Weeping leg ulcers

Jay-Jay, RN · Nov 24, 2003

Adriene, last time I had a patient like this, our WORN said to elevate the legs and put washable pads or towels under them, and change them when they got wet. If the leakage is really bad, a dressing will not be of any help, because the legs will be wrapped in wet gauze (or whatever the dressing is made of) all day, which will cause maceration, and further deterioration of the skin.

The key to the patient's treatment was aggressive diuresis, which got the legs back to normal in no time flat!

adrienurse, LPN · Nov 24, 2003

Yeah diuresis, need to make sure that gets done. The person wasn't on any diuretics :eek:

Well I slapped an ABD pad on it cause I was afraid of leaving drainage sitting on it, which can denude the periwound skin very easily. Didn't want to wrap the leg with gauze cause you don't want that biting into the skin of the edema gets worse.

We'll revisit it tomorrow I guess.

RNanne · Nov 24, 2003

When I worked home health and had a patient such as this, I would cover the skin opening with a hydrogel pad, which will absorb drainage and applyed an unna boot. Unna boots will help with the edema and the weeping. Also needs diruresis big time.

KP RN · Nov 24, 2003

Calcium alginates are quite effective in absorbing tons of drainage and keeping the periwound skin reasonable dry and healthy. Good luck!

P_RN, ADN, RN · Nov 24, 2003

That lady sounds like she has lymphedema. Is that right?

There are some protocols by the Lymphedema Society that work.

meownsmile, BSN, RN · Nov 24, 2003

It will be interesting to see what the end result answer is for this patient. We occasionally have patients that have weeping from leg edema. Normally we elevate and use the soaker pads under neith the legs.

adrienurse, LPN · Nov 24, 2003

We normally do everything we can to prevent this from happening, but you get a little skin break and all of a sudden you have a venous stasis ulcer.

Yes, she has lymphedoema.

hoolahan, ASN, RN · Nov 24, 2003

Agree with diuresis and elevating the legs. Is it possible there is a cellulitis as well? Is there any odor or cloudiness to the drng? Is the skin very red and indurated around the break? Then maybe also an antibiotic is needed.

I have seen this managed a few different ways.

One is to apply an adaptic to keep the periwound skin protected from maceration, then applying and freq'ly changing the abd's or whatever dsd on top. I have seen ca alginate drsg's used which do absorb well and protect the peri-wound skin, and then just telfa's w abd's on top. Nothing usually works unless the pt gets diuresed.

Another good thing to do if she has chronic lymphadema is to get alternating compression boots ordered. They can be applied over the drsg's too. I have seen lots of pt's use these in the home, and if they are compliant, they avoid this exact situation.

purplemania, BSN, RN · Nov 24, 2003

The WOCN treated my Mom's legs as if they had been burned. Her heart failure was the culprit and diuresis really helped, but treating the skin like burned skin made her comfortable and reduced the chance of infection. They used meds and dressings that are normally put on burns.

Jay-Jay, RN · Nov 25, 2003

Hools, the lady I was talking about had the skin mostly intact, with maybe just one or two small open areas. The leakage was coming RIGHT THROUGH the intact skin! There was no one focal point for it. I made sure the caregiver was using very good hygeine on the legs to prevent infection or cellulitis.

hoolahan, ASN, RN · Nov 25, 2003

Originally posted by purplemania
The WOCN treated my Mom's legs as if they had been burned. Her heart failure was the culprit and diuresis really helped, but treating the skin like burned skin made her comfortable and reduced the chance of infection. They used meds and dressings that are normally put on burns.

That is really interesting! Did they use Silvadene then? Or bacitracin? I'm asking so I can think about suggesting this the next time I see it.

Jay Jay, good job. I was just saying what I have seen done, I still am not sure I have seen anything actually work aside from diuresis and antibiotics though. It is a very chalenging wound situation, and it seems it is not managed consistently, at least in my area. If you look in the wound forum, I posted about this a while back too, looking for advice, b/c it is just a real problem.

https://allnurses.com/forums/showthread.php?s=&threadid=32898&highlight=weeping+wound