayer compression wraps, or wrapping an ace bandage or dressing from the toes or foot to the area below the knee. the type of compression treatment prescribed is determined by the physician, based on the characteristics of the ulcer base and amount of drainage from the ulcer.

the type of dressing prescribed for ulcers is determined by the type of ulcer and the appearance at the base of the ulcer. types of dressings include:

• moist to moist dressings
  
• hydrogels/hydrocolloids
  
• alginate dressings
  
• collagen wound dressings
  
• debriding agents
  
• antimicrobial dressings
  
• composite dressings
  
• synthetic skin substitutes
  

here is a video about polymem: http://www.polymem.com/ferrisanimationus.html

my experience with these ulcers have seen decrease in width with slight to large increase in length of wound as wound heals and celular debrise shifts in leg ---especially in patients who don't elevate leg or use compression.

some of my paitents have reported severe pain even to lightest touch so for them compression unaboots are torture and ace wrap falls down. some have tolerated setapress dressing.

article: compression therapy in wound healing

scabs are the body's way of bandaging itself. they form to protect wounds.... best to leave them alone and not pick at them +tend to fall off by themselves when the time is right. since you state wound care is weekly, i do tend to clean the scabbed area with nss/dermal wound cleaner then pat dry.---if getting significantly thicker and wound continues to lengthen + deepen then cetn eval + removal may be indicated. i'd continue with polymem dressing.

another important issue is adequate moisture to skin. after washing legs, apply lanolin based lotion daily to intact skin. prescripion lotionlac-hydrin has been helpful to those don't respond to usual lotions:vaseline, eucerin cream, vasline intensive care, landers coca butter etc.

one of our wound care physicians prescribes arginine (l-arginine) - mayoclinic.com for those with long term venous ulcers and encourages foods high arginine:

dietary sources of arginine walnuts, filberts (hazelnuts), pecans, brazil nuts, sesame and sunflower seeds, brown rice, raisins, coconut, gelatin, buckwheat, almonds, barley, cashews, cereals, chicken, chocolate, corn, dairy products, meats, oats, peanuts

good luck wiith healing your patients wound.

[chenoaspirit, ASN, RN]

Thank you so much for the helpful info. There are so many different types of dressings, I have no clue what to use when. I just hope this wound heals. Thanks again. Your post was VERY helpful! :tku: !!!