Wound Care

[WeirdNurseKelly]

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???

[lovingtheunloved, ASN, RN]

I would head straight for the unna boot.

[kitcwcn]

I would first obtain an order from the MD for a wound culture and an ABI. The hypergranulation suggests to me that it may be infected or may be too wet. My go to dressing in the meantime would be a silver alginate and foam to cover, kerlix and two layers of Tubigrip.

If the culture is positive, hopefully MD will order an abx. (The hypergranulation might need treated with silver nitrate stick, but this may need to be done by MD or perhaps a certified wound care nurse - depending upon agency policy. Sometimes, the silver alginate and foam will knock it down though.) If the patient's ABI is 0.8 to 1.0, then it would be ok to compress and I too would go to the unna boot - same cover dressing: silver alginate and foam till abx completed and then maybe just a foam with Unna Boot to cover. Should be able to leave in place for 5 - 7 days.