She's been kind enough to offer an 'ask Wendy' service, where she can answer some emails that pertain to outpatient wound centers. Send in your questions and if you know of any job opportunities, please let me know and I'll pass it along.

Dr. Allan Freedline

The AAWC has a job board. Go to http://www.aawconline.org/careers.shtml

Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

Bonnie

Soaking in a bathtub is not adviced. There are pathogens
(germs) in the water as well. This is why when people
have whirlpool treatments, antiseptic agents are added. These agents are good to minimize infection risk but also are harmful to good tissue. Injury to good tissue can delay healing. Please remember too that the area is around an opening where you have more germs. Soaking in warm water make the muscles around the anus relax, hence feces can easily get in the water.
Maria - PT, DPT, GCS, CWS

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Unn boots do not absorb much you can try a four layer compression wrap and use an alginate underneath. this will absorb more. as with all chronic edema the golden rule is compression and elevation for life. katy rnwcc
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Baby diapers might help, with a higher volume of absorption potential. Place them around the leg where needed. Wrapping with a gauze roll may help hold it all on. This sounds like a tough case, and you're doing a great job being creative in helping her.


Renee C., PT, PhD(c), MSPT, MPH, CWS
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We have used baby diapers instead of abd pads with great success in the home setting - wrapping ace wraps or tubigrips to secure - these tend to absorb and contain the drainage better. Any open wounds are of course covered with a dressing first.
Lynda Abbot RN
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Does she have someone assisting her at home?
It would still be better to use diuretics and someone
she trusts might help increase her compliance with
the meds.
It is good at least that the wounds are draining, otherwise need caution with compression due to her cardiac status. (We do not want to shunt the fluid back to the heart/lungs). Have you used Alginates? They are more absorbent and can be used with the Unna boot, although my personal preference is Profore simply because these don't get stiff like Unna
boot and more comfortable on. Any compression, especially in the elderly, I found it better
to get an ABI. This is to be sure there is also no arterial component.
Has she been referred to a physical therapist? PT can
benefit the patient who has weakness on the lower extremities and therefore less active, causing legs to be more frequently in dependent position in sitting, causing more edema. PT can teach the patient lymphedema exercises and strengthening exercises if there is weakness, as well as increasing ambulation. Muscle activity helps reduce edema.
They can also use a modality called low volt electrical stimulation with which PT's use a mode for reducing edema and promoting circulation. This can onlyh be used for patients who can remain still long enough for the treatment to be completed and with supervision. Therefore, inpatient faciltiy placement is recommended.
Case is similar to a few patients we have, when we diuress, followed closely by Nursing on labs, nutrition and alginate dressings were used - plus e stim daily for 2 hours after exercises and ambulation. Ambulation was repeated at least 6 times in the day with the help of caregivers - all for 1 week - then changing to alginates with profore and e-stim 2 hours 3 days/week after exercises, ambulation.Great results - With borderline ABI, alternative was Profore light.
Good luck,
Maria Carunungan, PT, DPT, GCS, CWS
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Some absorbent options for legs: Profore layered bandages, Exu-Dry specialty absorbent dressings (these are available in shapes/sizes to fit the lower leg completely with one piece). Lee Ann

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This is a perfect wound for a VAC therapy. call her doctor for an order and the company supplying the VAC will set her up with the equipment and dressings.
M. Bristol, wound care LVN

It's impossible to give a medical opinion without seeing her in person. You can find a wound specialist near you by looking at www.aawm.org and www.wocn.org.


Renee C., PT, PhD(c), MSPT, MPH, CWS
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Hello,

Anything with silver will reduce the bactieria, but try to use a light compression and elevation with the dressing in place, the increase in size may well be the retention of fluids or dependent edema from being in the sitting position too long.

Connie Johnson, RN, WCC, DAPWCA

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Venous ulcers occur due to poor venous circulation,
hence fluid builds up in the spaces in the tissues,
especially the legs. Eventually, fluid push through
the skin leading to ulcers. They can also get infected
if they are not cared for well or hygiene becomes an issue.
The usual treatment for venous ulcers is compression
using special stockings to control fluid build-up. Some doctors also place patients on water pill (diuretics) but this depends on how healthy the patient is. There are some patients who cannot go on diuretics, and there are some who can go on diuretics but need watched closely due to side effects.
Movement is encouraged, especially walking. The silver pad is okay as silver is now widely used to reduce bacterial burden (amount of germs in the wound which can cause infection). Antibiotics are only used if after a study of sample swab of the wounds, there is infection. So in this case, even if you cure the infection but the fluid build-up is not controlled, the wound will not heal or will progress very slowly. Ways again to control edema/reduce edema (fluid build-up) are: elevating the leg on a stool when sitting, frequent movement especially walking, compression (with special stockings worn during the day), and use of diuretics.
GOOD LUCK,
Maria Carunungan, PT, DPT, GCS, CWS

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Compression bandaging is the “gold standard” for lower extremity ulcers related to venous insufficiency. They can be difficult to heal using dressings alone without compression.

Lee Ann RN, BSN, CWS, FACCWS
 

RNFrankie posted your question to some other folks, and here was one reply:

I work for a medical distributor out of the Chicago area and they have the grid paper. You can call Leanne in customer service at 800-648-5190 and ask her about it. Also, you could go on the website at www.promedsupply.com

I am not sure if you were also looking for a camera, but Leanne could probably find that for you if you are. Yo can tell Leanne I said to call her.

Hope that helps.

Karen, RN, BBA, WCC