Viv

Unfortunatly there is not one protocol that will fit all wound needs, most wounds need re-evaluated every two weeks and if current procedures are not responding it is time to try something different. With all the new technology we have found that each wound is unique and require different approaches, and wounds with the same etiology often will not respond to the same treatment. Talk with your suppliers of wound care products and they usually have a pamplet with protocols for the different types of wounds.

Bryan Luster, PTA, CWS

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No. You need a wpond nurse as a consultant.

Pat Devine CWOCN

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Viv,

By asking this question, I applaud you. You've taken the first step-standardize. However,the one thing that I've seen over the years
which cause failure of wound care is when we apply the "one-size-fits-all" approach. I understand your desire to standardize the protocols, but, each wound type have different pathophysiology and we need to look at the causative factors, eliminate these one by one
so we can proceed with healing. For instance, a venous stasis ulcer will have failing valve systems, hence the edema results then tissue congestion which can impede healing. The gold standard for care of venous ulcers is the use of "compression" which if applied on an arterial ulcer (where the main causative factor is interruption of arterial flow), will make arterial ulcers worse. We also see the "one-size-fits-all" approach with the choice of
dressings. I would say 90% of providers still utilize "wet-to-dry" dressings for all wound types. You can standardize-yes, BUT
standardize the use of algorithms, decision tree, the questions you asked to assess the wound, and the action taken to heal
the wound.

What I suggest is for your facility to utilize wound care algorithms, decision trees. There will be standard questions asked of the characteristics of the wound (eg color of tissue, predominant tissue type, moisture, drainage type or amount, wound type, dimensions, etc.). For each characteristic, you will be directed on the next item to
look for, and finally a "what to do" (including what dressings to use). This way, all providers will ask the same questions, be on the same page with no one negating what effects other providers in the team are trying to get.

Other than developing algorithms, form a wound care team consisting of physician, nurse, PT, OT, nutritionist, surface specialist,
seating specialist, even a SLP. Each one will have their own set of questions, items to look for and their role in management.Wound healing is affected by different factors (nutrition, mobility, hygiene, etc.). You can provide adequate nutrition but your patient
might not be active enough to improve tissue perfusion, or be able to relieve pressure through frequent position changes, you won't
heal a wound. ETC.

Good luck!

Maria Carunungan, PT, DPT, GCS, CWS

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Other LTC facilities and wound product manufacturers are good resources for this information. I work with LTC. Contact me at labeck@insightbb.com for assist if needed.

L. Beck RN, BSN, CWS, FCCWS

Dear John,
I have recommended Hyperbaric to several patients. There was one patient that amputation was the next step, but instead he started hyperbaric therapy. He healed 100%.
Do research on it and good luck.
Amy Pastor RN CWS
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You will have success with HBO considering there is adequate circulation to the extremity, adequate nutrition and protein stores to support healing, and appropriate offloading. Seek a vascular consult if you haven't already. Hopefully you are under the care of a physician who is a wound care specialist. Go to AAWM.org to look for a wound care specialist.

Debby RN CWS
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Dear John:

In my wound clinic experience, antibiotic seeds were used by the podiatrist which 'cured' the osteomyelitis. We had Hyperbaric chambers at the facility for patients just as you. The treatments could be 30 or less. The patient had to be there at appointment time daily for the treatments. The success rate of wound healing was exceptional. Well worth the effort.

Frances J. Jessup, RN, BSN

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Fecal and Urinary Diversions. Management Principles by Colwell, Goldberg and Carmel would be a great guide. There are test questions in the text. The WOCN Society has a practice test with wound, ostomy and continence questions. A number of companies that make ostomy products offer contact hours on ostomy care with test questions and offer great information.

PC, MSN, RN, CWOCN
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Connect with your professional organizations
WOCN Society and AAWC

Pat Devine CWOCN

http://www.npuap.org/pr2.htm

Hi Tesha,

Stop the Panafil!! Your situation concerns me regarding the application of Panafil on non-verbal patients. Try a basic Hydrogel on the wound. That should be soothing and keep the wound bed moist. If the area around the wound is burning/stinging, try applying Cavilon No Sting Barrier Film around the wound. It will not burn at all and will protect the skin. If the doc is still concerned about infection, then I would suggest a product with Silver in it so you don't need to change the dressing so frequently. Sorry to hear you're in so much pain. If your doc is not willing to change treatment, I would suggest finding a new doc.

