Email - April 5, 2005

Wound Care Information Network

April 5, 2005

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I am a Physician Assistant and while working at another facility attended a lecture recommending the use of duoderm for not only pressure sores but also for second degree burns once the blisters had popped and drained; This was due to the temperature gradient and wound debrisment that occurs. WE had great success; However I am currently working in another hospital and would like to know what information you have concerning duoderm and wound care particularly in reference to burns. Thanks, Robert Du Charme	Hi Robert, I am a registered Nurse, Nurse educator and worked in a burns unit over a period of 14 years and have used many products on partial thickness and deep partial thickness burns. I have used duoderm on these burns following blister debridement. The type of duoderm: ie thin,CGC or E you will need to use will be determined by the amount of exudate from the wound. The amount of exudate from the wound will also determine the need for dressing change. E can be used for heavily exudating areas. One complication we noticed with prolonged use of duoderm was the development of hyper granulation Tissue. Trusting this will be of assistance to you. Kind Regards Lindy
I have just heard about the "Kennedy terminal ulcer", and the description of the ulcer is similar to a patient I Have. Would like more information on the development and treatment of this ulcer. Please email me at : juanitagauthier@bellsouth.net	You can go to www.KennedyTerminalUlcer.com for a lot of information on the KTU. Renee Cordrey, MSPT, MPH, CWS --- Hello, Butterfly-shaped on the sacrum only from the pressure on the area involved. The integumentary system has lost its ability to provide the necessary protection, as all the systems probably have. The patients I have treated who were purported to have this ulcer haven't had a good prognosis/outcome. Sorry. Respectfully, Chuck --- Try her website: Kennedy Terminal Ulcer.com Yvette Glenn, MSN, RN, CWS --- Unfortunately if what you are looking at is a "Kennedy ulcer" the best thing you can do is try to keep it clean. Concentrate more of your goals to pain management with the care of the person... if I remember correctly your pt. is looking at maybe 2wks. left to live. Tina (L.V.N./ wound care nurse) ---- The Gaymar Pictorial Guide to Pressre Ulcer Assessment by Karen Lou Kenndey has pictures and descriptions of the Kennedy Terminal Ulcer. The phone number for Gaymar is 1-800-828-7341 and the web address is www.gaymar.com. Address is 10 Centre Drive, Orchard Park, New York 14127, USA. There is also a website for the Kennedy Terminal Ulcer; I believe it is www.kennedyterminalulcer.com. Nancy B. RN, CWCN
To Whom It May Concern: My friend's brother has been in a wheelchair most of his 35 years and he has been battling a severe wound at the base of his spine (where there is a titanium? rod). He's been in and out of the hospital in Syracuse several times during that 2 1/2 year period, sometimes for 1-2 months at a time. I'd like to be able to give my friend some additional resouces she could contact about new treatments. Please let me know if there are: 1) specialty practice areas for victims of spina bifida with chronic wounds 2) trials that may be appropriate 3) certain hospitals or chronic wound care clinics that might be appropriate (The family is in Syracuse and the sister is in Northern Virginia.) Thanks, Tina Smith	Try to find a specialist on one of these sites. www.aawm.org and www.wocn.org Renee Renee Cordrey, MSPT, MPH, CWS
I saw your site on-line and I'm trying desparately to find a tube of "zinc oxide PASTE" for my elderly mother who's been treating an ulcer on her leg with zinc oxide paste which she was told to get by her doctor years ago. In any case, she just can't find this paste anywhere anymore. She has found zinc oxide paste 'OINTMENT', but this is not the best bet for her because it's too creamy and doesn't adhere to her skin. I've looked on-line and I'm just stuck...can anybody help? Appreciatively, Susan Susan Ferris	Zinc oxide paste can be found as products like Desitin. However, it is not optimal for wound healing. Try finding a wound specialist to see her now, and see what might be best for whatever type of wound she's experiencing. Many have special needs. www.aawm.org and www.wocn.org. Renee Cordrey, MSPT, MPH, CWS --- Sween CriticAId or Smith Nephew EPC ointment are stiffer zinc based preparations that may help. Jana B. Stewart RN, BSN, COCN, CWCN ---- aloe vesta sensive care has zinc oxide in it and works well of weeping leg ulcers. should be able to get it at your local DME.... lisa wcc ---- Hi You might be referring to a product we make called Critic Aid or Baza Protect - Critic Aid is a thick zinc based ointment/cream for barrier protection on skin that is very broken down and is open and weeping with drainage - typically skin is broken down like this due to continuous fecal incontinence. Baza Protect is also a zinc based barrier ointment used in the buttock region to protect against the effects of incontinence but not as thick as Critic Aid - These are made by Coloplast - call our number at - 800-788-0293 and speak to customer service - Good Luck Beth Rogers Territory Manager ---- Leg ulcers are caused by variety of reasons and treatments are based on the exact cause. Ulcers from venous stasis are treated with serial application of gauze impregnated with zinc oxide gel. It is important your mother sees a vascular surgeon for a complete evaluation KT Kishan MD Vascular surgeon Warsaw In ---- Susan, How long has she had this wound? Perhaps it would be best to get her to a wound care doc to see if there is anything newer out there. There are many options other than zinc. Is she diabetic? Does she have PVD? unsigned --- Zn O paste can be prepared by mixing ZnO powder with olive oil ZnO …………..50 gm Olive Oil ……to 100 gm Should be nearly liquid ZnO paste .... - ZnO .................................. 