What kind of dressing for this patient...

[selu1616]

I'm a relatively new nurse and brand new to home health. Haven't had much exposure to wound care so need some help. Currently taking care of a patient who is a paraplegic with 4 pressure ulcers. Here are the descriptions for the wounds (For identifying purposes, I will assign a number to each wound). I will also list the current tx for each wound (these were the treatment choices in use when i took over the patient). Wound 1 is to right ischium, minimal serous drainage, stage 4, currently cleaning with wound cleanser, packing with calcium alginate, securing with 4x4 bordered island gauze dressing. Wound 2 is to left ischium, stage 3, hardly any drainage present, same tx as wound 1. One concern I have with these 2 wounds is finding a dressing to place over the wounds that will stay in place. I see the pt. on Mon,Wed, and Fri and every time i come back the dressing has come off. Wound 3 is to right lateral ankle, stage 2, heavy ss drainage, cleaning with wound cleanser, applying medihoney, covering with gauze then ABD pads, wrapping with kerlix. Wound 4 is to left lateral ankle, same treatment as with wound 3. I was using the medihoney gel but i just switched to the gauze impregnated with the honey because of maceration to the wound edges (the wounds are in such a tough spot to apply the honey and it gets all over the good tissue when i put the gauze over it). Switching to the gauze has gotten rid of the maceration but everytime i come back the dressings are saturated with drainage. So for all you wound care gurus, what tx do you suggest? Also, can someone please refer me to an excellent website, youtube video, etc. that provides wound care teaching (assessing, documentation, treatments, etc.). I can see that wound care will be a skill i do a lot in home health. Thank you so much and if you need anymore info just ask.

[txnursegiggles]

If the dressings are becoming saturated, you may want to consider increasing the frequency of dressing changes or applying an alginate to absorb things.

Is the patient bed bound? Air mattress? Heel protectors?

[lorirn58]

Sounds like this patient needs to see a surgeon or go to the nearest outpatient wound care clinic asap. It also sounds like he most likely has some necrotic tissue in those wounds.

[jungle49]

I think, for wound 2 at left ischium, stage 3 with "hardly any drainage present" therahoney/medihoney would maintain moist environment. Stage 2 at the ankles will benefit from foam application, that takes care of heavy drainage. This will take care of heavy exudate and maceration. My questions is is he spending too much time in chair (wounds at the right & left ischial tuberosity)? Probably, time in chair needs to be limited. Consider cushion in chair to relieve pressure.

[dsharrison]

Curious what happened with this patient. For wounds 1 and 2 I wonder why they are being packed with calcium alginate if they are hardly draining? Usually calcium alginate is for moderate to heavy draining wounds. Is the alginate moist when it's being removed? Might be better to pack with something else. For wounds 3 and 4, I would culture to rule out infection. Switching to medihoney alginate (which is what the impregnated guaze is) was a good plan. Skin prep should be used on surrounding good skin to protect from maceration. Covering with more alginate, then try foam. If foam isn't lasting two days, or becoming oversaturated then daily dressing changes but with abd pads, guaze, wraps, etc. I would be highly suspicious of infection however if that is the case. Also, does patient have edema contributing to this drainage? If so, edema has to be resolved before wound healing will occur.

[kmlopez5]

What does the tissue quality of the wounds? And slough eschar? In also curious of the sizes. I am also curious of pressure relief methods being used?