JP DPM, Miami
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esha,

It is common for people to experience a burning sensation when using Panafil, which usually lasts 20-30 minutes. I assume you are applying a saline-moistened gauze pad over the wound site. I would be careful to apply only a thin layer on the wounded tissue, and be sure that it is not leaking onto the skin around the wound, which you say is irritated already. I suggest not using the A&D ointment, as you may be sensitive to the ingredients. You could try plain white petrolatum ("Vaseline"), or a thin layer of zinc oxide ("Desitin"), assuming you aren't allergic to either one (do one or the other, not both).
Although I can't determine that Panafil is the most appropriate product for you at this time (we'll assume it is), there is another enzyme on the market that is less often associated with burning, as it has a different target tissue to break down (collagen rather than fibrin).
The product is Santyl Collagenase. You would need a prescription for it also. Check in with your plastic surgeon about this problem. Good luck!
James Patrizi, PT, CWS
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Try something new
Clean your wound with 3M wound cleanser , apply no sting barrier to periwound (3M)
Apply hydrofera blue to wound bed (moisten with saline and squeeze out excess), may overlap the edges, cover with transparent film, change every other day.
Hydrofera is a bacteriostatic foam dressing impregnated with gentian violet and methylene blue
This dressing will also help with the pain
Good Luck

SCohenRN

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Get a "second opinion"

Pat Devine CWOCN

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Dear Tesha,
The reson for "Oanafil" is that it debrides and cleans the wound but other debriding agents can be used, if panafil is too painful. Patients have told me that Collagenase Santyl does "not" burn as much. The other thing you might be able to do is have the doctor order a numbing cream (lidocaine base) and apply a small amount into the wound bed followed by the panafil.
Good luck and I hope you get better,
Amy PAstor RN, CWS

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Ask your doctor to try Hydrafera Blue Foam dressing. This product is wonderful in healing wounds .. I'm a LPN currently working in a LTCF .. I've started using this on a patient that had 3 stage IV ulcers to the coccyx and bilateral buttocks. Patient had wound vac therapy ongoing that was not showing and signs of improvement, after researching I found the hydrafera blue foam dressing I called the Doctor and requested a order to change the wound vac order to Hydrafera Blue foam dressing to be changed every day. and after just a few months all these wound are now a stage II healing very well. the patient also is being followed by a wound clinic on a regular monthly follow up. The wound center can't believe the difference and time frame of the wounds healing so well It is a wonderful product ask your doctor to give it a try You will see a Big difference in your wound healing. It is very easy to use and change the dressing. It comes in a square that is flat and easy to cut to the size of the wound. You soak it in normal saline before applying to the wound, squeeze all the excess saline out of foam cut to size of wound bed don't put it out side of wound only apply to wound bed Clean the wound with normal saline before applying foam cover with 4x4's and secure with medipore tape. Give it a try

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Get polymem silver and leave it on for 5 days or until 70% saturated, then switch to regular polymem and do the same thing. it will heal with much less pain and aggrevation.

Patricia

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Hi Tesha,

I have been a nurse for >26years and love wound care!! I am wound care certified and the Director of the Wound Care Team in the facility for which I work, where I have many opportunities to try new things. One dressing/treatment which has come to my attention within the past 6 months eases the pain in the most severly painful dressing changes can be left in place for several days, it cleans as well as heals. We have nothing but great results with hydrofera dressings. You can find information as well as order on line at hydroferablue.com.

Good Luck,
Connie Johnson, RN, WCC, DAPWCA

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Panafil is a papain urea enzyme debriding ointment and they usually sting. Santyl ointment (Collagenase) is an alternative that does not usually sting – same indication, different ingredients (collagenase vs papain urea). It is a once daily application. For irritation of the skin around the wound from any of the ointments, sometimes a thick barrier cream helps, like Secura EPC cream or other good quality, long lasting barrier.

L. Beck RN, BSN, CWS, FCCWS

Angela, BSN, RN, WCC

The empty caviety will never heal, I had a man in Chicago (my home town) that had to have a surgical closure. Contact thorasic surgeon Bill Warren MD at Rush Prespyterian St. Luke Hospital in Chicago. he is THE BEST Patricia

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If the patient has Medicare B primary coverage, he will qualify for dressings to be delivered to his home. However, he must have a physician sign an order for appropriate dressings.

Sheri Bishop