What is your favorite wound product to use on heavily draining venous ulcers?

I like foam dressings and coban http://woundeducators.ning.com/video/3m-coban-2-layer-compression

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Permalink Reply by mildred heslop on April 28, 2011 at 4:52pm

I like to use layered compression with unnaboot, kerlix roll, ace wrap or coban and change it 1- x a week depending on the drainage. If needed I will use foam dressing over the drainage site.

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Permalink Reply by Beth Culpepper RN, BSN, WCC, CHT on April 29, 2011 at 6:58am

This is our standard therapy as well. We found that with a unna under a layered wrap there is less slipping down of the outer layers which leads to more compliance. However since we are not counting on the unna to be the compression ingredient for this wrap (mostly used to keep the layers up), we do not wrap the unna in a spiral technique, instead we use a fanfold technique so that the wrap is comfortable. They also get the benefit of the zinc paste on the legs. This helps a little bit with the itching from the traditional layered wrap.

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Permalink Reply by Kimberly Barcia, RN, CWS on April 28, 2011 at 4:52pm

I like to protect the periwound with a zinc product like critic aid, apply sorbion dressing to wound, and compress with profore or unna boot. Sorbion is a great product for managing heavy exudate....I prefer it over an alginate

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Permalink Reply by Michael S. Miller DO on April 28, 2011 at 7:59pm

The problem with using dressings that simply hold the drainage is that in reality, they do very poorly holding the drainage. It remains in contact with the skin guaranteeing maceration and more, that lovely smell that develops as the drainage putrefies. More, it is hard to get any sustained compression because the wraps systems (regardless of what you use) get wet and become ineffective. So to keep it real, the key to this problem would be to have something that would wick the drainage away from the leg so no contact is there thus eliminating maceration, would not let any drainage contact the compression so that it would not itself get wet and lose effectiveness, and by taking the drainage away, allow the compression to be on for a prolonged time instead of multiple dressing changes very frequently. Negative pressure seems to fit the bill but, using foam and/or the gauze alternatives can be difficult for amorphous, heavily draining wounds. The answre does exist. Accuro Medical Products of Denver just signed to take a new line of negative pressure dressings designed to solve this and many other previously unanswered problems regarding using NPWT for unusual situations. Visit www.anpthome.com to see this uniquer line of dressings soon to be marketed by Accuro.

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Permalink Reply by Dee Ann Berg LVN on April 29, 2011 at 2:21am

I would rather find out what the problem is, and why there is so much exudate, this is normally because of a heavy bio-burden of biofilm. Fix the problem, use compression and there is no need for expensive secondary dressings.

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Permalink Reply by Michael S. Miller DO on April 29, 2011 at 6:09am

My question is, what do you do for the ongoing putrefying, macerating drainage for the two to three weeks it takes you to find out what the problem is and then "fix the problem, use compression therapy..." ? The costs of what you call "secondary dressings" pale in contrast to the costs of carpet cleaning, hygiene issues, psychological issues related to their dealing with odoriferous, irritating drainage, etc. Sometimes the quality of life issues take precedence over our zeal to identify and resolve the wound problem.

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Permalink Reply by Dee Ann Berg LVN on April 29, 2011 at 10:23am

I know I'm on my soap box now, but Manuka Honey works every time for cleaning these wounds and greatly reducing exudates and smell in just 1 to 3 days. Use it in combination with normal Aquacel for keep the wound edges clean the the honey in place. The Aquacel should be at least 1 to 2 inches on to the periwound area. Honey should be applied once to twice a day as long as the wound has moderate exudate. But think, wounds have heavy exudate because of infection, heavy bio-burden or biofilm. Honey fixes all these problems, and it fixes them fast. After the wound has normal exudate again, then go back to whatever dressing you want to, just not anything with AG. AG can kill not only bacteria, but new cells as well. This procedure ensures the best quality of life for patients with chronic wounds. Of course, I agree that compression therapy is a must for preventing and healing these wounds.

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Permalink Reply by amy glenn on May 3, 2011 at 10:48am

I have never heard of Ag being cytotoxic. I have seen many wounds heal with various forms. Where is your info from? This sounds like something I would like to research.

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Permalink Reply by Dee Ann Berg LVN on May 3, 2011 at 11:21am

Hey Amy,

You can read the articles below and come to your own conclusions. I am not completely negative to silver, but it needs to be used with caution and on the right wound at the right time. Read and tell me what you think.

Dee

http://www.burnsjournal.com/article/S0305-4179(03)00295-X/abstract

http://www.woundsresearch.com/article/6503?page=0,2

http://www.burnsjournal.com/article/S0305-4179(06)00192-6/abstract

http://cmapspublic3.ihmc.us/rid=1266360336080_1899241812_15283/2MAI...

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Permalink Reply by Kimberly Barcia, RN, CWS on May 3, 2011 at 12:04pm

Thanks for the articles Dee Ann. I could only read abstracts on a few due to non-membership, but the information does bring to light our potential over use of silver products, and the possibility of causing collateral damage to the very cells we rely on to heal the wound. As good practitioners, debating these issues and reviewing any studies on the matter will only lead to better patient care as we achieve better outcomes.

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Permalink Reply by Dee Ann Berg LVN on May 3, 2011 at 12:22pm

I agree Amy, debating these very sensitive issues is very important and can save out patients, lots pain and suffering by researching and reviewing any products that we choose to use. It can also save the health care system lots of money by learning as much as possible about the products we are using and why we are using them. Lots of the products being used today are being used because of extremely good business and marketing strategies and less on research and proven results.

We shouldn't rely on things that we hear...but rely only on our own experience, research and clinical studies etc that we read from a reliable sources.

Dee