Michaela

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Versa foam is used for areas in which you do not want the dressing adhering to the wound bed like undermining, tunneling, skin grafts or abdominal mesh grafts. If you have exposed blood vessels or nerves, you must place the versafoam over them. Versafoam is a smaller cell foam and is impregnated with saline. When you use versafoam, you need to increase the pressure 25 mm Hg because of the smaller cells.
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The VAC Vers-foam (white foam) is a denser foam and pre-moistened with sterile water. It has non-adherent properties so does not require the use of a contact layer for grafts or in wounds with extensive pain or rapid growth of granulation tissue. It us usually used when the patient cannot tolerate the pain when using the Granufoam (black foam). Usually you need to increase the pressure using the Vers-foam due to the higher density of it vs the Granufoam. KCI also just came out with Granufoam Silver. Kills multiple pathogens in 30 minutes. Great stuff.

good luck
Carly RN CWS

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Hi I'm Jim. I am a General Surgeon and a WCC.
KCI could probably give you the best answer, yet I use versa-foam all the time. You may notice that the versafoam is much less fixed at the time of dressing changes. It is great for tunnelled sites and for undermined areas, shoud you wish to have negative pressure in these areas. Remember, if you use it in tunnuls or areas you eventually what to close, you must sequentially shorten the length of the versafoam, allowing the defect to heal from the furtheast point, progressing toward the nearest. Versa foam can also be used in contact with bowel. It can be used for enterocutaneous fistulii. I have uses it in wounds associatted with both of these situations. I hope this helps answer your question. Happy wound healing!

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Hi Michaela:

I highly suggest that you contact your KCI Rep. They provide a wealth of information about their product. I strongly suggest you visit KCI’s website at www.kci1.com which outlines all the information you need in regards to the different types of foams and what they are best used for. Just click. KCI has an on-line video library-you can actually watch a VAC being applied. KCI has one of the better wound care company sites —so take advantage of it.

Regards,

Jamie Pinnock R.N., CWCN
 

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inadine does that have any iodine in it? if so that is not a good ideal. constant exposure to an iodine mixture can cause kidney failure and kills healthy cells you want to keep a dry wound moist and a moist wound you want to manage draininge, it it is small superficial and dry you can use antibotic ointment and a cover

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"Necrobiosis lipoidica

Necrobiosis lipoidica is a rare skin disorder which can affect the shin of insulin dependent diabetics, although it may occur in non-diabetic subjects
as well. The cause is unknown.
Typically, one or more tender yellowish brown patches develop slowly on the lower legs over several months. They may persist for years. They may be round, oval or an irregular shape. The centre of the patch becomes shiny, pale, thinned, with prominent blood vessels (telangiectasia). A minor injury to an established patch can cause it to ulcerate. This is often painless. "

this may be the diagnosis inadine I think is a wrong choice for any diabetic ulcer be it of whatever
origin

kumkum

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Certainly you need re-evaluation. If the drainage you mentioned suddenly stopped, it is either because you have been using antibiotic that might have control infection and aid in the
temporary healing; characteristic of fistulae in the perineal and nearby regions, or it is actually not a fistula. As you might have known, fistulae must have their fully established tract excised before satisfactory healing can be obtained. Note that evaluation may reveal the presence of a foreign body; probably a fragment of the removed neurostimaulator left during the 'difficult' retrieval procedure undertaken and might be developing the 'lumpy' mass you are feeling: a process of fibrosis around a foreign body.

Ahmed Mohammed Sabo (MBBS, Msc)
Biotherapy division,
Human Physiology Dept.,
University of Jos.

