Wound Email - August 24, 2008

Wound Care Information Network

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August 24, 2008

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Can you tell me if an ABD pad is the same as a composite dressing? Also. the doc ordered to be changed every 8 hours. Medicare will not cover this amount. correct? Thank You!	An ABD pad is a soft cotton pad. This is different then a composite dressing which generally includes two seperate components,for example, an foam core with an adhesive. Michelle PT, CWS --- An ABD is not a Composite. A composite dressing must have a bacterial barrier, and absorptive layer (other than an alginate, foam, hydrocolloid, or hydrogel); a semiadherent or nonadherent property for contact with the wound, and an adhesive border. --- When i lived in Pennsylvania, medicaid would not cover these either. What an ABD pad is is a telfa wrapped thick bandage, usually 5" x 9". Theyr'e used in abdominal surgery coverage for weeping wounds. I found they are also called combine pads. Very rarely, you can order them on an online medical supply place for a big discount. Try calling them combine pads and get doctor to write a note on a prescription paper stating medical necessity for these! Also call your medicare caseworker with this info. If your wound is draining heavily, or needs the cushioning effect, try Kerlix(Bulkee bandage) They also come in pads, but not with the non-stick telfa coating. Medicarfe does cover Kerlix(bulkee). J.Oertwig wound care survivor ( try medline.com--manufacturers and sellers of inexpensive ABDs. Also called "surgical dressing 5"x9")
During a debridement session, our physician has biopsied the sacral and ischium, what would the appropriate CPT for these procedures? Thanks in advance you’re your help. Thanks, Grace Little CPC	sorry, no replies
I have an incision I'm packing twice daily until it heals. I would like to know what the new skin will look like as it is growing. Thanks for any information you can give me.	The wound should start to fill in with red "beefy" scar tissue. Then, slowly, the skin will start to grow on the edges. It will look pink at first (no matter what your normal skin tone is). Think about the new pink skin you see if you skin your knee or cut yourself. Then, slowly, the pigmentation (color) should start to migrate in, but it may take a long time. If you don't see significant size changes each week, you should see a wound specialist. (We usually don't pack wounds twice a day anymore.) You can find someone at www.wocn.org and www.aawm.org. Renee C, PT, PhD(c), MSPT, MPH, CWS
I am trying to find a policy regarding cleaning a closed pressure sore for a State Survey response. Do you have anything and do you have a resource? Thank you. Denita	If it's a closed pressure, what is there to clean beyond your normal skin care regimen? Skin cleanser, dry, follow-up with lotion to help the skin stay healthy. Renee C, PT, PhD(c), MSPT, MPH, CWS --- Any wound cleanser should do it. Also find out what is your facility or company wound protocol. Every building should have a wound protocol for pressure ulcers and non-pressure ulcers including skin tears. Josephine L Girandi RN,BSN,CDONA/LTC
I recently had a hysterectomy and I am having complications. Two days after I was discharged from hospital my incision broke open. I went to emergancy room where they told me I had a hemotoma. I have been going to my dr. to have it cleaned and packed everyday . I now have a home healh care that is helping me. He suggested the wound vaccum. Can that be used in a situation such as this? Christi	In general the Wound VAC is an excellent choice for dehisce surgical wounds like what you describe. Is something about your wound that would make it an exception to this rule? that can not be determined without actually seeing your wound however gauze dressings do not assist healing, they only prevent poor healing. The VAC assists healing, helps remove the fluid that caused your wound to open and greatly speeds up the growth of new tissue. Michelle PT, CWS --- I treated an open post surgical wound; the surgeon ordered daily cleansing and packing. The packing was to be placed snug inside the wound with length on outside to pull the packing out with. A very useful method is with the cotton end of sterile cotton tipped stick. Be very careful and gentle so as not to injure or break off. Trust this is useful. BEE LPN --- Hi Christi, If absolutely necessary, I would use the VAC therapy with caution because of the history of hematoma. The VAC will literally "suction" the fluid from the wound bed and that's how it stimulates healing. However, it will not be able to determine if what is being suctioned is blood, hence you must watch your canister like a hawk to ensure theres no blood in there! Estrella C. Mercurio, B.S.N., R.N., M.A., G.N.C.(c), E.T. --- VAC would certainly help provided there is no necrotic tissue in the wound. Kumkum --- Christi, Sorry to hear about your set back. The wound Vac is a very good machine, and will most definite help in healing your wound. I have worked with the machine many times with patients and the results are positive. Good Luck. MaryAnne Alessio R.N. --- A wound vac for any open surgical wound is appropriate. I would be curious to know however what other types of packing have been tried, as a wound vac should be last resort. But if it comes to the wound vac, It certainly should improve your situation rather quickly. Lynette Flick, RN --- It can be used, but , in my opinion, offers no benefit over good standard wound care unless there is enough drainage to require dressing change more than twice a day. Wound vacs are cumbersome and expensive. Dee
I am looking for generic Wound Care Policies for Inpatinet and Outpatient for a new wound care facility we are opening. I need policies for wound care as well as Hyperbarics. I would appreciate any help available. Thank You, Diane RN	Give me a call I will help you however I can Lu Ann Reed, MSN, CRRN, RNC, WCC Advanced Wound Care Program Manager PICC & URI Clinical Manager Drake Center 151 W Galbraith Rd Cincinnati, Ohio 513-418-2530
