It is fairly simple to make a one page guideline....rinse the wound with NS thoroughly to remove contaminents...I pat dry with sterile guaze...then start at one end and zig zag with the q tip culturette to the bottom. They call this the 10 point method. Patricia Seemann RN BSN WCC. If the bacteria isn't affecting my wound and there are no signs of infection. You can reduce the bioburden with silvasorb gel, or aquacel ag for wet exudating wounds. I also am still a fan of 1/4 strength dakins for abdominal wounds .

Patricia Seemann RN BSN WCC _

Compression bandage or just a tubular compression (like the knee cap) pulled up to cover the portion of the limb above the stocking.
kumkum

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I would have to recommend that you not use a whirlpool to treat your vascular ulcers. Whirlpool used to be a treatment of choice but it is usually contraindicated. The whirlpool may cause congestion in the lower extremities and worsen your condition. A more effective treatment is prevention and persons with PVD need lifelong compression therapy with appropriate graduated compression socks. Please find a vascular surgeon or a wound ostomy continence nurse to consult regarding your condition.
Laurie Ellefson RN, BSN, CWOCN, CFCN

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The last thing you would want to do for a venous stasis ulcer would be soak it in a whirlpool. The whole reason you develop these ulcers is from fluid congestion from bad veins. I am sure you have brown staining on your lower legs. Get polymem dressings for the ulcers...nothing heals them faster. Patricia Seemann RN BSN WCC

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I dont know exactly the big picture of your situation but since you mentioned that there is a blister formation on your legs I suggest consulting with a live wound expert (WCC,CWS, etc) before considering whirlpool.
Hope this helps,

Saturn, PT
 

Bruce

Patricia Seemann RN BSN WCC

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First of all a wound must demonstrate more than one sign before being considered infected. All wounds are contaminated. Rinse the wound with NS, pat dry with a sterile guaze and take a culture. Siversorb gel doesn't change the color of the drainage, and I haven't seen aqucel ag do that either. I use both products all the time. Silver shouldn't be used for long periods of time anyway. Get the bioburden out of the wound and move on to some other product.

Patricia Seemann RN BSN WCC

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I have seen some dark staining on the wound bed which gradually fades away with the use of Aqucel Ag. I have seen greenish drainage associated with Pseudomonas infection as well. What type of enzymatic debrider being used ? I had a patient in the nursing home who got alarmed and concerned by seeing a greenish drainage from the Panafi ointment which has been used as an enzymatic debridement. Although, you mentioned the use of Silver Imprgranted Aquacel, I presume that panafil is not used in this case because the Silver may deactivate the active ingredients of the Panafil which is counterprodcutive. Recenlty, I attended a wound care presentation and also learned from literature review that the use of Silver as an antimicrobial agent is controversial. I would consider wound culture in this case.

Saturn, PT

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Venous insufficiency or a venous stasis ulcer? Anyways, the person should be wearing graduated compression stockings to minimize venous stasis, as long as her arterial status is adequate. They make them to the knee, thigh, or full pantyhose. There is different degrees of pressure depending on if the person just has varicose veins or swelling and brown staining to lower leg. The restrictions would include no long periods of standing. If they have a desk job....being able to elevate the legs would be helpful. My husband has varicose veins and some venous dermatitis and has no restrictions at his job, because he wears the knee high graduated compression sock. His condition is stable.
Patricia Seemann RN BSN WCC

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Venous wounds are caused by poor blood flow return through the veins to heart.
Primary symptom will be edema in lower extremities.
Standing in one place or sitting with your legs hanging down interfere with the venous return because the veins are not working as they should.
Gravity pulls things down. A venous patient is always told to keep their legs elevated when sitting. Walking doesn't hurt, because the calf pump assists with sending blood through veins back up to heart, but just standing
in place will cause problems.

lynn sherwood
RN in wound clinic

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As a physical therapist actively involved in wound care, the question is rather difficult to answer as needed details are missing. Is the patient receiving an active wound care? Compression therapy in th presence of edema? How old is the patient and what type of job does he do (w/c bound or ambulatory). Generally speaking, any active muscle contraction in the LE's increases blood flow to that area which in this case the venous valves are not competent enough to drain fluid back to the heart which may agrravate the ulceration. Sorry no speciic answer.

Saturn
 

I would include your recommendations as part of your assessment that is in the chart. You may not write the order in the chart without getting the order from the Dr. (nurse responsibility) however I would continue to make recommendations. It is the DON's responsibility to see that each recommendation is addressed whether or not the Dr. chooses to follow then or not.

CDHRN