unsigned

Catalase does this extremely efficiently -- up to 200,000 reactions per second. The bubbles you see in the foam are pure oxygen bubbles being created by the catalase. Try putting a little hydrogen peroxide on a cut potato and it will do the same thing for the same reason -- catalase in the damaged potato cells reacts with the hydrogen peroxide.

Hydrogen peroxide does not foam in the bottle or on your skin because there is no catalase to help the reaction to occur. Hydrogen peroxide is stable at room temperature.

Donna Cameron RN WCC

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Peroxide always bubbles, no matter if there are a lot of a little bit of bacteria. Peroxide does damage healthy cells. But, if Jim is otherwise healthy, he should still heal fine. If not, no long-term
damage. Just switch the plan, and he'll be back on track.
Renee C., MSPT, MPH, CWS

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all the exposed cells were being damaged further by the undiluted (I presume) hydrogen peroxide. if it was adequately diluted then perhaps it just aided in debridement

kumkum

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taking slight variations in rate of healing, one solution is to ask the individual to remove the outer non-stuck outer layers on a stipulated date and go for a bath. Soak the stuck inner layers and not be in a hurry to pull them off but in due course of the extended bath let the innermost layer peel off. If this does not happen, let it remain stuck and trim off the loosened part. Now apply any oil or moisturizer of this after patting it dry and hope to succeed the next day or so.

kumkum

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Hi:

From Practice--it is usual for the dressing to be left on donor site until it falls off. I have never encountered a donor site wound that was not dressed with xeroform gauze and left in place until it falls off. I can only think that if a problem dvelops with the donor site--that it would be treated like any other wound. If this is the case: I would suggest selelcting a non-adherent dressing such as mepitel, adaptic etc over wound.

Best Regards,

Jamie B. Pinnock, RN, CWCN

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Ray-
Sometimes pain can be a good thing, when removing a dressing from a donor site if the patient doesn't have pain you really need to question why...
Trust levels will only be altered if you don't tell the patient in advance that the procedure will hurt. When I am changing a dressing I always pre-medicate for pain, always orally and sometimes topically. You may want to look into some of the Litocain based sprays if you deal with donor sites a lot, in order for it to work you will have to remove all of the dressing with the exception of what is in direct contact with the wound (typically a Vaseline based dressing like Xeroform).
Hope this helps.
Tina (L.V.N., wound care nurse)

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You dont say what type of dressing it is that you trying to remove, generally jelonet or similar is applied by the Consultant in theatre, by the time it comes to removal the dressing has severely dried out! If a semi-permeable is used however, the removal is much easier and less painful for the patient. The use of an oil to soak the dressing off is quite beneficial in the former instance.

unsigned

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Shirley-
As best I know you can't palpate a healing ridge with sutures or staples intact, however if you use a Q-tip to clean the incision you can identify areas of closure.
For example: a hip incision with 20 staples, numbering the staples from 1 (most proximal to trunk) through 20 (most distal), I would chart: note closure of incision with cleansing between staples 1&2, 9&10, 12&13, and 19&20.
Noting closure between staples can be offered as documentation supporting development a healing ridge or can work as a flag if healing isn't happening.
Good luck.
Tina (L.V.N., wound care nurse)

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Surgical wounds may be considered non healing the first four to five days after surgery if there is no palpable healing ridge. A healing ridge typically becomes palpable between day five and nine after surgery. Most newly admitted patients will be classified as having a non healing wound. This has implications for reimbursement as well as for improvement in surgical wounds being accurately reflected on Outcome Reports.
Link to VNA
Donna Cameron RN WCC

