The purpose of Aquacel is to absorb drainage from a wound. It may overlap the wound a little without causing harm, but what purpose is it serving covering good skin? A wound that has slough or fibrin in it will not heal because the dead material needs to be removed. Wounds begin healing when the base is a beefy red. Our doctors in the clinic use sharp debridement on patient clinic visits when appropriate. An enzymatic debrider may also be prescribed for daily treatment changes.
L.Sherwood RN

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Debridement of slough can be done with
1- enzymatic debriding medications like accuzyme or panifil
2- moisture retaining dressings like Aquacell or other alginates, hydrocolloids or foams. It depends on how much drainage there is. If the dressing is too absorbent it will dry out the wound. If it is not absorbent enough it will macerate the wound. So many dressings can do the job, it just needs to be matched with the wound characteristics.

The best choice, combine both of the above.

unsigned

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Weve, Aquacel dressings should cover the wound bed and at least half an inch over the peri-wound (wound edges). Depending on how much slough is in the wound you can go one of two ways. 1. either duoderm gel and cover with duoderm and change every 3 days or if wrinkled or soiled. 2. Acuzyme will enzymatically deride quicker. I have had many good results.



Hope this helps

Julie palmer RN WCC
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When using aquacel, as well as calcium alginate, it is important to fill the wound bed (lightly pack) without allowing too much to overlap on the intact skin. To help protect the intact skin, I find it helpful to apply a moisture barrier to peri-wound area.
There are many dressings that can help in removing slough from a wound. I will usually suggest an enzymatic treatment when there is a significant amount of slough.
Patti, RN, WCC

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depends on client and whether diabetic, have used intrasite gel, aquacel ag, with a biatain dressing

W Wood RN

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What about hyperbaric oxygen therapy? Ms. Wood RN

The purpose of packing a wound that has a tract is to utilize the packing as a wick to absorb drainage to outside. You insert the packing to the end of track and leave tail outside that prevents losing in wound. Wounds that have tracts must heal from the bottom up. They should never be overpacked. Overpacking can lead to blocking the drainage, rather than pulling away. L Sherwood RN

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NO, This is contraindicated by all current standards of wound care. All open spaces do need to packed to allow the wound to drain of the abscess and heal from the bottom up. Otherwise, another abscess will form if the skin closes over the opening.
Michelle PT, CWS

Is there a checklist of competencies that they should have?

Gisele McCarthy, RN

Sarah Rando R.N.

You always need to look at the co-morbitity of the resident. A bariatric mattress is no different than a regular sized one. You need to check for "bottoming out" in all mattresses. If the patient has a potential for breakdown then you need a "pressure relieving" mattress. If they have a stage 2 or 3 there are mattresses made for them and a stage 4 usually a speciality mattress is in order. I use a standard air mattress for many of my patients that are very thin, are total dependent in bed or have other health issues. An obese person has many issues that a special mattress will not help such as skin to skin contact. Get a clinical practice guideline book. Treatment of PU, free of charge. Type in AHCPR or NPUAP and the info will come up.
DE Rn BSN

Your father should be evaluated by a wound care specialist, check out AAWM's website for a list of wound care specialists in your area. The "donut" that you are referring to is no longer recommended. How much time does he spend out of bed? He should not be sitting in a chair for prolonged periods of time and should be on a low airloss mattress while in bed, and if he cannot do so himself, he should be turned and positioned off the ulcer at least every 2 hours. Good luck.

Debby RN WCC
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While donut shaped devices are sold for this purpose, it is not a recommended treatment. It does redistribute pressure from the wound but it increases the pressure (above normal) where the donut is, increasing the risk of pressure ulcer development.
At this recent stage, I would recommend focusing on:
Preventing/Treating infection.
Developing moisture balance in the wound.
Nutrition
Bed and chair surface (low air loss bed or other, pressure relieving seat...)
Total nutrition (protein requirements increased to 1.2 g /kg of body mass with wound)
Turning/ repositioning more frequently.
Medications affecting healing.
Its not just the size/stage of the wound but the medical status of thew whole person: their mobility, activity, moisture, sensation, ability to communicate.

Best wishes to you and your father ,
Michelle PT, CWS

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Sadly, this has been caused because your father was not repositioned frequently. However, he needs at least a low air loss mattress for pressure relief. The wound also needs treatment and I am sure by now some physician has seen the wound and given a recommendation. Julie RN WCC

Julie Palmer RN

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Get him a pressure relieving mattress.
Pat Devine Rn CWOCN

PJ

unsigned

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lidocaine will burn at first once applied to open wounds. give it a few minutes and this will go away. I work at at wound care center and that is what we use prior to sharp debridment. Has the would been cultured? would want to know that prior to having any multi layer compression placed on your leg. keep your leg elevated. This might also cause
burning until the swelling decreases some.

Hope this is helpful,
Michelle RN

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Get a second opinion from a wound care specialist.

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What type, have you tried viscopaste, or perhaps plain aquacel with acticoat 7, dependent on drainage coverage, ? allevyn, mepilex, and cover with abd pad, secure with a micropore tape,
wrap not too tight with conform

I have a question to you in regards have you had a leg ulcer assessment, what did or do they recommend, or have they recommended, wraps [compression] curious as to edema bilaterally or not,

Ms. Wood RN

Visit the web site www.wcei.net for course information. I recently took this course and it is wonderful. They will take layman up to md's!!

Tami Redman, RN, WCC
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Check out WCEI.NET.
Debby RN WCC
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Contact the wound ostomy and continence nursing society

unsigned

simplyandrea@echoes.net

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the wound vac is wonderful and can close a wound by up 50% faster than conventional wound care. Are they using white foam as well as the black? And if so is the vac increased to 150 mmhg negative pressure. I would expect that your wound should be much smaller after 3 weeks if all is ok. Maybe you could call KCI (the company) and have a RN rep
stop by to see you. Any would care centers around you.? Check to see.

Good luck,
Michelle RN