Email - August 15, 2004

Wound Care Information Network

August 15, 2004

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I have used Arginaid for a patient admitted with pressure ulcers. The outcome was good. She has remained on the product but d/t cost the family and nurses are wondering if this could be discontinued (currently subscribed bid). Is there some protocol or recommendations for using this product for prevention. (80 year old female, 75 pounds no kidney disease). Any information appreciated. Marilyn McCall, RD. LD	Marilyn- Typically Arginaide is used to promote wound healing then DC'd. However prior to DC'ing the med I would look at why she was started on it to begin with: -Does she have a history of problematic healing? -Is she eating enough to maintain good skin integrity? (caloric value vs. health maintenance) -Is she on any other vitamins that would aide with health maintenance? Or was she and did she refuse to take them r/t G.I. upset or flavor? (Arginaide tends to be less offensive to the oral cavity and G.I. tract) Tina (LVN, Treatment nurse)
Are there any new studies that document the efficacy of the VAC for specific recalcitrant wound types? Sam	sorry, no replies. Suggest you contact the maufacturer, KCI.
Need advice on pt we recieved from prior hosp. whose entire back ecchymotic and skin sloughing. What type dressing best for wound plus what can be used to adhere it w/o causing more skin to be removed, as edges are fragile and skin loose. Pt is vent dependent we are attempting to wean, but cachexatic. Has tube fdgs in progress. Thanks, Lois Gibbs, RN BSN	Dear Lois, Have had some experience with this type of problem and our solution was an Aircell XL Mattress. This is an awsome air mattress and we have had great sucess with rapid healing and prevention with it's use. If you are interested in more information please feel free to email me at medicinewoman79@yahoo.com and I will pass the information on to you. Good Luck, Jan, LPN Wound Care Coordinator--- --- gentle cleaning as often as necessary depending on amount of soakage. do not use any irritants for cleaning. apply Aloe Vera lotion or gel or cream (anti-inflammatory, anti-oxidant, anti bacterial and fungal actions ). cover with any reasonably-priced absorbent-padded-sheet made on the lines of a diaper; do not stick it on just lay it under the back. continue adequately timed change of position to prevent additional damage by pressure... in view of the slough there is a strong possibility of contamination /infection by a wide range of organisms, so on the necrotic areas one could use various local applications like: metrogyl gel, anti-fungal powders, silversulphadiazine cream. and to protect the areas of intact skin from maceration, zinc oxide paste on intact skin unsigned --- Lois- I have recently started using Xenaderm under ace wraps with CHF pts. and noticed a DRASTIC improvement with healing time. Ecchymosed that was expected to take 4 weeks was gone in 4 to 7 days, dry flaking skin- gone with the second day of treatment, and I'm not sure this will make a difference to you but snug ace wraps are loose at the end of the day. What I do believe will be important to you though is that Xenaderm doesn't require a dressing, just apply and walk away. Check out the web site: www.healthpoint.com Tina (LVN, Treatment nurse) --- Hi Lois, I've taken care of quite a few patients in a Long Term Acute Care Facility who were Vent Dependent, GT, Foley, Dialysis, multiple systems compromised and with multiple Pressure/Vascular wounds. Most of them were being treated Palliative with the Wound Care and the majority of them had multiple, large, macular shaped, dark purple/red ecchymosis that would tear from a simple finger touch. I always treated this type of fragile ecchymosis with Xeroform. The last patient I had taken care of with this type of ecchymosis had it on the Bilateral Upper Extremities, which were grossly edematous, and also all over his Thoracic area. Xeroform comes on a spool or roll. I would wrap around his upper extremities, loosely, in the same manner as doing a Kerlix or Ace wrap. Then cut off long sheets of the Xeroform for the Thoracic area. As long as the patient didn't have a lot of drainage, this worked very well. From turning the patient and such, sometimes a lot of drainage would occur. I then would just place a chuck under the area to absorb the drainage. Xenaderm, manufactured by Healthpoint, is another product I'd use if there was very little drainage. Xenaderm is a thick clear salve and secondary dressings are not required. I would apply the amount directed on the label and leave open to air...again would put a chuck under the area if needed for drainage. It's tricky doing this, as applying too much pressure can cause the ecchymosis to break open, causing skin tears and drainage. For the Thoracic area, these patient's turning scheduled were left and right only every two hours. A clinician friend of mine had used Silvadene without secondary dressings and also Vaseline Gauze without secondary dressings..said he had good results with both. I have used the Vaseline Gauze on the upper extremities and had good success. I never had a patient to completely heal, as new ones would develop, as the old ones would heal. And, like I said, most of these patients were being treated Palliative, so I wasn't being aggressive with treating the ecchymosis. Good Luck, Cecelia LPN, WCC, Wound Care Coordinator Long Term Care
