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WHY ABI?

October 20th, 2014

What exactly is an ABI?  ABI stands for Ankle Brachial Index. This is a non-invasive bedside tool that compares the systolic blood pressure of the ankle to that of Doppler_BloodPressureCuffthe arm. It is done to rule out Peripheral Arterial Disease in the lower extremities. The ABI is considered the “bedside” gold standard diagnostic test and can be done by any trained clinician in a clinic, hospital, nursing home and/or even the home care setting. All you need is a blood pressure cuff and a hand held Doppler.

Why do we do the Ankle Brachial Index or ABI?  Well, there are several reasons why we include the ABI as part of our assessment for the patient with lower extremity wounds. First of all, in order to heal a wound we have to be sure that our patient has adequate blood flow. The ABI will tell us if the patient has impaired arterial blood flow, and how significant that impairment is.  We also need to know the amount of compression that we can safely apply to the venous patient, in general the lower the patients ABI reading, the lower the amount of compression that can be safely applied.

When do I need to do the ABI? Standards of care and Guidelines dictate when we should be doing the Ankle Brachial Index. Our current standard of practice states to do the ABI: Anytime a patient has a lower extremity ulcer, when foot pulses are not clearly palpable, prior to applying compression wraps / garments or when the lower extremity ulcer is no longer healing.

What does the ABI “number” mean? First we need to be aware that not everyone’s ABI is reliable, in fact patients with diabetes or end-stage renal disease may have incompressible vessels rendering a falsely high ABI score. For these patients we use another diagnostic test called the Toe Brachial toe_cuf_wound_care_education_institutePressure Index (TBPI) instead of the ABI.  For those with ABI readings, in general as the patients ABI score decreases, this signifies that the patient has arterial disease of the lower extremity, and poor blood flow. Any patient with an abnormal reading needs a referral to a vascular specialist. Bedside interpretations of the ABI that we use as wound clinicians are: 1.0 considered a normal reading, an ABI of 0.9 indicate more venous, 0.6-0.8 indicate a mixed etiology (venous and arterial) and less than or equal to 0.5 is indicative of arterial disease of the lower extremity.

We as wound care clinicians are held to certain standards of care and must follow those guidelines established by the experts.  Performing the ABI on patients before applying compression and on patients with lower extremity ulcers is one of them.  As wound clinicians we use the ABI and our clinical assessment to help guide us into determining what type of ulcer we are dealing with so we can make appropriate referrals and develop the best treatment plan for our patients. It’s a step we can’t afford to leave out; our patient’s limb may depend on it.

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How To: Creating the seal by making the right choices

October 13th, 2014
Joy Hooper RN, WOCN, OMS, WCEI Instructor, Medical Craft, LLC, Tifton, GA

Joy Hooper RN, BSN, CWOCN, OMS

Ostomy Webinar now available through Wound Care Education Institute®:  This popular session is recorded from the Wild On Wounds National Conference and provides ostomy continuing education credit.

Achieving a leak-proof seal between the skin barrier and the abdominal skin surrounding the stoma is the cornerstone of ostomy management. In this session, Joy Hooper will focus on assessment, interventions, and techniques for choosing the right ostomy products for creating dry surfaces, contour management, securement, and peristomal skin protection. 

Wound Care Education Institute is featuring various webinars on topics from this years’ conference.  TO REGISTER CLICK HERE or visit www.wcei.net/webinars.

 

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Hot Topic at WOW – Nutrition Gems

October 6th, 2014
Dr. Nancy Collins PhD, RD, LD/N, FAPWCA, President/Executive Director Nutrition 411.com

Dr. Nancy Collins PhD, RD, LD/N, FAPWCA, President/Executive Director Nutrition 411.com

Dr. Nancy Collins received an overwhelming positive response from attendees after her lecture on “Nutrition Gems:  Hot topics in Nutrition”. One attendee remarked that she learned more from this one hour lecture than any previous presentation she has heard on this topic.

It was fascinating to hear about the advances in the field from an expert who has helped shape the current landscape yet remembers when her most common intervention when assessing wound patients nutritionally was to order “Milk and graham crackers!”

She covered a new development on the timing of when protein should be ingested based on recent research.
Breaking up protein ingestion at each meal has been shown to make it better available to the body to use verses protein loading at one meal, usually dinner. This can help our patients heal faster by providing the body with the protein it needs to build in that new tissue.

Did you know why Arginine and Glutamine, Conditionally Indispensable Amino Acids, are often need to be supplemented in the diet of our wound care patients?

Because under the stress of a wound, the body may not be able to keep up production of these important nutrients. Without adequate amounts of Arginine and Glutamine in the diet, the signaling pathway to build in new tissue is not activated and wound healing can stall.

