Wound Care Information Network

 

 

May 16, 2006

 

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 Previous email questions & their replies are listed below. Remember, replies have not been validated for accuracy or truthfulness.

Does anyone know if patients or family members are allowed to do home VAC dressing changes? I cannot find anything written on KCI's website. Is anyone out there having patient's/families do the dressing changes?

KJ

I was a home care Wound VAC clinical consultant for 2 ½ years. I had several patients where the family did the dressing changes. However, a weekly evaluation by a nurse or physician is necessary to continue authorization for use of the VAC.

Kari RN
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IF THERE is a competent family member that can be taught, our home health agency lets them do the dressings and the nurse goes once a week to monitor the wound

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We had a patient who was doing wound vac dressing changes himself with his wife’s assistance. You can contact the KCI Rep for information to give to the patient. The patient received a video and written information from the company. Our Nurses went out to observe and assess the families ability to do the dressing changes on a large abdominal wound with the full abdominal contents exposed.

The information & telephone numbers were found online at the KCI web site.

Hope this is helpful to you.

Glenda Black ARNP

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They sure can! There are portable VAC units available, and if the wound is in an easily accessible area, the client can be taught to change the dressings. Usually, a home care nurse will change the dressing (especially in hard to reach areas), since they are only changed about 3 x week. Clients and family can be taught how to reinforce dressings in between visits, if necessary.

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yes they are. The caregivers are inserviced by either home health care or by KCI
Marilyn Graff, MSN, CNS CWOCN, CWS

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I have had a family member doing vac changes. If you call the KCI 800# you should be able to discuss the possibility with a KCI clinical rep. You may want to keep a HH RN involved on a less frequent basis or see the person in your office to monitor progress and for problem solving.

Carol Price, RN MSN

Certified Wound Specialist
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I worked in home care and one of my goals is to have the pt/caregiver become competent in doing the dressing changes, the nurse will still need to go once a week (or per your agencies policy) to check the wound and obtain measurements.

Marie Simons RN
Wound Care Nurse

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Yes we in our agency have patients' family's do the dressing change if they are willing

Pat Devine RN CWOCN
Mass -

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I am in Iowa and do currently have a wife doing dressing changes #xweekly! She also does pt's tpn, NG flush and he has a huge abdominal wound that she changes the dressing on!!!


Tami Redman
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Hello,

I did home care for 4 years, and we always did the VAC changes ourselves. However, I don’t see a reason why a family member who was well-trained and demonstrated competence wouldn’t be ok to do them. Family members do other types of dressings in the home after being trained by home health staff. A home health nurse or PT should probably check in at least weekly to monitor progress.

Vicki, MSPT, CWS

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We have trained several families to have family members changes the dressing 2 of the 3 changes per week due to no insurance. We still see in the wound care clinic or whirlpool at least once a week to make sure things are progressing well.

Wayne D. McHowell, RN, BSN, ONC, CHRNA

What would acetic acid be indicated for wound care?

acetic acid is used for pseudomonas colonization which is indicated by green drainage we use it either as a bid wet-to-dry or a 20 min soak (gauze soaked acetic acid) with dressing changes area is rinsed before dressing applied
it is not for long term use but it does a good job cleaning up a wound
marilyn graff MSN, CNS, WOCN, CWS

---

Acetic acid is effective in treating Pseudomonas infections.

Sara, PT, WCC

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Acetic acid is indicated when a wound is critically colonized or infected with pseudomonas. It needs to be done three times per day.

Bill Richlen PT, WCC, CWS
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Acetic acid would never be indicated for a wound. "Never put anything in a wound that you wouldn't put in your own eye". There are so many great products out there that do what you need done without compromising the wound bed.

Gerry, LPN
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Infected wounds
Pat Devine RN CWOCN
Mass

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It used to be commonly recommended for specific types of infections. However, modern information and modern dressings have made acetic acid obsolete. A silver-impregnated gauze or alginate may be appropriate if you have an infected wound. See a wound specialist.

Vicki, MSPT, CWS
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For some, acetic acid is indicated for wounds wich are highly colonized with P aureginosa. It has a good coverage with this types of bacteria.

