Wound Email - May 2, 2006

Wound Care Information Network

May 2, 2006

Automated removal instructions are at the bottom.

Sponsor's message:
"Change your life in one week"...Wound Management Certification Seminar

Wound Care Education Institute presents
Wound Care Certification Course
One week seminar, CEU's, and exam
for "WCC" Wound Care Certified Credentials.

click here for details

mention code EDU0401 for your
$ 100 discount

"...One of the best educational experiences I have ever had"
Carol K. RN, Aurora, IL

Submit your new question to the group right now: wounds@medicaledu.com
Sign up with our Email Service to see replies.

Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.

I have a very small stasis ulcer - the first in 5 years. What is the protocol for quick healing? Products. Thanks, Dave	The most important thing with venous insufficiency is compression regardless of the dressing treatment itself. You must do an ankle brachial index first to determine if your circulation is adequate enough for the compression and if it above .8, that is sufficient. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY
Hello, my father is a diabetic who has CVA and has an open wound on his ankle. I work for a therapy company and know some about wounds. He has gone to a wound care center before and was not inpressed by them. I have been using aqua gel AG on his wounds. this seems to help tremendously how ever though the store we have been buying it from no longer carries it and will special order it but for 10 sheets which is the lowest you can buy it is almost $400.00 they are on a fixed income. is there some thing else that would work better or just as good that is ALOT cheaper? or where can I get this product at for a cheaper price? Thank you Judy Mace	I don't know the exact price, but if you could buy 1 sheet of Medline's silvasorb gel sheet, you can cut a piece to fit the wound and save the rest for later. Remeber each sheet can remain on the wound a week, even if you change the outer parts of the dressing - I think that would be the most economical. They also make a silvasorb gel you can apply. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY ---- THERE IS ANOTHER PRODUCT THAT YOU CAN USE: MAXSORB AG FROM MEDLINE GOOD LUCK TANYA CORNELL, RN ---- I don’t know if you can purchase this or not but Medline makes a silver product called Silvasorb gel. It is very cost effective, especially since you can get multiple uses out of one tube. Our facility pays approx. $25-30 a tube. I have had some really great results with it. Sue, CWS --- MAR-J Medical Supply always has Aquacel AG in-stock. It is available for immediate shipping. Since you mention a box of ten, I assume you are using the 4" x 4.7" size. Our price is way less than $400/box. Please feel free to contact us at (888)347-7997 or via email info@mar-jmedical.com. We look forward to hearing from you. Jason --- Are you seining Aquacel AG because of infection? If not why not use normal Aquacel it is less cheaper. Don’t forget to use compression. Works well. Julie Julie Palmer RN
To Whom It May Concern, I am a nurse working at a home health agency in Ohio and am the consulting nurse for wounds in this agency. I would like to know what AHCPR's definition is of a "quantitative swab/culture" is and the technique used or recommended to obtain one. Thank you for your time. Marybeth Wilpula, RN	I can tell you what WOCN recommends which is usually along the lines of government agency edicts - you irrigate the wound thoroughly with saline. In a 1cm area of the cleanest part of the wound, circle the sterile swab culture to obtain sample. Some others practice the Z-swab technique which is going back and forth across the wound in a Z pattern, but I believe there is too much chance of picking up contaminants that way from the edges of wounds, which usually culture under 100,000 and are not indicative of the real pathogen. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY --- According to Sharon Baranoski and Elizabeth Ayello, both CWOCN nurses, well published and well received, the Levine Technique of swab culture is the most accurate, as it collects samples from within the tissue, not simply from the wound surface. The Levine technique consists of rotating a swab over a 1 cm square area with sufficient pressure to express fluid from within the wound tissue. This technique is more reflective of “tissue” bioburden than swabs of exudate or swabs taken w/ a Zstroke method. The wound being swabbed must be cleaned first, and the area sampled must be over viable tissue, not eschar. Ellen Jardine, RN, BSN
I am a licensed practical nurse with my WCC. I need some salary quotes, I have been working at a rehab facility with 110 beds doing wound care for the last four years. Please give me some solid salary quotes for my CEO. Thank you very much. Paula	You don’t say what state you are in so your survey results will vary, but in Massachusetts, I do the same thing you are doing, although for over ten yrs. now, and I am getting paid just below $33/hr. (LPN)