Another key point made by Dr. Collins was the need to interpret lab data (Albumin, Pre-Albumin and Transferrin levels) only in conjunction with a full body nutritional assessment. These lab values have been shown to be inaccurate in patients with inflammation occurring in their bodies. Changes in Albumin, Pre-Albumin and Transferrin should not be used to suggest changes in protein status in individuals with acute or chronic inflammatory states. That can and should help all of us to do a better job in conducting a nutritional evaluation of our patients.

Dr. Collin’s passion for nutrition science and her ability to make it relevant to the wound care world was greatly appreciated by all who had the good fortune to attend this lecture.  To learn more about Dr. Collins go to: http://www.drnancycollins.com/

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Diabetic Foot Ulcer Assessment and Hands On Lab

October 1st, 2014
Donna Sardina RN, MHA, WCC, DWC, OMS

Donna Sardina RN, MHA, WCC, DWC, OMS

Do you know the components of a Diabetic Foot Exam? It is so important that all of us in wound care know the steps to preventing foot ulcers on our diabetic patients.  And that starts with a routinely scheduled comprehensive foot exam.

Donna Sardina took us through all the aspects of a comprehensive exam during the pre-conference session “Diabetic Foot Assessment.”

The key word here is comprehensive. A proper exam involves much more than just a test of sensation using a Semmes Weinstein monofilament or a tuning fork. What about skin color, texture, temperature, foot deformities, nail deformities, glucose control, and critically important perfusion status. Did you know that it is estimated that 50% of amputations in diabetics are a direct result of improper footwear? That statement gets my attention every time I hear it.

In this session we learned how to examine our patient’s footwear for signs of trouble. Included in the handouts was a document “Diabetes: Shoe Fitting Tips” that will be extremely helpful when putting our knowledge into practice. In recognition of the fact that we are not all specialists in the diabetic foot, Donna shared a “Simplified Sixty Second Foot Screen” published by Dr. Sibbald in 2012. It is a validated tool that has just 10 items on it that can be completed in less than 60 seconds. This seminar was empowering to all who attended and gave us the tools we need to make a difference in this at risk population.

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2014 Annual Wild On Wounds, (“WOW”) National Conference Sets Record Attendance

September 26th, 2014

For Immediate Release – PRN Newswire:

2014 Annual Wild on Wounds, (“WOW”) National Conference

Sets Record Attendance

Plainfield IL – September 29, 2014 The Wound Care Education Institute® (WCEI) successfully completed its largest “Wild on Wounds” (WOW) conference in Las Vegas, NV. WOW is fast becoming the largest fall wound care conference in the United States drawing close to 1,000 clinicians, students and industry professionals to the four day event.   Picture1

WOW is specifically designed to advance the skills and knowledge of healthcare professionals specializing in wound care.  The educational sessions and hands-on workshops help them stay on top of ‘today’s standards of care’ and teaches the latest in wound care treatments and technologies.  “I  was  overwhelmed  by  the  outpouring  of  thanks  and  gratitude  from  the attendees,” said Nancy Morgan, Cofounder of WCEI and WOW.

This conference appropriately themed “Skin is in” was held at the Rio Hotel and Convention Center, September 17-20, 2014. Highlights of the conference included:

  • Close to 1,000 practicing nurses, therapist, physicians and industry professionals who influence wound care decisions from all care environments
  • 50+ basic to advanced educational sessions
  •  20 “How-To” and “Hands-On” programs
  • Renowned speakers and industry experts
  • Live certification courses include Skin and Wound Care, Diabetic Wound Care and Ostomy Management
  • Exhibitor partners
  • Clinical poster presentations
  • Wound Care Certified (WCC®) Outstanding Achievement and Scholarship Awards

WOW 2015

Next year’s WOW conference will be held September 2-5, 2015 in Las Vegas, NV.  If you are interested in receiving more details about WOW 2015 email WCEI at info@wcei.net.

 

About the Wound Care Education Institute

WCEI provides healthcare professionals with ongoing education support and comprehensive online and nationwide onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and

OMS™ national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®).   Website: www.wcei.net

Wild On Wounds National Conference Brings Back the Maggots to Las Vegas!

