December 15, 2003
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having a discussion about decubitus ulcers?
Can a decubitus with slough be staged?
Some think yes a 3 or 4,,,,,others say no because you can't see the wound
My name is Amba, a student of physiotherapy studying in India.
As per my course requirements, I am to submit a project work on the topic of
my choice. The topic I have selected is "Recent advances in wound care with
electrotherapy". I would like to know what are the various electortherapy
modalities available in the treatment of wounds and also would be greatful
if someone could give me links to websites carrying relevant subject
material. I have searched for HVPGS, but haven't found any describing the
exact procedure of treatment.
doctor says I would be a candidate for Dermagraft, however, my insurance
company will not cover the cost as I am not a diabetic and they say it is
still in testing stage. I have two trauma ulcers, one on each leg, that will
not heal. Has anyone used Dermagraft and has it worked to close this type of
you please help settle a debate? Is tincture of iodine better for wound care
than triple antibiotic cream?
anyone had any experience with a product called CircAide T-3 boot and sleeve
for compression of LE venous insuffiency. Does this product increase patient
compliance? Does it seem to be an effective alternative to multilayer
compression wraps to remove edema? I have a patient who is currently having
a difficult time transferring from multilayer compression wraps (Profore)
that I put on to being independent with her compression garments. Each time
we get set to go Independent, something seems to happen where she is unable
to get her compression stockings on at home...more edema...more
wounds...back to Profore. Is the CircAide boot and stocking a viable
I was wondering, what are some of the alginate
dressings or other dressings that are absorbable if left in the wound bed
(most likely accidently)?
Someone told me that all alginates work this way, but I don't believe them.
I'm a PT that has been practicing wound care at a major hospital for 4
years. I had a question about iodoform packing strips. I know certain levels
of iodine are indescriminately cytotoxic. Doctors in the hospital always
seem to order iodoform packing strips (which I most often am able to change
to a more heaing-friendly dressing). But if you were to use this dressing,
is the level of iodine in these gauze dressings still cytotoxic to all
tissues?? Is there any research that shows what levels of iodine would be
"appropriate" (I use this word very loosely) ?
Thanks for your time.
a long-term bed the patient, the buttocks and the left hip have a pressure
sore, NaCl wet packing for 4 months, because the wound heals slowly, changes
by the seaweed rubber surgical dressing, but healed is still slow, asked,
what method I possibly did use to improve it? (Has picture)
I am interested in finding out about any type of exercises presecribed for
people with vascular insufficiency. I have two diagramed exercise protocol
from dow hickman(simple exercises to improve circulation) and Lower
extremity exercises for people w/ diabetees from Novo Nordisk Daibetees
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type of dressing or product is available that can help to control odor
caused by hard to heal wounds?
of all, you have to control infection, because the bad odour is a result of
microorganisms destruction, if you destroy the bacteria, there will be no
Did you ever try Curasalt by Kendall - it is very potent dressing for wound
infection control, it is 20% NaCl impregnated gauze and it really doesn't
matter what kind of bacteria is involved - nothing can survive in 20%!!!
You should use it carefully - put vaseline around the wound and never put it
on healthy tissue!!!
I found Actisorb very good to help control odors. It has charcoal in it and
it helps in the wound healing also. It's a good product. Good luck.
This is hard to answer since you didn't post
a description of the ulcer. However, you can use Panafil by Healthpoint, its
a debrider/ deodorizing ointment that is really great in controlling odor
and healing wounds.
Actisorb by J&J has silver and charcoal
together so has an antimicrobial effect and charcoal for odor. Smith &
Nephew has Acticoat and Acticoat absorbent where in theory if you have
antimicrobial effect should decrease bacteria and therefore odor. Again all
silver dressings from different companies are antimicrobial, but J&J's
product has the added charcoal for odor. Iodosorb by Healthpoint in another
option-antimicrobial with iodine. I would contact your local sales
representatives to get the research, samples and then you can make your
Lisa, MPT, CWS
Depending on why you have an odor. You need
to determine what the odor is caused from and the goal of your tx and
If there is necrotic tissue it has to be debrided.
