Wound Care Question

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A little background first: My hubby had a pilonidal sinus and cyst excised in mid Feb. A few weeks ago was his last visit to the surgeon and he was healed to the point that it didn't require packing at all! Well, during the last week the wound has re-opened itself! We paid the surgeon a visit yesterday and he had to slice some tissue that was growing over the top.. he said it was already a reoccurance! Now we're back to packing BID. :rolleyes:

Anyways, we won't have the homecare nurse visit for another week and they sent me home with as many supplies as possible.. but while packing his wound this morning I noticed some things were missing. Main question is, is rubbing alcohol the same thing that's on those alcohol pads? I am just wiping the tips of tweezers.

For the packing before, we were using all kinds of stuff. First saline soaked gauze, then aquacel for a few weeks, then acticoat silver. The surgeon's nurse said to use saline soaked gauze but to wring it out really well, so that it was just damp. Our homecare nurse was really persistent on using the other things, which I told the surgeon's nurse about and she said not to. So if we get the same nurse and she is persistent about using the other stuff, is there a way I can politely tell her perhaps not?

Also, do you have any tips you can share about packing a wound like this? That would be great! Nursing school is only 3 years off in the future :chuckle

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Specializes in ICU.

To be honest I would go with the home care nurse she sounds like she knows what she is talking about.

Rubbing alcohol is not the same as what is in those little swabs.

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Specializes in LTC,Hospice/palliative care,acute care.
A little background first: My hubby had a pilonidal sinus and cyst excised in mid Feb. A few weeks ago was his last visit to the surgeon and he was healed to the point that it didn't require packing at all! Well, during the last week the wound has re-opened itself! We paid the surgeon a visit yesterday and he had to slice some tissue that was growing over the top.. he said it was already a reoccurance! Now we're back to packing BID. :rolleyes:

Anyways, we won't have the homecare nurse visit for another week and they sent me home with as many supplies as possible.. but while packing his wound this morning I noticed some things were missing. Main question is, is rubbing alcohol the same thing that's on those alcohol pads? I am just wiping the tips of tweezers.

For the packing before, we were using all kinds of stuff. First saline soaked gauze, then aquacel for a few weeks, then acticoat silver. The surgeon's nurse said to use saline soaked gauze but to wring it out really well, so that it was just damp. Our homecare nurse was really persistent on using the other things, which I told the surgeon's nurse about and she said not to. So if we get the same nurse and she is persistent about using the other stuff, is there a way I can politely tell her perhaps not?

Also, do you have any tips you can share about packing a wound like this? That would be great! Nursing school is only 3 years off in the future :chuckle

Since you won't have a homecare nurse for another week why don't you call the surgeon's office and ask to confirm the order if you are un-comfortable with what you are doing now? I believe you can certainly depend on the home care nurse-she will be assessing the wound and changing the treatment as needed as the wound heals-......The saline gauze sounds appropriate at this point until the home care kicks in......
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saline gauze is appropriate if the wound is clean and pink inside. yes, you can use the rubbing alcohol to clean the scissors. and if you're packing the wound yourself, once you wring out the saline gauze, open it/fluff it and then gently pack the area. when it's opened/fluffed, it will cover more surface area. that's unfortunate that you're doing this alone w/o any guidance. it's difficult to advise you w/o seeing the wound.

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saline soaked gauze is really only appropriate if the goal is to apply a wet-to-dry dressing to debride a wound - rarely used nowadays since we have access to a plethora of superior dressings...

i agree with gwenith, your home-care nurse seems to know what she's doing; let her continue to evaluate the wound and change the treatment to suit the characteristics of the wound as the wound progresses. sounds if she is up-to-date on wound care practice (can't say the same for the surgeon's nurse) :imbar

also, do you have any tips you can share about packing a wound like this? that would be great! nursing school is only 3 years off in the future :chuckle

...never force a packing tightly into a wound, pack loosely.... :p

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it's difficult to advise you w/o seeing the wound.

You had to say that, didn't you? :chuckle Fortunately, I have a digital camera and a willing husband. Here are photos from this morning's packing:

Here is the wound, my DH's fingers in the picture so you can get an idea of the size. DH is reaching around holding it open.

wound.jpg

Another angle for depth

wound2.jpg

My inner packing job - I have swabbed the outer area with those 3M things to protect the skin from adhesive (sorry I don't know what all the terms are).

inner-packing.jpg

And my final outer packing job.

final.jpg

I hope I haven't offended anyone with the pictures. Also, I found out we only have TWO visits with the homecare nurse!! She came once and dropped off supplies but it was only a bunch of 2x2s and 4x4s and some tape, forceps, and a syringe.

I have been wringing out the gauze and fluffing it, packing tight at the top because there is a pocket under the scar and packing loosely through the bottom.

Thanks so much for all of your support. You're helping me so much!

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great photos! :) the wound looks nice and clean with healthy granulation tissue. looks like you are doing a good job. :balloons:

i would pack with aquacel or aquacel silver (the silver has antimicrobial properties and you mentioned in your first post that was what the home care nurse had suggested). as aquacel (or any other hyrofibre or alginate dressing) is very absorbant and suitable only if the wound is still draining, once the drainage decreases then you need to reevaluate the treatment. (assuming you still have drainage at this stage).

it is good that you are using the 3m skin protector, protects the skin and also helps the dressing to stay in place. can you tape the bottom edge of the dressing and to try to make it more occlusive?

i have been wringing out the gauze and fluffing it, packing tight at the top because there is a pocket under the scar and packing loosely through the bottom

don''t pack tightly, if there is a pocket - cut a "tail" into your strip of aquacel and insert it gently with the help of the wooden end of a sterile q-tip.

good luck, let us know how it's healing!

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Very interesting article!

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Thanks for the article gwenith!

And kay, thanks SO much for the advice! I'm going to ask the nurse for aquacel or acticote silver when she visits the last time this week. There is still drainage. Also, my hubby prefers no tape on the bottom, he says it feels like it restricts him more. If I was using aquacel I would tape the bottom though because once when it turned to goop it fell out while he was walking! :rotfl:

Anyways thanks so much for taking the time to reply! :)

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Specializes in ICU.

Have you thought of using a feminine hygiene pad instead of tape??? Poor hubby!!!

Kay thank-you for answering this question so well I just did not have time the other day.

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what about a VAC system?

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