June 3rd, 2014
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This is just one of the sessions you can enjoy at our
National Wound Conference
Session 305 
HANDS ON:
Maggot Debridement Therapy
Dr. Ronald A. Sherman, M.D., M.Sc., D.T.M.H., Director, BioTherapeutics
We are pleased to welcome back Dr. Sherman, leading expert in maggot therapy and currently Chairman of the Board of Directors of the non-profit BioTherapeutics, Education and Research (BTER) Foundation, which supports patient care, education and research in maggot therapy and the symbiotic medicine.
Taught in two sessions, this course will give you the didactic and the practical hands on education on maggot therapy. Learn about the history, current status, mechanisms of action, as well as indications and contraindications for maggot therapy. Then put all that to use when you actually learn the technical aspects of maggot debridement therapy by applying live maggot dressings to mock wounds.
This session has limited seating and fills up fast so don’t wait.
 REGISTRATION INCLUDES:
  • 3 days filled with wound care education
  • 2 days of vendor showcase exhibits
  • Lunch all 3 days with a lunch speaker on day 3
  • Party poolside with a robust buffet and drinks!
  • Complimentary collectible event T-shirt
  • and MORE!

The blank white buttons with download pictogram            The blank white buttons with download pictogram

 

I’m going to conference! Are you?

August 7th, 2014

Donna_headshotBy: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Years ago, when I first started out in the wound care specialty, the only way to learn about new products and what was going on in the field was to “go to conference” (wound care conference). All year long, planning and excitement continued to build for our big trip. Not going wasn’t an option; our facility, patients, and administrators needed us to attend. If we didn’t, we’d be way behind our competition in regard to cutting-edge, hot-off-the-press wound care treatments and techniques.

Besides being a forum for displaying new wound care products, conference is an opportunity to network, to see what others are doing—what’s working and what isn’t— and to hear firsthand from researchers.

Living in the digital age has changed things for us. We’re blessed to have innovative information at our fingertips whenever we connect to the Web via computer, smartphone, or tablet. Manufacturers’ websites, government guidelines, and social media sites can keep us informed of what’s hot and happening if we just take the time to check them.

But as glorious as the Web is, I still believe in the power of attending conference. Some things are just meant to be seen, touched, and experienced—live and in person. Being in a convention hall with hundreds or even thousands of clinicians who love the same icky, yucky, stinky, and sometimes-nauseating challenge of wound management is something you just can’t experience on the Web. The power of passion, excitement, and inspiration from others is so contagious.

It’s understandable that money and time constraints play a big part in decisions to attend conference. Nonetheless, I believe all wound and ostomy experts should figure out a way to go to conference every year, or at least every other year. Here are some creative ideas for funding your conference expenses:

Educational grants from suppliers
State or local educational grants
Employer’s tuition-reimbursement program
Combining your annual family vacation with the conference trip
Holiday or birthday gift from your family
Simple negotiation with your employer.

Currently in the United States, we can choose from several wound conferences, including the National Alliance of Wound Care and Ostomy cosponsored event Wild on Wounds (WOW). I encourage all wound and ostomy experts to support and advance our specialty by continually educating and updating ourselves—and one way to do this is to go to conference.

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS
Clinical instructor
Wound Care Education Institute
Plainfield, Illinois

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

47 Days to WOW Conference

August 4th, 2014

It’s not too late to register for WOW!  Don’t pass up the opportunity to network, learn and participate in some of the top wound management sessions. Jennifer talks about two of her sessions and what you can expect in this video.

Jennifer Oakley RN, WCC, CWCA, DWC, OMS, Clinical Instructor

SESSION 406

The Wound Care Quiz Connection
In this session you will have a plethora of wound care information presented in a fun and fast moving quiz format to get you and your colleagues thinking again without overloading you. Join Jennifer, test your knowledge and inspire others.
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SESSION 106
Finding Common Ground…Your Guide to Surviving Wound Care Communication ChallengesIn this session you will learn effective communication techniques that will enable you to effectively deal with the day-to-day challenges you face as a wound care clinician.
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Even our exhibitors and sponsors are getting in on the knowledge.
SESSION 702 
HANDS ON : Use of Collagenase SANTYL Ointment in Wound Bed Preparation

Amy Bruggeman NP, MS, APRN-BC

Proper wound bed preparation is crucial for wound repair to progress normally. The overall goal is to address the necrotic burden and achieve a stable wound with healthy granulation tissue.Debridement helps remove necrotic tissue, which is a key component to wound bed preparation.

This program will review wound bed preparation and the role of debridement. It will analyze evidence based medicine in the treatment of chronic wounds and it will summarize the benefits of Collagenase SANTYL® Ointment in chronic wound debridement.Don’t put it off any longer. Book your sessions today and get your hotel room ready.
See you in Vegas!
 

wcei logo

Wild on Wounds Productions, Inc.
25828 Pastoral Drive
Plainfield, Illinois 60585

Compression Made Easy Hands-On Lab

June 25th, 2014

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Due to popular demand, this dynamic duo is back to lead the hands on lab during the WOW Wild On Wounds National Conference in Las Vegas, NV on September 17-20, 2014.