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You need to have this evaluated.
Michelle, PT, CWS

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definition of
fistula - An abnormal duct or passage resulting from injury, disease, or a congenital disorder that connects an abscess, cavity, or hollow organ to the
body surface or to another hollow organ. sinus - An abnormal passage leading from a suppurating cavity to the body surface so if you call it a fistula, was it a urinary fistula? did it drain continuously and copiously or only during the voiding process?
it is more likely to have been a sinus connecting the implant cavity to the surface. if all the debris has drained out then it should not recur. However
if there is some residual nonviable tissue the tract may reopen when this
liquifies.
kumkum

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We switched to the Blue Sky pumps and they work just as well as the KCI pumps in most ways. There are no alarms so the has to be more visualization of the sponge. Basically its like using wall suction for a wound which means you have more suction power and the drainage capacity is significantly increased. So you decrease the costs of renting the pump and number of cannisters used on copiously draining wounds. Would rather deal with Blue Sky people as they are quite a bit more professional than the KCI reps that have dealth with in the past 5 years.


Wayne D. McHowell, RN, BSN, CEN, CCRN, CHRNA

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I know that Medicare has given Blue Sky a billing code under Negative Pressure Therapy. I also know that KCI is seeking legal action. I have not heard any positive results from Blue Sky therapy. I would check on both companies web sites for the answers to your questions.

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I have been using Blue Sky for wound vacs for almost two years now. I have had great results with it. What I like about it is that you don’t have to use the foam and you can be creative in what you choose for dressings. For example, you can put a chemical debrider like Accuzyme in the wound bed if you need it, or a silver impregnated gel. You can pack with a calcium alginate and use almost any cover dressing you like as long as you get a good seal. I had a very large wound once that was measured in feet, not centimeters, and we used Saran wrap as a cover dressing as we could not find anything else large enough. It worked great! The suction can be set to constant or intermittent. The only thing extra I do is to fill the large canister with about 700 – 800 cc’s of water so that in case you have a bleed, it will only bleed about 200 cc’s before the machine shuts off. If you are in doubt, have the sales rep loan you one for a trial. That is what we did. Once you get used to it, you will wonder how you went without it.

Sue, CWS

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I would encourage you to call Blue Sky Medical and locate your local representative. I did this about 6 months ago and he has been a great resource. They are recognized by medicare now. I have had wonderful success with this device and am very happy with my rep. They are new in a market that has had no competition so the stats may not be abundant but I believe if you trial it, you will like what you see.
Michelle, PT, CWS
 

ES is reimbursed when done in a SNF by a licensed Physical Therapist as a modality after 30 days. TO both Part A and B Consult your CPT 4 Manuel for the CPT codes. As with all treatment, complete documentation including description of the wound and mesurements is required. ALso some improvement must be noted or the therapy will be considered failed and could be denied on Post Payment review. If in a SNF, your MDS coordinator should be informed so that proper levels of reimburrsement will be recieved. As for inpatient hospital the DRG payment May be affected so the billing office shold be notified. Out patient or PArt B remimbursement whether SNF or Hospital will be limited to $1500 per case. COnsult you Medicare rules and regs for PT

Jeri Means RN Wound Coordinator in a SNF and former Medicare Investigator

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Medicare part B pays for electrical stimulation done by a physical therapist if you have a stage III or more wound and it has been non-healing for at least 30 days. Part A would pay in a type of facility such as a rehab, etc. if you were accessing your 100 days of skilled nursing. Sue, CWS
 

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Unfortunately, yes it is legal for a nursing home to turn away a person who has a complicated medical condition that they may not be able to care for. Pressure ulcers fall in the category of complicated medical condition... The best advice I can give to you is take her to the hospital, have the doctors there admit her if for nothing else, debridement of the wound. Then get in touch with a case manager and let them know that you are seeking placement in a nursing home for her, they will know which nursing homes take the complicated wounds and which ones don't have the accommodations for them.
Tina (L.V.N./wound care nurse)