mavis lpn wound care nurse

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Several suggestions. Instead of skin prep, use a barrier cream, whatever you use on red bottoms to protect from incotinence. Just put it periwound. Also, if his arterial supply is adequate (a simple ABI, or a more sophisticated arterial study could confirm this), then he needs better, more consistent compression. Try one of the mulit-layer
wraps (again, if the arterial supply is sufficient). It could be changed twice a week to manage the exudate. I would probably use Aquacel and foam underneath the wrap. Also, I typically use Iodosorb under my wraps to help absorb and manage bioburden. Has the wound been
cultured? That could explain the extra heavy exudate. I love Aquaphor for the dry skin. It will soften everything, and keep the bandage from
sticking. Also, give that dry flaky skin a good scrubbing with a very soapy washcloth. Lastly, you said the edema is 1+. Is it really
pitting edema? If so, that could be CHF. Active CHF is a contraindication for compression therapy. That extra fluid could explain the heavy exudate also. Maybe he needs to be checked by the cardiologist?

Renee C., MSPT, MPH, CWS

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Have you tried using hydrofera blue and a barrier ointment on periwound?

unsigned

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Hello,

As long as you have edema in the leg, the wound will tend to drain quite a bit and macerate the wound edges. In this patient’s case a four-layer wrap like Profore might be more beneficial, with a wound dressing under the wrapping as appropriate (for instance, I have used adaptic if the wound is clean and just needs protection from the wraps, or a silver gauze like Acticoat if I was worried about bacterial load). Also, don’t forget the old stand-by, Unna’s boot with coban to secure; I recently had a patient that responded better to the drying effect of the calamine in that than he was to the 4-layer system. Elevate the feet with sitting!

Vicki, MSPT, CWS
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ZnO paste could act as a good protective layer for the surrounding skin. The sanitary pads which maintain a dry contact surface could also help by taking up the copious discharge.
kumkum
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Hi:

When there is a lot of edema in a leg and it decreases--the normal process is for the skin to shed--after all the skin has been receiving little nutrients because of the fluid build up in the tissue. Based on what you describe I would recommend cleansing area with a non soap cleanser and moisturize with amlactin otc or lachydrin otc. eucerin is also good. Sometimes this has to be done on a regualr basis to be effective. It takes some work--but a healthy peri-wound promotes a healthy wound. I would also recommend that you continue good compression if the patient is able to tolerate. Is the dressing being changed daily, Is the compression dressing being applied properly--is the patient applying hiself? Compression wraps must be applied from above toes to 1-2 inches below knee. If the leg is weeping and the exudate is sticking to the ace bandage and causing trauma with removal I suggest a higher compression like modified 4 layer, setopress, surepress to continue to address edema. Sometimes it is not the best thing to stop using a high grade compression when the edema decreases because the venous congestion is the underlying cause of venous ulceration. If the patient's circulation is adequate for 30mm hg or more at the ankle then i would suggest continuing compression.

Best Regards,

Jamie B. Pinnock, RN, CWCN
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At my facility, we apply zinc oxide to the peri-wound to prevent maceration.
Debby
RN/WCC

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HI Mavis,
At our facility we have had very good results using Unna Boots and changing them 2-3 times per week. I would never use ace wraps as compression dressings as you can't accurately control the amount of pressure being applied. Hope this helps.
Donna Cameron RN WCC

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Try using aquacell under an unaflex made by Convatec. You will be shocked the amount of drainage that it absorbs. You may also want to change this type of compression dressing about 4 to 5 days versus 7days. Jennifer PTA

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Hi:

Did you read the package insert? This is a good question-- I will have to read the package insert. Have you tired calling 1-800 number.

Best Regards,

Jamie B. Pinnock, RN, CWCN
 

there may be some avascular bone fragment (attached or loose) at the depth of the sinus and until it comes out or is brought out, the problem may persist. The HBOT may aid the local viable tissue in loosening the nonviable portion thus allowing it to be thrown out or lysed and debrided by the defence cells (phagocytes) of the body. Flushing the tract with dilute hydrogen peroxide could be tried if the tract is wide enough to allow the solution to flow out easily and not get loculated and bubble its way deeper creating new tracts due to pressure build up by the bubbles.
kumkum