DALE BRIAN T. GAVIOLA,RN, WOCN

---

acetic acid 0,25% is recommended for pseudomonas wounds-- c. orzolek CWOCN ET

my husband started with a bed sore on second week of being in hospital he was transferred to a rehab.nursing home on the third week. the wound got worst and the nursing home tried everything. the wound has really gotten worst.my husband is bed riden sinc he has parkinsons. what can be done for this type of wound.

Rose

Please ask the nursing home to have a wound care nurse or Doctor see the patient. They may have in-house staff to see your husband or they may need to make an appointment with a wound care clinic. Make sure there are pressure relief devices in use, such as a RoHo
cushion in any chair he sits up in, and also a pressure relief mattress on his bed. He should be turned frequently to relieve any pressure on the wound. Nutrition is of vital importance as is keeping the skin clean and dry.
I hope you will get the help you need from a wound care specialist.


Marie Simons RN
Wound Care Nurse

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Consult with a wound care specialist
Pat Devine RN CWOCN
Mass

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Hello,

A primary concern should be pressure relief!! He needs to have a pressure relieving mattress if at all possible (air mattress), and be repositioned often. Then, good wound care should heal the wound if his nutritional status and any infections are taken care of.

Vicki, MSPT, CWS
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Hello:

Wish that I could give you an answer to your question however having had a Daughter who had this disease I found that air mattress really helps to ward off bed sores. Patients really need to be carefully checked for any sign of redness on a regular basis. Prevention is much better than the cure which can be difficult if allowed to progress

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He should be evaluated by a wound care specialist. Check AAWM's website for a listing of certified wound specialists.

Debby
RN WCC
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HAVE YOU OR THE NURSING HOME TRIED ANY SILVER BASED PRODUCTS. I HAVE HAD REALLY GOOD RESULTS WITH THIS..

Michelle Ergle LPN
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Hi Rose, I am not a medical professional but I am a patient advocate for MDT. Maggot debridement therapy, which is now FDA approved. Being a former patient I know how well it works and how cost effective it is, also. I had diabetic ulcers that my doctor could not heal with two years of conventional treatments. Maggots healed up my ulcers in a very short time. I faced amputation within days. The maggots are raised, disinfected and sold just for medical purposes. They eat JUST the dead infected tissue and excrete enzymes to promote healing and also kill all the bacteria. Please do the research and be your husbands advocate, for a healing. Check out our website BTER Foundation.org

Pam Mitchell
Patient Advocate
BTER Foundation.org

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I would definitely check his nutritional status. That's usually what causes the pressure sores to begin with. He is probably very deficient in protein and especially vitamins C, E and Zinc. Hospital and nursing home food is usually terrible to the taste and also poor in nutritional quality. He needs vitamin B Complex too for the stress he's under. Adding vitamin supplements should show some improvement pretty quickly. For more indepth info contact me at healednow@aol.com and I will be glad to talk to you about this in more detail.

Yvonne Asay LPN

Hi!

I was at a conference recently, and we were told that Medicare's new policy is that they will cite an agency that uses gauze as the primary dressing. The reasons used were the increased infection rates, slower wound healing, increased pain. My team does not use gauze, but I work with some providers who maintain that gauze is their first choice. Do you have any further information? Thank you!

CDR Catherine J. McDonald, NC, USN
 
sorry, no replies
I have poor circulation in my lower legs. 1 year ago I developed a venous stacious ulcer near my left inner ankle at the ankle bone area. 1 year later thru pressure wrapping and packing my wound it has closed up. However I have a large area of redness / looks like a burn scar.
and cannot seem to balance the right amount of moisture to the wound area. It is either to dry and itched like crazy or to moist and if you scratch to much You could loose some skin..when the are gets to dry the skin pulls tight around my ankle and my foot swells with fluid. I am about tired of messing with it and any advise would be greatly appreciated thanks

Don Houston, Texas

The underlying cause in venous stasis ulcers is edema (swelling) use the compression stockings as directed by your Doctor. A moisturizer can be used, avoid those with fragrance, and check the ingredients to avoid
those with alcohol in them as this could be irritating to the skin.