12.5 gm - Talc .................................. 12.5 gm - white soft paraffin .............. 12.5 gm - Lanolin .............................. 12.5 gm Zinc Oxide Oint - Zno......................................15 gm - Vaseline ............to ............100 gm Used as: Astringent, Soothing and protective. Kumkum ---- Try using Zipzoc zinc paste stocking. We have excellent results and stays on for up to 7 days so cost effective too Lorrna --- Please don't take this wrong... get Destin (diaper rash ointment)... It is zinc oxide and will sufficiently adhere to your mothers wound. Tina (L.V.N./ wound care nurse)
i have a pt. with small ulcer with want seems like yellow necrotic which just now has pin size opening and slight dry drainage on gauze last two times at changing it is being treated with regranex and wet to dry dsg.i am concerned about harded area which has been decreasing in but ever so slowly any ideas to speed up healing. lpn ny	Hi, If this wound is covered in yellow material, instead of being red and healthy (granulation tissue), the Regrainex is being wasted (and it is an expensive thing to waste!). The wound needs to be cleaned up appropriately, and then it will be ready to heal. Since I can’t see it, I can’t tell you how to proceed. See if you can find a wound specialist who can help you. Vicki, MSPT, CWS ---- Regranex won't work on necrotic tissue. It's a waste of money. The "hardened areas" probably should be debrided. Renee Cordrey, MSPT, MPH, CWS --- You need to have the attending physician look at that wound, in order for regranex to work it has to be applied to healthy tissue, if you believe that you are looking at yellow necrosis then you are wasting about $300 on that little tube. Tina (L.V.N. /wound care nurse) P.S. Check the color of the regranex, if you have kept it refrigerated like it should be it will be clear, if it has been left out and all of the growth factors are dead it will be yellow and that could be causing your "yellow necrosis". If it is yellow it is trash. unsigned
Are there any over-the-counter products that will speed up the healing of a forehead wound that has already scabbed over? the scab seems very attached and has been for a few days. Should it be covered? Should I protect it from getting wet? Thanks for answering my inquiry. Betty Blum	Scabs are natures little bandaides, if it is scabbed and doesn't look infected, leave it alone... when it is ready it will fall off on it's own... Do Not use peroxide on it, you will harm the healthy tissue under the scab. Tina (L.V.N./ wound care nurse)
Dear Sir/Madam, Hello, my name is Natasha and I am a registered Physical Therapist in Australia. As an Australian trained PT, I did not receive training in wound care or ulcer management specifically. Physical Therapists in the US however, are obviously quite involved with patients who develop complex or serious wounds/ulcers - as noted from your website. As I would like to work in the US as a PT in the future, I am researching the various roles a Physical Therapist might play in the management of such patients. I am interested to know whether Physical Therapists are solely responsible for assessment, treatment and management of these clients. Or, whether PTs simply provide treatment e.g. using modalities such as electrical stimulation, after receiving a referral or instructions to treat from e.g. nursing staff or a patient's physician. I would greatly appreciate any information and time you could provide to help me better understand the role a PT plays in wound management. I look forward to receiving your responses and wish you a very pleasant weekend. Sincere regards, Natasha Australian PT	Hello, I sure hope there isn't anyone who's solely responsible for wounds. Here in the United States we mostly take a team approach, although there usally is a team leader. I have seen PT's giving alot of whirlpool Tx's and subsequently dressing changes if that helps. Respectfully, Chuck --- Hi Natasha, I work in Arkansas, and our state practice act allows us direct access to patients, which means I don’t have to have a referral from anyone to dress or take care of wounds EXCEPT for sharp debridement. Our state act specifically states we do have to have an order for sharp debridement. I am the chair of the wound team at a 61 bed rehab hospital and the adjoining 52 bed acute care hospital. I do most of the wound care at the facilities that require pulsed lavage, debridement, or specialty dressings, or just wounds that have had a history of being chronic and the MD specifically asks me to follow the wound. The fact that I am inpt helps me be able to do wound care that I could not bill for on an outpatient basis; the hospital is game for me to do whatever if it gets the patients discharged more quickly. The MDs at our facility know me and 99% of them write “eval and treat” orders for me and leave me alone. However, at a place I worked at before, I had no such autonomy, and the ET nurses wrote orders I had to follow. I didn’t stay there long, because I disagreed with the approach of these particular nurses. So, in summary, it depends upon the specific facility where you work. Vicki, MSPT, CWS --- PTs treat wound patients much like they do with other diagnoses. We often function as part of a team, since wounds need multi-disciplinary care. Whether or not you need a physician referral depends on the state you're practicing in and who the payer is. Often, we are the specialists for wound care, making recommendations to others. Renee Cordrey, MSPT, MPH, CWS