If it is a fungating type of tumor you have several options. There are
several types of dressing that have carbon impregnated ( most are foams) in
them that you use as a secondary dressing, but they are EXPENSIVE and will
not work if they become saturated with drainage. You can also use Metrogel
gel to the wound bed but it also expensive if your wound is large. Dankins
solution at 0.025% is very effective and inexpensive for a wet to dry daily
to three times a day dressing and at this dilution it is not likely to be
cytotoxic and it is bacterialstatic if the odor is caused by an infection
such as pseudomonas.
Another trick if the odor is just a minor wound odor is to change your
dressing as normal (wet to dry, whatever) and on the top of the dressing
place a "downy" dryer sheet, this just masks the odor.
I would recommend the product Didaksol, from
Century Pharmaceuticals. It is a prepared, buffered, stabilized solution of
sodium hypochlorite, or Dakins Solution, at 0.0125% This is 40 times more
dilute that the standard solution of .5% At this dilution, it will
effectively kill all bacteria, including MRSA, but will not kill that cells
that make the new tissue. By reducing the bacterial load, there will be less
drainage and odor, pain and inflammation. Cost $5 for 16 oz. Very easy to
use as a wound cleanser or wet gauze dressing. Best of luck!
Trish , RN, MSN, ANP, CWOCN
We use a Charcoal based dressing if the wound has mod to severe exudate. If
it is light, you can use a Acetic acid wash.
There are lots of approaches to dealing with
odiferous wounds. If the goal is more palliative, then approaches like
Dakin's dressings or even kitty litter or charcoal in the room will help.
If healing is a goal, then consider one of the charcoal dressings. Even
better is to go after the cause of the odor, which is necrotic tissue and/or
infection. Silver dressings or cadexomer iodine (Iodosorb) can help, as can
sprinkled over the wound. Topical and/or systemic antibiotics can help.
Lastly, sharp or surgical debridement is needed to
clean the wound, and remove the dead tissue.
Renee C, MSPT, MPH, CWS
I have found the use of Panafil, with
chlorophyl in it helps to control odors. If concerned about bacterial load,
Dan DPM, CWS
I AM A CAREER COUNSELOR WORKING
WITH A WOUND CARE NURSE. WE ARE TRYING TO FIND WORK WHERE SHE WILL DO SOME
WOUND CARE NURSING. SHE SAYS SHE NEEDS SPECIALIZED TRAINING BUT WE CANNOT
DO YOU HAVE ANY CLUES.
can go through a WOCN training program, and sit for that certification exam.
www.wocn.org will have a list of programs,
including web-based ones if there is no local school. If she doesn't want to
make that level of committment, then there are many wound courses and
conferences out there.
www.woundcaresymposium.com www.symposiumonwoundcare.com are the
two major conferences. Someone will probably suggest the course by WCEI to
get the WCC in one week. However, it is generally not
respected or recognized by wound care clinicians, since its requirements are
significantly less (only a one week class with a
test, no experience needed) than the other certification options, which
require significant experience and training. www.wocn.org www.aawm.org
Renee C., MSPT, MPH, CWS
The best program to do is an Enterostomal
Therapy Program. There are several in the US
K. Paige, NP, CWOCN
I am an LPN and board Certified in Wound care
and Management through the American Academy of Wound Management.
The web site of the Wound, Ostomy, and
Continence Nurses Society (WOCN) at www.wocn.org has information on
education programs for baccalaureate prepared nurses.
found a great deal of material on collagen dressings including that they are
for exudating wounds. The animal collagen apparently combines with the
exudate providing a protective barrier. Does this sound right for all
Also, I have not found any recommendation for frequency of change of
dressings. Would you be able to tell me this?
not sure about the first question, but Promogram is usually changed based on
drainage (Promogram-collagen dressing). I could be wrong but believe it is
active in the wound for 72 hours--can contact J&J.
Why is dakin's sol'n used for decubitus ulcers?