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i dont know how it works as far as legal issue i am guessing nursing homes have the right to turn away people they are a bussiness and a stage 4 wound can be costly either way she need medical attention the sooner the better!!! the only time a surgen usually opens a wound is if their is deep tunnnling or infectiion that needs to come out
if you find a nursing home to take her make sure they have a good wound care program ask a Dr to reccomend one also thier are wound care centers that would probally be the best thing for her. another option if she is home bound is home health to come in a treat the wound
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Stage 4 ulcers are deeper as deep as to expose bone. Necrotic tissue can be "slough" (stringy yellow that can be loose or adherent to the wound base) or "eschar" which is brown/black tissue which is usually adherent to the wound base. These both need to be removed so healing can proceed (that is, if there are no other factors which can delay healing such as poor nutrition, stress, pain, pressure, etc). The mode of debridement can be either by use of enzymatic debridement (topical agents applied to the wound directly), or by sharp debridement (by a trained therapist or nurse, or if extensive- by a surgeon). There are other forms pulsevac or by syringe.Patients with a stage 4 ulcer has more needs than just care to the wound, but involves intensive care procedures for the patient herself. One reason why centers might turn down a wound might be their anticipated inability to provide adequate care for someone with special
needs. You do not really want a center to take on
a patient like your mother with complication when they are not sure they can provide adequate care...
With a stage 4, I suspect there are nutrition problems,
metabolic problems, maybe even meds and other
conditions that make it hard to heal the wound.
Look for a center who would look at the patient's
meds, nutrition, can provide specialized pressure
relieving devices, adequate staff to help your mother
with mobility, provide adequate skin care, adequate
monitoring of patient's nutrition, lab values- one who
has a dietitian well versed in meeting a challenged
patient like your mother, a center with a wound care
team which includes a wound specialist, a nurse, a
therapist, and a physician who can regularly come to the center to assess the wound. Look for a wound specialist who might usually know which centers in your area can best take care of your mother's special needs. Good luck,
Maria Carunungan, DPT, CWS

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A stage 4 ulcer means that something other then skin is involved in the wound...fatty tissue, muscle, fascia or bone. If there is osteomylitis, surgical removal of any infected bone will aid in healing. A surgeon can cover the wound with a skin graft or a flap that will certainly speed up the healing. PLEASE, do not make the common mistake of overlooking the nutritional needs to heel a stage 2, 3, or 4 wound. No treatment will be great without the bodies ability to support healing. Protein demands and vitamin demands are high. This is well documented in medical books/ literature but to often not acknowledged. You really need to have preliminary blood work to determine where she is currently so the correct dietary plan can be established. As to the legality of refusing to take your mom in as a SNF resident, I am sorry I do not know the rules governing this.
My best to you, Michelle PT, CWS

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Hi Ms. Benetz:

I can only imagine that the condition of your mother-in-law is frustrating for you-especially when you have many unanswered questions. I hope you can get answers here to help you. I am no expert on the legal obligations or regulation of nursing homes, but I would say that based on the risk that a nursing home would have to take in caring for a patient who is admitted with a pressure ulcer of stage 3-4 that they have some right in denying the patient. Unfortunately, with the high number of law suites and new regulations nursing homes have encountered-they are very cautious—especially if they are a small company. I would highly recommend that you have a wound care specialist evaluate your mother-in-law. The benefit will be- getting a thorough evaluation of the wound and recommendation for treatment. There are many factors that affect the course of action in treating a wound, and all these factors need to be evaluated in order to make the best decision for your mother-in-law. Some of these factors are: nutrition status, other diseases etc. Honestly, you may need more than one opinion—if your mother-in-law is healthy- this wound may heal with the right hands on treatment that does not include a surgical procedure. Another specialist may differ- sighting that the wound has been open for 6 months and the quickest resolve is surgery. But is your mother-in law a candidate of surgery? Having her evaluated by a wound care specialist in a wound center is a good step.