Question: Is there a "Book" that can be bought referencing what products to use on different stages of wounds?.... Thank you for your very kind consideration... Karren Dunklee	Wound Care by Cathy Thoomas Hess is a good one Deborah Harris, BSN, JD, RN, CWCS Louisville, KY --- There is a handy, dandy little book called the Clinician's Pocket Guide to Chronic Wound Repair that will give you lots of helpful info of what to use for different stages and lots of info on dressings and other things you need to know. It's put out by the Wound Healing Institute Publications, P. O. Box 7672, Long Beach, CA 90807-0672. Phone: 310-595-8180. Hopefully they are still make this little book, as mine dates back to 1995. Gerry, LPN
As a sufferer with Fuchs dystery I am wondering if there is a collegen treatment being employed as a treatment for this disease. It seems to me that the properties of collenen would be a good choice to treat Fuchs Dyestry. What can you tell me about this subject? Fred Watson	sorry, no replies
Hello My question is about an open wound as a result of skin cancer surgery on my dads ear. It's at the outer edge of the cartilage and has almost gone right through to the other side. In addition to that site, there are other small areas on the outer/back side of the ear where the skin is gone due to adhesive removal of the dressings. The doctor is applying Gentamycin ointment and cleansing with peroxide daily with bandage changes. There is no improvement at all and it's such a painful situation for my 89 year old father and he has been dealing with it for many months. Can anyone suggest any other treatment options for wound closure at the ear? Or anything else aside from an antibiotic ointment that can be applied to aid in closure? Thank you so much Mary	You might want to check product guidelines for use, but I have used mepiform by MoIlynke which you put on after cleansing and maybe applying some nonsting skin prep. I leave it on virtually til it comes off on its own when healed - it is flesh colored and you need no cover dressing (unless there is drainage). Deborah Harris, BSN, JD, RN, CWCS Louisville, KY --- WE HAVE HAD GREATE RESPONSE WITH XEROFORM, OR SCARLETT RED DRESSINGS. WE ALSO, USE AN ANTIMICROBAL WOUND CLEANSER. GOOD LUCK. TANYA CORNELL, RN
Hi, I am presently packing a 4 cm. deep, moderately exudating wound with Curasorb rope, but the opening is fairly small. Do you suggest moistening the rope before inserting? The opening that I am trying to maintain open is only .5 x .5 cm. Would it be preferable to put in a very thin piece of dry rope? Thanks for your input, Jan, Home Health Care R.N.	You can think those calcium alginate ropes to the width you need. Another product is aquacel, which if you hold on either end and pull a strip taut quickly, to the desired thinness you want, it is easier to use in those situations. It is not a calcium alginate, but works in the same principle and is made by Convatec. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY --- You defeat the purpose of the rope by moistening it with NS. It is made to absorb drainage. I have used sterile scissors in the past to cut the rope to the thickness I need which works quite well. You can also go with the old standby of Nu-Gauze for packing. It comes in many smaller widths. I have used this before with the addition of a silver gel product applied to the packing strip to reduce the bio burden of the wound and promote healing. Good luck, Sue CWS
I have a question regarding chronic venous stasis ulcers. My father in-law does have this condition and has been prescribed Unna boot dressings. However, he can not tolerate the constriction & heat that this particular dressing causes. I understand that improving his circulation is imperative, but is there another dressing that he could use until the ulcers heal and then begin using compression stockings. He simply will not where the Unna boots and my primary concern now is infection. I would greatly appreciate your in-put regarding this. Thanks	Compression is the #1 way to heal venous insufficiency, however, I can understand how the unna boot constricts a little too well. You may want to try Smith & Nephew or Medline's multilayered compression wraps, which give when you ambulate and allow some 'breathing room'. You might want to check with a doctor, and if there is no allergy to sulfa, I have found that silvadene with a xeroform cover and then wrapping with kerlix under the compression wraps works well. However, you will need to also check with the doctor on frequency with that. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY ---- Compression and elevation are essential in treating any venous disease. The only exception would be the presence of co-existing arterial disease, or CHF exacerbation. Ellen Jardine, RN, BSN --- While an Unna Boot is usually the treatment of choice for a venous ulcer, some patients do not tolerate them. There are other options. He could simply go into his compression stockings now and then simply do a daily dressing change to the ulcer with a product that will manage the drainage such as a foam dressing (allevyn, polymem, lyofoam). Is best to discuss this option with the physician to be certain there are no other contraindications. Linda Stricker, RN, BSN, ET, CLNC --- There are many types of compression dressings on the market that can take the place of Unna boots. A lot of people find them intolerable. Profore by Smith and Nephew is one. I would suggest finding a wound clinic or specialist that can help you choose the appropriate one. Sue, CWS