Is it a cleaner, disinfectant , debrider? I would love to know Thanks
Dakin's is a cytotoxic antimicrobial solution. It kills cells, both bacteria
and healthy tissue. It has a role if healing is not a goal (eg: fungating
wounds, terminal patient), or for a few
days of irrigation, followed by NS rinses, to reduce bioburden. However, for
a wound with a goal of healing, it should not be left on the wound or used
for more than a few days.
Renee C, MSPT, MPH, CWS
Dakin's solution should not be used on
wounds. It impedes the healing and
is not recommended for any type of wound.
Anne RN, BSN, Onc.
Clinical Nurse Educator
Hello. Dakins solution is necrotic to tissue
and should not be used. I have physicians order a 1/2 strength "Paint" to
wounds but even this is frowned on. Heide C. RN
It's bleach that's basically used to control
the odor of foul-smelling
ulcers. Was widely used once but it's very caustic to wounds so its not
part of the national wound care guidelines. Hope this was helpful.
Dakins solution is not used much any more, however it was used to decrease
Dakin's solution is sodium hypochlorite, and
has been used for many years. It does indeed cleanse and debride wounds. The
standard solution is .5%, but at this dilution, not only are the bacteria
killed, but also the cells that help the wound heal. A more dilute solution
of 0.0125% is available from Century Pharmaceuticals. At this dilution, the
wound will be cleansed of bacteria and dead tissue, but the cells needed for
healing remain active. The cost is only $5 for 16 oz. It is used by
moistening gauze and applying it to the wound. The dressing should be
changed daily. I have used this solution for ten years with consistently
good results on many kinds of wounds. Good luck!
Trish , RN, MSN, ANP, CWOCN
YES dankins is all of those.
For use on Pressure Ulcers you would use it IF the wound has minimal
necrotic tissue (although I would use an enzyumatic debrider instead), I
would use it if contaminated with bacteria, especially psuedomonas which
stops the wound healing progress and creates an odor. It is really
inexpensive, so if the patient had limited finances it is acceptable, I
would recommend the strength of 0.025% which has very low potential for
We use it for cleaning the wound when there is significant odor. It is used
for approximately 5 days then changed to normal saline cleaning. Hope this
DAKINS SOLUTION IS A LONG TIME OLD REMEDY, IN THE WOUND CARE CENTER WERE I
WORK WE USE AND RECOMMEND DAKINS SOLUTION FOR WOUNDS INFECTED WITH
PSEUDOMONAS. ITS WORKS, GOOD RESULTS. GOOD LUCK!!
|I am a
community nurse , I always come across chronic leg ulcer patient, Their
edge has already rolled in, slow epithelialization, only granulation, how
can I solve this problem in order to speed up epithelialization? Thanks!
they having compression therapy with the dressings? Deborah
Using silver nitrate sticks around the wound
edge can help with the rolled edges. Leg ulcers is vague. If it's a venous
ulcer, then compression is crucial (if the arterial supply is adequate). If
arterial, need need evaluation by a vascular surgeon if they haven't
Renee C, MSPT, MPH, CWS
when the wound edges roll in the wound thinks
that it has healed itself. I have found success with silver nitrate sticks
used around the wound edges can promote granulation again.
WHEN YOU SEE THE EDGE OF WOUND ROLL IN YOU NEED TO SUGGEST AND SURICAL
DEBRIDMENT, THE WOUND EDGE NEEDS TO BE REMOVED, THIS MAY CAUSE THE WOUND TO
INCREASE IN SIZE BUT IT WILL HELP THE WOUND HEAL QUICKER. GOOD LUCK
These patients really need to be evaluated by
someone experienced with wounds. The only way to heal true venous stasis
ulcers is with compression, but compression is not to be done unless you
have ruled out mixed etiology arterial disease. These patients need vascular
studies to determine if they can tolerate compression especially if they
have untreated, undiagnosed heart disease (esp. CHF). Once healed, these
patients need to ALWAYS wear some sort of compression hose to prevent
When a wound edge rolls in, it impedes
healing. I've found that silver nitrate works best in these situations. Yves
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