Archive for the ‘Compression’ Category

Not Yo’ Grandma’s Stockings

Friday, May 27th, 2016

By Christopher Miles, OT, CLT, CWCA, medi USA

Compression garments aren’t what they used to be – and those of us in wound care couldn’t be happier.                                      Not Yo' Grandma's Stockings

Unfortunately, when patients think of compression garments they think of socks that are too tight and difficult to get on, or tend to roll and pinch. What they might not be thinking is that compression therapy is practically the only medical treatment likely to reduce the rate of recurrence of their nasty, painful and smelly venous leg ulcers.

(more…)

The Truth About TED Stockings (it might not be what you think)

Friday, September 11th, 2015

Photo - TEDs for bedsAnyone with access to the Internet has most likely heard of TED Talks – those powerful but short talks covering the subjects of technology, entertainment and design. But those of us in wound care are way more familiar with another kind of TED, as in … TED stockings.

You and your ambulatory patients know all about these “sporty white stockings,” as they’re sometimes described.  And while they might not get as much attention online as the other TED variety, they are certainly quite popular among physicians, who prescribe them on a regular basis. But do you know what their true purpose and benefits are?

The Truth

We’re sure you’re familiar with that designated area on a patient’s treatment sheet to sign when you put TED stockings on them in the morning, right? And then there’s another spot to sign when the stockings are taken off at bedtime. But guess what? While the stockings are prescribed for a variety of reasons, most clinicians are shocked to hear that they are not actually designed to treat the edema of venous disease.  They simply do not provide enough compression to effectively treat that condition.  So, why are they prescribed?

The Purpose

According to the manufacturer’s instructions, TED stockings are anti-embolism devices designed to prevent DVT’s in patients who are non-ambulatory.  The directions actually tell us to put them on while the patient is in bed. As in … when they go to sleep. At night. Wait, what? So putting them on in the morning and removing them at night (which is what most orders require) is exactly the opposite of what we should be doing.

Putting on TED stockings in the morning and removing them at night is the opposite of what we should be doing.Click To Tweet

The Dilemma

This begs the question: is it important to use products for the indications listed on the product insert?  From both a patient safety and legal standpoint, the answer is, yes!  You are legally responsible for assuring that products are used according to manufacturer’s instructions.

Now some might argue that no harm will come to the patient if the stockings are used incorrectly as described above.  But this brings us back to the reason why they were ordered in the first place.  If they were ordered to prevent DVTs and they are incorrectly removed at night, then major harm could result in the form of an embolism.  If they are ordered to treat the edema of venous disease, then they will prove ineffective, and the patient’s condition will remain untreated.

The Solution

No matter what way you look at this, we need to be aware of the true purpose of TED stockings, as well as the proper way to use them in order to help our patients in the best way we can.  This is why the phrase, “TEDs are for Beds,” has become widely used as a way to remind us of their proper use. They should be worn at bedtime. And that’s the simple truth.

Can You Relate?

We really want to know about your personal experiences with TED stockings. Do you see them ordered and used correctly or incorrectly in your care setting?  If they have not been prescribed according to manufacturer directions, what steps have you taken to correct this situation?  Were your efforts met with resistance? Please describe your experience and leave your comments below.

 

 

 

What is Charcot foot?

Thursday, January 1st, 2015

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of Charcot_Footour diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.offloading_devices

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

 

A Stinky Situation: When Wound Odor is a Problem

Monday, November 10th, 2014

You may have become desensitized to it, but If your patient has odor in the wound bed, consider it a problem that you need to fix.

A Stinky Situation: When Wound Odor is a Problem

 

As healthcare clinicians, in a way, we are lucky.  We become desensitized to things we encounter over and over again, they just don’t bother us like the first time we were exposed. This stands true for those wounds with odor. We almost become immune, yes we are aware the odor is there; but to our noses it is not an issue. The real issue is for our patients and their friends and family. Odor is subjective. Depending on the patient and family members ability, they may be very much aware of the odor. It can be very bothersome to the patient and their loved ones. The patient maybe embarrassed by it, and may try to self-isolate. They may not want to have people around them because of the way their wound smells. This is something as wound care clinicians we need to fix.

The first thing we need to look at is, what is causing the odor? Is it from necrotic tissue that supports the growth of anaerobic bacteria? Is it from a high level of wound exudate? Is there an actual wound infection? Do we have the wrong wound dressing on the patient?

Once we figure out the cause then we need to remove it, whether its debridement of necrotic tissue, managing the high level of exudate with dressings or using Negative Pressure Wound Therapy; we need to find what works.  With an actual wound infection, treating with antimicrobial dressings or antiseptic’s/antibiotic’s are a must to remove the organism causing the infection and the odor. Sometimes just changing the dressing more frequently will help.  Using dressings like those with activated charcoal, or those dressings with medical grade honey in them may help the wound odor. Another option is topical Metronidazole Gel to the wound bed, this may help eliminate wound odor as well.

Just because the odor in the wound bed isn’t offensive to us as wound care clinicians, doesn’t mean it isn’t offensive to others. As a rule, if your patient has odor in the wound bed, consider it a problem that you need to fix.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and OstomyManagement. 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®). For more information see wcei.net.

 

47 Days to WOW Conference

Monday, 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.
________________________________________________
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.
_______________________________________
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

Wednesday, June 25th, 2014

WOW2014_SKIN-IS-IN_758X290_eHDR

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”