Recently I have underwent foot surgery on my right foot for a surgery stitch opening that would not heal properly. My Doc went back into the wound, reopened it and removed all of the scar tissue and sewed me back up. For the last two weeks, the second surgery did not heal properly and a small hole about the size of a matchhead has not healed over but is oozing infection. My Doc looked at the infection and gave me antibiotics for two weeks, hoping that the would will stop oozing and heal itself. A pharmacist recommend, in addition to my antibiotics, that I use Goldline Ichthammol Ointment 20%. Would this assist or hinder in the healing of this wound? Please let me know what your opinion would be. Thanks Gary	Dear Gary, I'm sorry about your complication. I would not apply the ointment your pharmacist is suggesting. The fact that your wound is still draining may suggest that the wound is healing faster on the outside than the inside. Do you know if deep wound cultures were taken at the time the doctor removed the scar tissue? Appropriate antibiotics should be given based upon culture and sensitivity. If the wound has not healed after the second attempt, you may need to pack the wound open and allow healing to occur from the inside out. This may in fact create a larger scar but the wound should close over time. Dan Klein, DPM
How would you heal a wound that is actually a slit between the buttocks? Thanks Shawn	Shawn, On the Gluteal Cleft wounds (Slit), I generally like to recommend something to reduce friction/shear/moisture which are common etiologies of this type of wound. I usually recommend, based on other wound factors such as moisture, drainage, periwound skin, depth, etc. 1. Criticaid Clear (Coloplast): This is a top of the line moisture barrier that sticks very well to superficial areas and weepy/denuded skin, especially for those with diarrhea that causes the problem. I like this because it is clear, and people tend to not want to "Scrub" every little bit off. I would suggest to apply TID and prn. 2. Triad Paste (Coloplast): This is a form of hydrocolloid dressing in a paste form that again, sticks to weepy,denuded skin, can be used to treat partial to full thickness wounds. It acts as an occlusive dressing to promote a warm/moist environment to promote healing, and I like to use it because it seems to stick, rather than trying to place a dressing over that area, which is usually difficult to get to adhere. Remember, that when using this paste, make sure that it is not, "Scrubbed" off, as that can cause removal/trauma of the epidermis. Encourage to cleanse the soiled area, then reapply paste at least TID and prn. 3 . Hydrocolloid Dressings (Comfeel/Duoderm, etc..). You want to get the most size appropriate and not something that overlaps too much.This type of dressing will maintain a moist warm environment, but you have to monitor it because it is occlusive and can cause too much moisture resulting in maceration. This dressing helps reduce friction/shearing forces, and prevents contamination from occurring. When you apply it, make sure the area is clean and Dry, otherwise you won't get it to stick. I also encourage to hold it in place with palm pressure to heat-fix it to the skin, for at least 15-30 seconds. I would suggest changing it every other to every 3 days and prn. I hope these suggestions work for you. These wounds can be tricky and it is important to investigate the cause/etiology and correct it. Have a nice day. Sincerely, Erin C. BSN, RN, WCC --- I would first determine why they have a slit like wound between the buttocks. Once that is determined how to treat it is much easier to decide. Is it fungal? moisture? scabies/ scratching? Michelle PT, CWS --- Consult with your physician to inquire if there is space enough to pack and if advisable. BEE LPN --- Very hard, but what I found to be helpful is keeping it open to air and just apply calazime cream to the area. Very important to keep the person clean & dry. If the wound is been there for a long time and no changes observe I have tried using Puracol dressing which I have healed a wound on the same site of a very skinny 106 year old lady. Good luck. Josephine L. Girandi RN,BSN,CDONA/LTC --- Comfeel Paste is what I use for this problem. Hydrocolloid dressings just do not fit right in this area. Comfeel Paste 2 or 3 times a day should do the job. Carol --- If it is fairly shallow - I would use Cavilon no sting barrier film Helena Waller Senior Nurse
I have a patient with ms. w/c bound. Past medical history of stage IV wounds on coccyx. On assessment tunneling was found a 12o’clock and 6o’clock with some stage II on bilateral buttock. What treatment would you suggest to be the best? The second pt is w/c with stage III on her ankle not history of arterial problems. Wound bed is yellow margins are erythematus. A scant amount of serous exudate. Again, what treatment would you suggest? Thanks, Wanda	For patient 1: Make sure she has a good wheelchair cushion and is well nourished. If the stage IIs are from incontinence, then make sure she's on a good program and skin care, including a moisture barrier, for that. For the wound itself, it's hard to give good recommendations without an in-person assessment. Perhaps you could refer her to a wound specialist near you. www.wocn.org and www.aawm.org. For patient 2: It sounds like she needs debridement of some kind (enzyme or sharp). I can't tell from the description if the erythema is from infection or chronic inflammation. Again, an examination by a specialist would be helpful. Renee C, PT, PhD(c), MSPT, MPH, CWS --- Wanda, There is an endless number of dressings treatments for these two patients that would be appropriate. And there is no one miracle dressing that soot's all wounds. What you want to do is. Restore moisture balance; pick a dressing that absorbs the right amount or donates the right amount to keep it moist not wet. Remove any necrotic tissue impeding healing and increasing infection risk; surgical debridement, sharps debridement, autolytic debridement,or enzymatic debridement. Which is available. most appropriate for that location/patient/ wound. Decrease bioburdon. Does it require surgical excision of infection, oral or IV antibiotics, or topical antimicrobial dressings to keep the bioburdon low? There are gels, foams,alginates, and VAC supplies that all have antimicrobial in them. Eliminate or reduce the repetitive trauma that caused the problem to begin with: Friction, Shear Moisture and pressure! Don't forget about the nutritional needs. Protein energy mal nutrition, water and vitamins is what life is made of! Please don't be swayed by someone who tells you a specific product. Only the clinician seeing that person can determine what it right using there knowledge and the above guidelines! Michelle PT, CWS

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