Regards,

Jamie Pinnock R.N., CWCN

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There should not be a connection. However what are you looking at, and how is the anemia affecting him?
Sonja
BSN, NHA, CLNC, CNAC, WCC

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Anemia can inhibit cell production (slow healing), I would find out if the wound became infected during the duration of unforeseen events. If the wound is infected it will not heal.
Tina (L.V.N./wound care nurse)

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Hi Josephine,
In response to your question reagarding anemia and yhe healing process. In my experience as a home care nurse, we try to treat all aspects of the patient underlying problems that will potentially hinder wounds from healing. If an anemic situation is presaent that will hinder the healing process to some degree. Oxygen is carried to the tissues via hemoglobulin and if oxygen supply is decreased the healing process is delayed. Other factors may also
impact your client as well. He more than likely should be on vitamin supplementation, extra protein
supplememts to help promote wound healing.
Obtain a nutritional consult so that all of the avenues can be explored.
Good Luck to your client !
Nina Winston, MSN, OCN
oncivrn@starpower.net

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Venous ulcers take longer to heal and usually
treated with compression therapy (by specialized bandaging or by pump) but this may be modified if there are other pathologies (conditions present) which might affect healing. If a person has venous ulcers, there are usually factors within the patient which predisposed him/her to developing venous ulcers...same factors which if not resolved can also cause the venous ulcers to not heal. Having burn wounds adds on to the increased demand on the body for nutrition. So you now have the venous ulcers plus the burns tacking on this stress
and extra demand for increased nutrition. Wounds
rely on good circulation also to heal. If a person is
anemic, the oxygen-carrying capacity of the blood is reduced. Anemia can result from blood loss and
volume loss from major wounds like burns, but is
easily resolved with proper medical care. Venous ulcers usually drain as well as burns so you have fluid loss.
Your client can benefit from a visit to a wound specialist and burn specialist, dietitian.
Maria C, DPT, CWS

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Venous ulcers tend to heal well when the wound is infection free and compression is applied to eliminate fluid congestion in the tissue. Ability to heal will be affected by nutrition, hydration, and oxygenation. These may be preventing the patient from healing. This can all be addressed following blood work that will trace the patients intake of protein, vitamin and iron. Identifying these factors and changing the diet may be all your client needs to get back on a heeling track but ultimately venous disease will not be cured and he will be at risk for developing wounds for the length of his life. Sounds like he had some pressing and severe medical concerns that needed to be addressed first and he can now return to the business of adapting life style changes that will promote healing. (venous wounds, burns and pressure sores drain heavily and protein needs raise dramatically...it can take a long time to reach a good balance.)

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Hi :

I hope that the patient is recovering. I can say proving some sort of causal relationship will be difficult for you. I can only give you my opinion based on the facts you have presented. If a patient has venous ulcers prior to being in a fire—then unless the fire was set by the wound care specialist then there is no connection between the prior treatment of the wounds and the current treatment of the patient who is obviously in a more acute if not critical state. If the patient sustained burns to the areas of the venous ulcers—these areas are treated as burns first in an emergent situation. Having a venous ulcer is not an emergency-it is most often a chronic condition that is recurrent. The factors that affect venous wound healing: Compression dressings, good local wound care, compliance of Pt., Is there also arterial disease etc. I really don’t see how you can bridge any causal relationship to pre- fire and post- fire—because the patient requires different care plans at either instance. But, a burn does add to the severity of the patient’s condition, that affects all the patients systems and how a wound is approached after the critical stage is past-depending on the outcome. Well, you could conclude that the patient should have had compression dressings on that may have potentially protected the limbs from burn damage—but this is a far stretch, because the material is most likely highly flammable:)

Regards,

Jamie Pinnock, R.N, CWCN

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I consult with Helene Taylor, RN, BSN,WOCN
with RECOVERCARE.
e-mail address: htaylor@recovercare.com

Nina Winston, MSN.OCN
oncivrn@starpower.net

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Theere are many references. Just do a GOggle search. some trade names are Silverlon, Acticoat, Aqualcell AG. Prisma. Look them up and you will find references for positive reseach SOme research with less positive results would be Liza Ovington at Liza Ovington and Associates But you need both sides of the story

Jeri Means WOund Care Nurse

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Silver has been a known antibacterial/viral agent since ancient Egypt but it is an exciting new contribution to medicine. There are several products that utilize silver ions to decrease bacterial and viral load on wounds. My favorite is Aquacell AQ. I would suggest contacting the drug rep. He/she would be able to provide you with ample current research to act as a launching ground. Good luck!