Cindy_Michael_speakers

Cindy Broadus
RN, BSHA, LNHA, CLNC, CLNI, CHCRM, WCC, DWC, OMS,
Executive Director, NAWCO
Michael Miller
DO, FACOS, FAPWCA, WCC, CEO Medical Director, Miller Care Group

 

Session 301
HOW TO: Hands-On: Compression Made Easy

Venous disease affects over 15% of the population so its important to learn how to properly apply compression therapy. This session is a one-hour hands-on lab practicum in which you will practice your wrapping skills on each other.  You’ll learn the spiral and figure eight techniques and then use those skills to apply a multi-layered system.

This session is predominantly hands on with minimal didactic, therefore, attending session 200 will be helpful.  This is just one of many hands-on labs being offered.  To download the event brochure  CLICK HERE.  For details and to register online   CLICK HERE.

We hope to see you in Las Vegas!

"Thank you for having this in small groups. It helps to have the one on one attention"

“Thank you for having this in small groups. It helps to have the one on one attention”

I Stage, II Stage, III Stage , IV…. Making Pressure Ulcer Staging a Little Easier

June 6th, 2014

There has to be a way to get everyone on the same page.  You would think that over the last 6-7 years since the National Pressure Ulcer Advisory Panel (NPUAP) had released the updated staging guidelines we would have gotten better at this.  Not necessarily the case. blog
Lets try to make pressure ulcer staging as simple as possible.  We will take out the all the extra verbiage; you can read that later on.  We will break staging down to some user-friendly terms.  Now remember, we are talking about pressure ulcers, so all of these skin injuries pressure had to be present, sure – friction and shearing can contribute, but pressure must be present. They are usually located over a bony prominence but we know they don’t have to be; they will be located anywhere the skin has had unrelieved pressure.  If they are related to a device they will take on the shape of the device that has caused the injury to the skin.

Stage I.  This is an area of non-blanchable area of erythema (redness) of intact skin.  That’s what it is. Period.  Intact red skin.  Non-blanchable is when we push on the skin it stays red; it doesn’t turn white or blanch.  So, intact, non-blanchable area of erythema, a stage I pressure ulcer.

Stage II.  This is a superficial or shallow open area.  We say it is pink, partial and painful.  The damage is into the dermis here so the tissue we see will always be smooth pink/dark pink, not granulation tissue.  Never will we see any necrotic tissue here; your wound won’t have yellow, black brown colors in it.  It also may be an intact serum (clear fluid) blister. So there you have it; a stage II is a superficial open area with NO necrotic tissue or it can be an intact or ruptured serum filled blister.

Stage III. This stage is easy.  Damage is now into the subcutaneous tissue, but not through the subcutaneous layer.  So this is the start of full thickness tissue injury.  Now here is where we can start see slough, eschar, and granulation tissue in the wound bed.  Tunneling and undermining may also be present in the full thickness pressure ulcer.  In the stage III pressure ulcer we may see healthy subcutaneous tissue, necrotic tissue or granulation tissue.  What we WON’T see in the stage III is muscle, tendon, ligament or bone, ever.

Stage IV.  This is full thickness tissue damage where we now see muscle, tendon, ligament, or bone in the wound bed.  The definition also states “palpable” so if we can feel tendon or bone here, we would stage it as a stage IV.   Cartilage in the wound bed would be included in the stage IV pressure ulcer.  We can have granulation tissue or necrotic tissue present in the wound bed as well.  Undermining and tunneling may be present in a stage IV, but what I MUST see or feel are those underlying structures – muscle, tendon, ligament and / or bone present to say it’s a “stage IV”.

Unstageable pressure ulcer is a stage we use to classify the pressure ulcer that has enough necrotic tissue present to make the clinician uncertain whether the pressure ulcer is a stage III or stage IV.  So until enough necrotic tissue can be removed we place it in the “unstageable” category.  Once that necrotic tissue is removed and we can evaluate the actual level of tissue destruction in the wound bed, that is when we will stage it and it will either be a stage III or a stage IV.

Suspected Deep Tissue Injury (SDTI).  To be a SDTI the skin must be intact, it must be purple or maroon in color or an INTACT BLOOD filled blister.  Once this intact SDTI pressure ulcer opens up, we would then reclassify it based on our assessment or tissue type in the wound bed.

We need to use the staging definitions set out by the National Pressure Ulcer Advisory Panel (NPUAP) correctly, and all clinicians who assess skin need to have a good understanding of these definitions in order to properly stage pressure ulcers.  What was discussed about above is just a summary, there is more reading we need to do, but this will give us a good place to start with the staging.  We need to start staging consistently across the healthcare continuum; it really just comes down to good wound assessment skills, knowing the tissue type that lies before your eyes and identifying the level of tissue destruction and applying them to the NPUAP staging definitions. Lets get this right!