Wound Treatment Question

[Lynx25, LPN]

Sorry to keep using this forum as a cheat sheet, but this wound is driving me up the WALL!

It's an elderly lady with a hx of reoccuring C-diff. The facility cleared her with a single sample, but there was an enormous mucus filled, foul loose stool while I was doing wound care today, so I am suspecting it's back.

At any rate, she has a sacral wound that is approx 15 cm wide, 15 cm long, 2-3 cm deep, with slough covering about half the wound. The wound tunnels around the edges perhaps 3cm- and has a very foul smell. The left edges of the wound also appear to be necrotic, and loose. She has multiple smaller ulcerations leading down towards her orifice. This is post surgical debridement that occured at the hospital, and I'd say the whole wound is around three months old. She's been moved off of my unit recently after a hospital stay, so I don't know the exact measurements anymore.

Honestly I think she needs to go to the wound clinic, right now they are just packing it with dakins, but it's continuing to decline.

No one at this facility is Wound care certified, so the dressings get a little screwy sometimes I think.

[Nittybelle]

Our doc would arabella misting to remove slough. What about wound vac? Debride, get rid of infection and slough. If there is no infection and you have healthy granulation, the vac should prove to be beneficial. Don't forget about hyperberic treatment. You'd have to take care of all the ick first.

[Nittybelle]

Get her to wound care. They can debride, arabella, put her on abx. Get the wound in proper shape for the vac or hyperberic treatment.

[Lynx25, LPN]

Blegh.

I have been pushing and pushing to get this person to the wound clinic.... The Unit manager and the DON say, "Oh... yeah. Maybe..."

FFS, people.

[Nittybelle]

Maybe because od the bureacracies of health care and her age. Too bad. Hope you can get her there, all you can do is keep trying... She really needs more than what you can provide, such a going to the wound clinic