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HYDROGEL SHEETS HAS A "COOLING" EFFECT ALSO

Amparo (Amy) Pastor
RN, CWS, Manager of Clinical Practice
Gentiva® Health Services
 

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I personally like silvasorb by Medline - the gel sheet - not the gel in a tube. You cleanse the wound, apply sheet and put a cover dressing over it and it can stay a week. It works wonders for all types of wounds and reduces bacteria as well.

Deborah Harris, BSN, JD, RN, CWCS
Director of Clinical Services
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Hi.........I like wound care........not an expert by any means.

For hypergranulation in Home Health--- I would use a foam......this forces the hypergranulation to diminish. Of course, sharp debridement could be used also.
this is just my experience.

Frankie

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hydrgel or saf gel will promote moisture and can be changed less than daily.
Starting with daily and observing if wound stays moist if so then decrease to qod ultimately go to monday, wednesday, friday. Make sure the wound
stays moist.

homecare RN

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Polymem can be a great product for such situations. Change every two to three days.

unsigned

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First of all the physician should have handled the hypergranulation. This could have been done by using a scalpel or with silver nitrate sticks. Instead of using an Allevyn as your cover dressing how about using a hydocolloid like Repleicare. It only has to be changed weekly if you don't have too much drainage. I will cover, protect and autodebride if you have any slough. The wound bed will stay moist for good moist healing and it sticks well.
de, RN BSN

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We've had excellent results with hydrofera blue with MOHS patients, a bacteriostatic foam dressing, dressing change every 1-3 days. Actually used with a gentleman who eventually lost his ear and had very large scalp wound. This MOHS surgeon uses hydrofera very often

Sharon , RN New York

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You may want to consider Apligraf for this patient.
Santo

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MRSA is a common problem with surgical patients. Vanco is the drug of choice and Zyvox has shown good results. Who is culturing the wound? Once you have MRSA I believe you are going to be colonized with it. Usually you don't need to repeat the Vanco. Does she have a fever, drainage, pain at the surgical site. If she has no signs or symptoms of infection then she is most likely colonized. Another thing is that if a swab culture was done it only cultured the surface of the wound and that will always be contaiminated. The best culture would be a needle aspiration done by a physician.
de Rn BSN ICP

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Silver is know to eliminate MRSA. There are several costly but great wound dressings that contain silver. AQUACEL AG for heavily draining wounds or ACTICOAT SILVER that can stay inplace for seven days. Silver can not be used with saline, you must use clean or sterile water

unsigned

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Infected hair follicles are not uncommon, especially in the perineal area, or those with curly body hair, as the hairs sometimes grow back into the skin.

The use of hydrogen peroxide to heal a wound is unfortunate, since it is a cytotoxic agent, meaning it is deadly to the cells that are needed to heal a wound. Hydrogen peroxide is toxic to fibroblasts, and their ability to proliferate is essential to any healing wound.

The use of Neosporin is something I have stopped using in my practice altogether. Over the years I have seen many people develop a sensitivity to it, which I believe is due to the fact the the ointment is over used. Rather than applying the product to only the wounded cells, it often is spread out over the skin surrounding the wound, which of course does not need to be treated, as it is not wounded (...yet..). Applying any chemical to intact skin can often result in a reaction, so the periwound skin should not be seeing the antibiotic ointment.

As far as a sinus tract is concerned, it can develop any time there is a wound whose base does not fill in at the rate necessary for the skin on the perimter to be able to cover over it. In other words, the periwound skin wants to advance over unhealed, healthy tissue. If, when those new skin cells on the border of the wound are ready to walk across the wound, but there is to much depth present, the new skin cells can walk down the wall of the wound. Once skin has grown vertically, rather than hoizontally, there is no chance for the skin cells to reunite from one side of the wound to the others. A surgeon may simply debride, with a scalpel, the rolled edge of the wound, down to healthy, bleeding tissue, and have you do some sort of gentle packing of the wound depth (must always be filled in, never to get dried out), and there are a variety of products for this, depending on the characteristics of the wound. It may be a simple piece of gauze ribbon, or some hydrogel (water based gel). In any event, the void of the sinus must not be allowed to be a void; we don't want the tissues to dry, nor the temperature of the tissues in the sinus to lower, due to the open space.

I hope this LONG answer helps! See the surgeon:)

James A. Patrizi, PT, CWS, FCCWS

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Monica,
Sinus tracks are extremely difficult to treat. This is because you can't fill the void with any supplies. A surgeon is the only way to close the wound with the help of antibiotics. Scaring can be cleared with a wonderful product from Smith/Nephew called Cica-Care. Applied to the area for a few weeks and its gone and it self sticks. Similar products can be purchases at drug stores.
de RN BSN

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When a sinus track remains open but the surface closes it creates a cavity trapping wound drainage and bacteria. It becomes an abscess and needs to reopen to drain its contents. It will never be gone until in fills in from the base up and then closes over. The opening needs to be kept open and the fluid wicked from the sinus track until the track is gone. There are several products designed to reduce scar formation after the wound is closed. Look into silicone sheets. Be aware, it takes 2 years for the scar to fully mature.
Michelle, PT

Mavis..........you are correct. "Disregard" her opinion, if you can.

Frances J. Jessup, RN, BSN

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Safclens is a no-rinse product! It contains no soap.
deRn BSN

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You are correct. Saline may be used for wound irrigation, but once the container is opened, it should be discarded within 24 hours. Commercially available wound cleansers are safe and effective for cleansing wounds, and do not need to be irrigated out of the wound site. You can refer to either the WOCN website for additional information, or the Clinical Practice Guidelines published by the (now disbanded) Agency for Health Care Policy and Research, Publication #95-0652, Dec. 1994. Of greater concern is the practice of using cytotoxic agents for standard wound cleansing, such as Dakins soluntion, Betadine, Acetic acid, Hydrogen peroxide, etc. These chemicals have very specific uses, and rationale must be clear as to why a wound may briefly need such a strong agent, and justification for repeated use of them must be well documented.

James A. Patrizi, PT, CWS, FCCWS

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Mike:

Most wound care nurses would emphatically disagree with using hydrogen peroxide on any wound. Cleanse with normal saline, pat dry with gauze. Apply a THIN layer of antibiotic ointment.......neosporin, bacitracin (preferably), polysporin. Cover with gauze dressing...skin prep intact skin, and tape in place.

These are my suggestions for your wound care.

Frances J. Jessup, RN, BSN

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The Neosporin was recommended to prevent infection, if the doctor who recommended it insists on something preventative ask him for an antibiotic cream like Bactroban. unsigned

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H2O2 is toxic to wounds and should never be used full strength. If you must use it half strength is adequate. Normal Saline has been proven 100% safe and the infection rate is no greater then ones treated with H2O2. H2O2 will actually delay healing time. A better choice then Polysporin would be Bactroban because it works against MRSA. Ointments do not prolong healing.
de RN BSN

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Research has heavily shown that a healthy wound is a moist wound. The correct balance of moisture will promote the bodies ability to fight infection and close the open area. Hydrogen provide is cytotoxic, destroying the good cells as well as the bad ones. It over drys the tissues decreasing the ability of the cells to fight surface contaminants and prohibits the perimeter of the wound from contracting. Topical antibiotic/antimicrobial ointments are good to use sparingly and keep the wound clean and covered. Michelle, PT

unsigned

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Has a culture been done? Not only for infection, but underlying conditions such as cancer? Are there underlying co-morbidities that could affect absorption? How old is this patient? Are you testing pre-albumin rather than albumin?

Deborah Harris, BSN, JD, RN, CWCS