Wound Email - December 13, 2006

Wound Care Information Network

December 13, 2006

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

I am a home health care physical therapist. I have a patient who is having difficulty with independent mobility because of the equipment he has attached to himself! He has a tube feeding attached to an IV pole on the L and a blue sky wound vac on the R. He said that when he was in the hospital they used an IV pole that had an extra attachment, sort of like a shelf, that the wound vac could sit on, so that he pushed the IV pole and it carried his wound vac. I am having trouble finding a DME that has even heard of such a piece of equipment. Any chance you might know more about this? Thanks Crissy	I know exactly what he is talking about. Please call me at 888-750-7828. Deborah Harris BSN, JD, RN, CWCN, Director of Clinical Services --- We can provide either a clamp on basket or an IV pole with a shelf. Please contact us at info@mar-jmedical.com for more information. We look forward to hearing from you. Jason ----- Crissy, you need to call Blue Sky they have a bracket you can rent to attach the wound vac to the IV pole. We used this all the time. Dex Bayani, PT --- Set him up with a KCI home VAC. They have a portable size that he can wear over his shoulder and get rid of the pole. unsigned --- Why not get the wound vac that is small enough to go into the pouch that he can carry? --- The Blue Sky rep responsible for this patient can get you the attatchment. My rep actually includes the pole and attachment with each unit we use. Glenn Carr,RN
I am sorry to bother you, but could please send me the correct definition of boggy as in boggy heels. I am having some difficulty with staff in regards to this, they don't want to classify boggy heels on residents that are non-ambulatory. The heels I am specifically talking about have definite induration when heel pressed, it may not have redness or purplish color and I am told this is not boggy, even though the induration is greater than 2 seconds. So If I had your specific definition it would help greatly. I have looked in many terminology books and not able to find definition. Thank-you so much and any thing you can do would be greatly appreciated.. Marika LPN Clinical Care Coordinator	boggy would refer to "spongy", and induration is "firmness" not fliud. Of course in reference to pressure ulcers the heels are of great concern in an individual that is non-ambulatory or total care. Documentation that the nurses would feel more comfortable with could be "soft spongy heels", then describe the color of the tissue, and interventions to prevent pressure ulcers on the heels. Remember stage I is non-blanching erythema and a stage II could be a blister (different from soft and spongy). Hope this helps. R DeLaney LPN, CWS, FCCWS
To Whom It May Concern, I had thought that the AHCPR guidelines advised against the use of sheep skin to prevent pressure ulcers. Could you please let me know. Thank you, Allison Dunbar MPT, CWS	I have not read that the AHCPR advises against the use of sheep skin. I do know that the "sheep skin" we comonly see is not "sheep skin" but a synthetic product which causes friction with rubbing, and friction can be a predisposing factor for pressure ulcer development. Remember PRESSURE is PRESSURE, wether you are using sheep skin, pillows, heel boots, foam pads etc... example, If you are using a sheep skin or heel boots on the heels and they are resting on the bed or chair, then you still have pressure. R DeLaney LPN, CWS, FCCWS
Hello, I am a Director of Rehabilitation dept in a SNF. Can anyone give me any suggestions or guidelines or references re: documenting ultrasound for wound healing. Since Medicare does not cover ultrasound as a treatment for wounds (due to lack of efficacy data) how are we suppose to provide the service that has been proven to help with wound healing and ensure payment? What kind of functional goals should be written? We continue to struggle with this so any suggestions would be greatly appreciated. Thank you. Sincerely, Denise Adamski, DOR	Your ultimate question is ambiguous and I don't really know what you are asking. Medicare reimbursement is a long-standing issue - if research is not done proving efficacy, Medicare may not reimburse. Since you are probably getting PPS funds anyway, that should not be an issue. If it works for you, go for it. As to documenting, you can go directly to the distributor, I'm sure they would have something, or use your own documentation as you would for any wound care plan. You can also run your own studies and even write them up for publication. You could do case studies or actually run trials with similar wounds using traditional therapy and those using ultrasound. Every piece of evidence helps the medical and nursing profession in general. Debbie Harris, BSN, JD, RN, CWCN
Hello. I am undertaking some research about wound cleansing and in particular the choice of Water or saline for this purpose. i would be very grateful for any information that you could help me with. Many thanks Alison Moss	sorry, no replies
I have "ADAPTIC' , 3 packs, to use on a leg wound (skin has been hit and rolled back). Is this used to contain moisture on the wound? Do I put antibotic on before or after application of Adaptic? Sincerely, Dorothy Hauser djh2919@stx.rr.com	sorry, no replies

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