I am an RN and recently I saw an RN cleaning sutured wounds with hydrogen peroxide.Can you give me your thoughts on that procedure please. Linda	Linda- I have been taught H2O2 is more harmful then positive, however I am seeing more and more surgeons ordering it. Tina (LVN, Treatment nurse)
What is the best way to apply a dressing to the heel? unsigned	It depends on what dressing you're using. If it's a square, like a hydrocolloid or foam, I make two cuts in the foam, about a third of the way down from the edge, and a third of the way in from each side. Then, you can fold it into a cup shape over the heel. Some dressings have a special heel design. Renee C, MSPT, MPH, CWS --- This would depend on the type of wound and dressing for the heel. Is it a Pressure or Vascular wound? What type of tissue is in the wound bed? What are your goals for treatment...healing, palliative care, etc? Cecelia LPN, WCC, Wound Care Coordinator Long Term Care
Hi there, I had a pilonidal cyst removed, spent the night in the hospital, a week later during the follow-up the surgeon decided to use silver nitrate to speed up the healing process, the next thing I know I lost all feelings in my lower half of my body and started sweating and guess I passed out, ended up in the Emergency Room for a couple hours, the pain was very intense in the wound area... don't know if that was the cause but just enquiring if anyone had any experiences with using Silver Nitrate on a pilonidal incision. Thanks AJ	I see no way silver nitrate would result in that effect, unless you had an allergy, which would be unlikely. What reason for the symptoms did the doctors give? Renee C, MSPT, MPH, CWS
My name is Teresa Flores and I am a physical therapist assistant. I am wondering if you have actual number/force that occurs during lateral transfers either up in bed or flat to flat. Or even any resources I can refer to. Thank you for your time. Teresa PTA	sorry, no replies
At my hospital in Anchorage AK. We do not have a Burn Unit, but do on occasion admit burns 25%TBSA and below. My concern is A Physician continuing to order whirlpool. when I was in AZ no Burn Unit uses whirlpool due to infection control issues. Does anyone have any information on NOT using whirlpool for burn care? Sandra	Hello, Thankfully, at our rehab/OP therapy clinic we now rarely use a whirlpool on any wound. If a wound needs to be cleaned and debrided we usually use pulsed lavage. However, having said that, I just last week used a tepid-temperature whirlpool twice on a burned foot to help soften eschar to allow debridement. I dont have any journal publications to help you, but you are on the right track with your careful consideration of whirlpool use. Kloth and McCollough's book "Wound Healing: Alteratives in Management" speaks of this topic. Vicki, MSPT, CWS --- There is a lot of evidence pseudomonas and klebsiella stays in whirlpools, even after meticulous cleaning. If you type "whirlpool" into PubMed, most of the articles which pop up will be on this topic. Renee C, MSPT, MPH, CWS
HI MY NAME IS ALIBALI. I AM NEEDING SOME ADVICE ON A SUITABLE DRESSING TO MANAGE A SCROTAL WOUND WITH GREEN OFFENSIVE EXUDATE. THE WOUND IS OVERGRANULATED WITH SLOUGHY AREAS THAT LOOKS LIKE A PIECE OF CAULIFLOWER. THIS PATIENT HAS FOURNIERES GANGRENE WHICH HAS BEEN DEBRIDED SURGICALLY.WE HAVE BEEN USING ACTISORB SILVER DRESSING THAT HAS NOW STOPPED WORKING TO ITS FULL POTENTIAL. WE HAVE TAKEN A WOUNDSWAB. COULD THIS POSSIBLY BE A FUNGATING TUMOUR.?ANY ADVICE WOULD BE GRATEFULLY RECEIVED .THANKS Alibali	Hi, I think you're smart to wonder about a tumor. If it turns out that its not a tumor, you need a dressing that will deal with the drainage and the possible bacterial load that may be the cause of the drainage. A silver alginate such as Acticoat absorbant or AquacelAg might be appropriate, or a hypertonic dressing such as Curasalt. Again, this will all depend upon what exactly is going on and the wound bed characteristics. If you are able to access a certified wound specialist, it would be a good idea. Good luck, Vicki, MSPT, CWS. --- It could be a tumor, or it could really be hypergranulation. Try to get a biopsy, or try silver nitrate to help the hypergranulation. For the infection, I really like Iodosorb and pulsed lavage. Renee C, MSPT, MPH, CWS
I am case managing an individual who has advanced lymphedema. She initially developed one open lesion on her thigh, which is now progressing. The latest treatment has been utilizing the wound vac. Although it has facilitated wound debridement the depth of the wound has increased from 4 cm to 8 cm. We have been using the vac for approx 2 mths. The company has not been able to give any clear cut information on use in a case like this. Where can I go to find some info. Thanks-Sandy ANP/CCM	I don’t know how advisable it is to use the VAC in such a situation. To my understanding the combined effect of the high pressure of the accumulated lymph and the negative pressure of the VAC would only perpetuate the problem of continued drainage and thus prevent the healing process from making its otherwise slow progress which is associated with such cases. unsigned

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