We have a resident with a heavily draining wound on her left trochanter that is requiring dressing changes four times a day. What do you advise?
First, you need to determine the cause of the drainage and treat accordingly. Drainage in a wound is usually caused by debridement of necrotic (dead) tissue, topical product (too much or inappropriate choice), bacteria levels, edema or malignancy in a wound.
If there is a large amount of necrotic tissue, consider referral for sharp debridement. This is the quickest method for removal of dead tissue. Other choices for debridement could include the application of enzymatic chemical debriding ointments.
More is not always better. Monitor dressing changes to ensure that excessive amounts of topical ointments/creams are not applied and during dressing selection choose cover dressings that absorb moisture, not choices that donate moisture to the wound. Some examples of dressings that absorb moisture would include calcium alginate, foam, or specialty absorptive dressings.
For high bacteria levels in the wound, utilize antimicrobial products that also provide for absorption. Some examples would include calcium alginate or foam dressings impregnated with silver, alginate dressing with honey, or specialty absorptive dressings with silver or cadexomer iodine.
If the wound is draining more than 1? oz (45cc) per day, consider the use of a wound pouch/drainage collector to collect the excess drainage. The use of a wound pouch/drainage collector will provide accurate measurement of drainage, eliminate frequent dressing changes, limit spread of infection and protect the peri-wound. Application tip: Always choose a pouch with opening that is 1/8 inch (0.3cm) larger than the wound size.
Another consideration may be the use of negative pressure wound therapy.
From the December 01, 2007 Issue of McKnight's Long-Term Care News
