Painful drressing changes
I am the wound nurse in a nursing /rehab facility and take care of an elderly man who has basal cell cancer of the left side of his face and it has slowly advanced into his ear auricle . It has a moist yellow-red wound base with irregular border and extends from just in front of his left ear and up to and just entering his sideburn hairline. Over the past several months it has become increasingly painful when even gentle cleansing with a saline wipe. His current dressing is Xeroform gauze and Mepilex lite , change QOD, but due to drainage and him touching, picking at the dressing it has to be replaced daily. The wound is not painful unless it is touched/cleansed with dressing changes. Does anyone know of a dressing that wound be less painful. Maybe just lidocaine spray prior to dressing change?
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Replies to This Discussion
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Permalink Reply by Lydia A Meyers RN BSN CWCN on -
If it is yellow, you are not doing anything to get rid of the yellow in the base. I have use medihoney for wounds like this and 2 things happen, it cleans the wound bed and it fight if possible infection.
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Permalink Reply by Enid Mercado,BSN,RN,CRRN on
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Try applying 2% lidocaine to the dressing prior to removal. You can aspirate the lidocaine witha syringe and gently soak the dressing a few mins prior to dressing changes,You might also want to either pre-medicate the patient or give him something for anxiety 15-20 mins prior to dressing changes. God luck!
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Permalink Reply by Lydia A Meyers RN BSN CWCN on
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lidocaine is a good idea, i agree and definitely always premedicate with a pain med. But it does not sound like, using the right dressing, esp since yellow in the wound be and needs debridment
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Permalink Reply by Pamela "Pam" Smith, RN,MSN,CRRN on
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Amen! I do this also and it really helps the patient's comfort level. Especially for wound-vac removals Lidocaine directly down the vac tubing about 5 minutes prior to the procedure plus the premed works wonders. Not only does it moisten the dressing for easier removal as Enid mentioned but it numbs the wound bed.
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Permalink Reply by Michael S. Miller DO on
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Have you considered the other dressings by Molnycke? They are silicon based and their Safetac adhesive allows for good adherence but removes very easily. They are a bit more pricey than the standard composite dressings but for your problem, should work just great. Several choices based on the amount of drainage, size, etc. Self manipulation of wounds and dressings are tough to treat. Have you considered a barrier such as a light bicycle helmet that would be hard for him to remove?
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Permalink Reply by Terri Koopai, RN, CWCA on -
I have a similar patient. Are you trying to heal it or keep him from pain? My patient just wants pain relief and the appearance of "normalcy". If you want to fight infection use Aquacel AG or just calcium alginates. Allevyn over it might be able to contain the fluids Pre-medicating would be nice but everyone responds the same when gauze that sticks is pulled out, it still hurts no matter how much saline you use. Lidocaine topically would help when putting on a new one. Is he on hospice? Aren't there more funds for him to use in dressings?
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Permalink Reply by Pamela "Pam" Smith, RN,MSN,CRRN on
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Have you tried also perhaps adding hydrogel to the xeroforom? It adds hydration to the dressing and can very much ease in the removal.
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Permalink Reply by Ma. Elliza Vigo on
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I agree. Just don't forget to apply skin barrier on wound edges to prevent maceration depending on the amount of exudates.
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Permalink Reply by Christine L. Cummins on
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These are surely one of the most painful wounds to have- I have had patients who even the fan running gently across the room caused much pain due to the air circulating-So sad. I would agree with the lidocaine, Can you decrease the amount of dressing changes? How much drng does he have? Could you use Mepitel- a silicone contact dressing over the area? It is a bit expensive, but each piece can be cleaned and re-used for several days. I have had good luck with that, covered by a silver foam. If you have odor, a Dakins solution could help with that as well. Can he have anti-anxiety meds as well prior to the drsg change? Sometimes just the thought of what is about to take place makes it so much worse. Good luck to you and him.
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Permalink Reply by Ma. Elliza Vigo on
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I have similar experience with one of my elderly patients with basal cell carcinoma on bilateral lower extremities. I irrigate the sites instead of just cleansing it or spray the old dressings and leave it soaked for at least 15 mins prior to dressing removal. Mepilex is an excellent choice:)
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Permalink Reply by Dorothy Jean Steigerwald on -
Thanks to all who have replied,, all good advice,, my CRNP did come up with the Lidocaine dsg... It is applied in the am and removed in the pm and my resident is soooo happy now..We use the Lidocaine patch and a Mepilex Lite dsg qd ... he has light to moderate drainage,,, the treatment is palliative so,, far so good...Thanks again for all the input
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