We recently instituted a SWAT (Skin & Wound Assessment Team) in our 300 bed hospital. This will be an ongoing project requiring continuing education including providing experience with all wound types. My concern is that we are being asked to consider having wound nurses start photographing "problematic" wounds when their experience in wound care at this point is minimal. Long term this would be a good tool but I feel photos taken at this stage may create more litigation problems than it may prevent. The staff has had one 8 hour introductory class thus far with a wide range of experience, none of these nurses are wound certified. I feel our primary goal at this time should be to build their skill level ,then discuss photographic documentation when their skill sets demonstrate appropriate wound management. Any thoughts would be welcome as well as any references that I could access. I have found some info from Ruth Bryant but wondered if there are any specific references addressing this issue. Thanks Sandy, RN/BSN Wound Resource	I feel strongly about this issue and wish to add my opinion and take it as that. I think documentation of wounds via pictures is a professional and great form of documentation and can do more to protect than harm you. You must remember that when you do, do not use patient identifiers except for medical record number and location of wound and date to comply with HIPPA. However, here is my constant defense of this. I went to a conference where I heard that this attorney had given advice to a nursing home (and then it spread like wildfire) that one should NEVER take pictures because he had just lost a case when the plaintiffs blew up a picture and it inflamed the jury. I take exception to this as a nurse and an attorney. For one thing, the picture was not taken by the nursing home, it was by a family member. Another thing, if the nursing home had been providing good care, they could have had their own pictures that showed the progression of the wound which may have been worse to start off and then supported their own case. However, if they simply did not provide good nursing care, then they may have deserved the verdict. However, any time good nursing care is given, it should be supported by any underlying conditions or factors that may affect the wound progression to support their stance, and if they showed that they did everything they could, but the wound progressed anyway, it would support that position also. However, when good nursing care is provided and photo progression is shown, there is nothing better. The facilities that do not, may have something to fear. DO NOT, in my opinion, take the advice of a sore loser attorney. Deborah Harris, BSN, JD, RN, CWCS Louisville, KY ----- You might consider browsing a book entitled "Wound Care Essentials" by Sharon Baranoski. You'll find a lot of inputs there Thanks Dale Gaviola, RN WOCN Philippines
Is there a provider network for billing insurance claims for wound care centers? Eg a pass through service which is registered with many carriers so you don’t have to file with each and every insurance company? Thanks. Patrick	sorry, no replies
I have heard that some facilities are using Nitroglycerin paste on wounds related to peripheral vascular disease. Could you give me some information. If it is being used, what is the correct amount, is it used in the wounds or around them. Thank you	I had an MD prescribe nitro paste for the perimeter of a heel ulcer several years ago. He had read the same info I had about its use for that! The rationale behind it is that it is supposed to increase blood flow to the area. The heel ulcer did quite well and healed quickly, although I cannot say for sure that it was due to the nitro paste. It did not cause any side effects though. We just applied a thin layer to the periwound. I have had some experience with using nitro paste and also a nitro patch for a spider bite, believed to be a brown recluse. The MD wanted to debride the area as it was starting to turn necrotic but I had read that you can release more venom into the tissues that way so I convinced him to try the nitro. It worked great. The wound was completely healed within 2 ½ weeks, again with no side effects or scarring. Sue, CWS

Please note that this email summary page was compiled from emails submitted to the Wound Care Information Network. It is simply a forum for people to discuss wound care cases, treatments, products, etc. Email replies included in this forum are not evaluated for accuracy or correctness. Please verify all information presented with your own sources of information, such as; doctors, nurses, manufacturers, published literature, etc. We do not know who the authors of the email replies are and their stated credentials have not been verified or validated. Read the disclaimer below.

Disclaimer - Acceptance and publication by this email and/or web page of an advertisement, news story, or letter does not imply endorsement or approval by the owner of this website of the company, product, content or ideas expressed in this email. Any medical condition should be evaluated and treated by the appropriate healthcare provider. This email is for informational purposes only and is not a substitute for competent human intervention. The owner of this email list and web site does not check for accuracy or legitimacy of ideas expressed by the individuals who post messages.

Automated removal Instructions shown below.