Marie Simons RN
Wound Care Nurse

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The first thing I think is to address the problem correctly. If you have a venous insufficiency, I would be better if you use compression stockings . You might want to consult a vascular surgeon or a vascular nurse specialist regarding this.

Dale Gaviola, RN WOCN
Manila, Philippines

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I have used a "Profore' brand compression bandage. I have used Silvasorb gel for infection control with good results.

Dan Klein, DPM, CWS

Hi,

We are having a debate on the use of Shur Clens vs. saline for rinsing/washing wounds.

What is your opinion?

Thank you,

Patricia Lewis
Saline is still the cleansing agent of choice in most of the institutions that I have seen, at least here in the Philippines

Dale , RN WOCN
Could someone please tell me the best treatment for a patient with developing decubitus, such as stage 1, moving toward stage II. We have been using various ointments in the home setting, also pressure relief/repositioning, but it is hard to know what the best strategy is, once the skin starts to thin and deteriorate. Is there some type of healing ointment that works really well? We’ve used so many kinds, it would be hard to list them all!

Carole, LPN/home caregiver
 

Stop the ointment. It's not working, now you can use calcium alginate or aquacel and a hydrocolloid twice a week, and as needed if falls off. Your description sounds like you are dealing with a stage II. Will the doctor allow blood work? Pre albumin/Albumin will let you know how the
protien reserves are, and how well the body is able to heal, let alone maintain needs. H & H will determine anemia, and needs to be addressed. How well is the person eating,and are they taking stress tab with zinc?

Erin RN, BSN

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I work with a Doctor who always says, " there is no magic potion, we must relieve pressure!"


Marie Simons RN
Wound Care Nurse

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You do not mention how close to stage 2 you are, but if you are still at stage 1, Xenoderm works very well on these type of wounds.
Cheryl LVN
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I have brought 2 facilities back into compliance after they were cited for wounds. The biggest offense were stage I's that became II's and II's that became III's because of lack of prevention. Swiss-America distributes a Braun product, Transorbent Dressings. Either 4x4 or 6x6. I don't use anything else for stage I's or II's or for prevention. Neither one of the facilities uses hydrocolloid anymore. The cost, while not outrageous, is well worth it. Used with a skin-prep, it is most effective even for incontinent patients. Hope this helps. I stake my reputation on it.

Teresa LPN, WCC

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When pressure is exerted on a bony prominence it is often in the deepest layers of tissue where circulation is compromised and cell death begins. Often, when the classic discoloration is evident on the exterior, the injury to the deep tissue has already occurred. Because of this, it will appear that a stage one is worsening into a stage 2 however it is really that the full extent of the damage is just evolving its presentation. For example, when a cut flower is removed from water, it begins to wilt, and gradually losses its color and shape until it is fully dead. If you place the flower back in water a day latter, it is already dead, even it it only looks wilted. It may not be a new product you need but a new approach to prevention.

----

I have had wonderful results using xenaderm ointment. I am always amazed at how well it works. It increases blood flow to the area it is applied to and provides a moisture barrier as well. It remains on the skin even after two to three washings. A combination of xenaderm and off-loading work wonders

Michelle, LPN, Wound Care Manager

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As well as offloading and topical treatments are important, it is also important to address the nutritional component as well.

Debby
RN WCC

Hi,

Can you advise me if there are any labs that would be especially pertinent to watch other than hemoglobin and albumin for:

1) wound prevention and

2) wound healing.

Thank you for your assistance in this matter.

Vickie W. Lipps, RN

total protein

Robin Roach LPN
Wound Care Nurse

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Total protein and glucose level

unsigned

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Some other labs to consider are transferring iron, Iron profile, and vitamin B. Pre albumin will give a snap shot of how therapeutic the protein supplement is. If an area is declining, I like to have complete metabolic panel. It will give me a quick reference if multi system failure is occurring. Depending on the body part, an x-ray or bone scan for osteomyelitis can be indicated.
Erin RN,BSN


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