I've just started using Ethezyme 830 on a back surgery wound, and am wondering whether there are any side effects, such as dizziness? Ed St. Clair	I doubt that is a side effect, since it is a topical drug. I've never seen anyone complain of that. Renee Cordrey, MSPT, MPH, CWS ---- no, dizziness isnot a side effect of ethezyme; ethezyme is a chemical debriding ointment that contains papain-urea; transient stinging is a SE
what are the best resources for finding information on the various suuport surfaces for pressure ulcers on the market? thankyou unsigned	www.wisdomking.com and www.allegromedical.com these are two online medical suppliers, kind of a catolog on line, I find a lot of useful information on these sites. Tina (L.V.N./ wound care nurse)
to whom it may concern, i am desparately seeking information about the effectiveness and appropriate technique of applying blue stone (copper sulphate)to wounds. could you please explain exactly why it is applied, how it should be applied, what type of wounds are indicated for its use and the adverse reactions that it may cause. the practice is used at the hospital i work at and i believe it is all 'hocus-pocus' - please prove me otherwise! thankyou, please reply, emily manton	i use CuSO4 crystals only when I need to tackle a hyper-granulating wound on an out-patient and the site on the body does not allow the use of a pressure dressing. the advantage in this situation is the haemostasis (similar result with silver nitrate stick) I keep a few crystals of CuSO4 ready on a gauze and I also keep some saline ready. I touch the crystals on the wound but some of them adhere and stay there. in about a second i wash the wound with saline and push off the adherent crystals with a wet gauze. Continued contact causes deeper damage and produces significant sloughing of the wound surface. snipping off the hyper granulation is much better as it dosent leave behind freshly killed surface cells but the bleeding can be unacceptable in an out-patient. kumkum
Hi, I am trying to find info on litigation involving unqualified staff attending to wounds. My dept ( which is a private outpatients dept uk) would like to encourage healthcare assistants to attend to clip and suture removal after having in-house competences performed. As I am the wound care link nurse for that dept I will be responsible for completing their competences. My concern is after the HCA's are deemed competent to perform these tasks that as qualified nurses we will be responsible for the HCA's actions therefore by attending to wound care in relation to litigation I understand then that we will be held responsible even though we did not perform the procedure. I am aware that the NMC is proposing that level 3 HCA'S can become registered which would then allow them to be accountable for their own actions but at present they are not. If anyone has any information regarding this or where I could obtain some information I would be very grateful. Terri	sorry, no replies to this question.
Hello, I'm from Malaysia and i have done my simple research which is to compare Morinda Citrifolia and Melastoma Malabathricum in blood clotting. Straight to the point, Morinda citrifolia enhances more blood clotting (coagulation) than melastoma malabathricum. So, I really somebody help me what the chemical compounds in both of the plant species which contribute to blood coagulation. For your information, i'm in secondary students. not a graduated students from university. Thank you very much. Mior	In looking at Scifinder (a chemical database) for you there are 217 citations regarding studies on Morinda citrifolia, and 34 with Melastoma malabathricum. The latter contains tannins, a group of compounds which can be styptic. I am an ethnobotanist (Plants Affecting Human Health, John Wiley 2003) and in your query you do not say what part of the plant, and what led you to examine these for blood clotting capacity. Cordially, Memory Elvin-Lewis, Ph.D.
I have a question concerning the use of 97602 in a out patient wound care facility. When the patient is in active wound care and nonselective debridement is being performed is it appropriate to use a code from the CPT range of 11040-11044? Since the nonselective debridement 97602 is not covered by Medicare how would you bill this when performed by nursing? Thank you for your help concerning this matter. Shela	97602 is no longer a valid code. Nurses often bill incident-to a physician, if done in a physician's office. The 11000 series codes require the use of anesthesia. Renee Cordrey, MSPT, MPH, CWS

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