Wound Care

[WeirdNurseKelly, BSN, RN]

I have a pt with PVD who I cannot seem to get his stasis ulcers to heal. They start to look better and then gradually get worse. They go back and forth. I have changed the dressing order several times. Right now it is hypergranulated and draining moderate amount of yellow draingage after 2 days.

I put on a wet to dry dressing today. I have tried covering it with a telfa pad and 4x4's, also putting aquacel AG on it. Wrapping the leg with gauze and then coban. I have gone back and forth betweent these different types of dressings. What can I do now???

[RNnbakes]

Seems like the patient needs to be debrided on a regular basis. Have you tried medihoney on the wound? Also is there any edema in the LE, that might be delaying wound healing.

[WeirdNurseKelly, BSN, RN]

I am just learning the different things we can do for wound care. Does hypergranulation warrant debridement? There is no slough or eschar, just hypergranulation.

He does have 2+ edema to his foot going up his calf. Pt was just treated for pneumonia. PT was having leg pain along with SOB. I suspected either pneumonia or DVT. Unable to get a good US view because of the swelling to r/o DVT but was diagnosed with pneumonia. Doc wont put pt on lasix because of kidney functions. History of stroke, 2 MI's a few weeks ago, the list goes on and on. Elevated BP's dispite multiple changes in his medications.

What is medihoney?

[jmn126]

Use foam on hypergranulation, it will reduce it.

[smurfynursey]

What about hibiclense?

[WeirdNurseKelly, BSN, RN]

We discussed this in case conference today. I brought up using medihoney. The other nurse who I work with felt that I should just apply lotion to the leg and put a dry dressing on it, wrap with gauze and coban. I am doubtful this will work. I am a little frustrated with the advice given by the other RN I work with. I do not know that I entirely trust her. She feels it will just scab over and heal.

I will try this and see what happens.

Smurfynursey, I have not tried hibiclense. When I was there to provide wound care yesterday I used a wound cleanser instead of normal saline hoping this might help a little. Time will only tell.

Thanks for the advice everyone. If just putting a dry dressing on it doesn't work I will definitely try one of the above suggestions.

[sugirl09]

Have you tried a compression dressing?

[MomRN0913]

We have a hospice patient who had awful stasis ulcers. We weren't intending to heal, just keep comfortable, but lo and behold they are almost healed. Vasoline gauze then cover with telfa and wrap with kling. Some are healed, others looking much better.

[RNnbakes]

The reason I asked about edema is because with edema the wound will not heal unless there is adequate compression to decrease the swelling. Dereased swelling will lead to increased blood flow and faster healing. For compression we use full profore (4 layer), modified profore (3 layer) and unnaboots. But some clinics say they are able to use a kelix and coban wrap (i.e 2 layer) that is also effective in decreasing edema. I believe that is what your co-worker is suggesting, try it and let us know if this helps.

Medihoney is a calcium alginate dressing that has honey in it. About MEDIHONEY® « Derma Sciences

[MomRN0913]

The patient I mentioned was nicely diuresed with aldactone and bummed and that helped a lot.

[MomRN0913]

Bummed= bumex

[jammycakesRN]

We use unna boots frequently & they work well for most of our patients. Clean well with cleanser, apply unna boot wrap toes to 1" below knees, then Kerlix wrap, then coban wrap. Change 2-3 times a week.