Adjunctive modalities apply when wound care basics aren’t enough

December 11th, 2019
Clinicians discuss adjunctive modalities to treat a wound.

Have you ever felt like you may have run out of options to heal a wound?

We have all been there in our wound care careers. Before you throw in the towel or pull your hair out in frustration, take a step back and make sure you started the process in the correct manner.

First, ensure you have successfully addressed all the basics of wound healing:

  • Removed the cause
  • Provided moist wound healing
  • Removed the necrotic tissue and epibole
  • Managed the bioburden
  • Ensured adequate tissue perfusion
  • Ensured adequate nutrition

Then review treatments that can accelerate the healing process. You have to build your treatment plan on a solid foundation of basic approaches before considering more expensive, adjunctive modalities. 

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What’s all the fuss about wound dressing change frequency?

December 4th, 2019
A clinician maintains a patient's wound dressing change frequency.

Let’s take a one question wound care quiz.

What is more important for wound dressing change frequency?

  1. Expert application of a dressing
  2. Frequency of the dressing change

The correct answer is the frequency. Now let’s talk about why.

I do not want to take away from the importance of properly applying dressings because that certainly has its own merits. But when it comes down to it, the frequency wins hands down. 

As we teach in class, wound healing is a dynamic process. As the wound progresses through the phases of healing, all kinds of cellular activity is happening.

From the neutrophils and macrophages to the growth factors and fibroblasts, each phase has a job to do for the wound to move to the next phase and ultimately close.

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Is the Kennedy terminal ulcer diagnosis outdated?

November 27th, 2019
A nurse holds the hand of a patient who as a Kennedy terminal ulcer.

The term Kennedy terminal ulcer was identified by Karen Lou Kennedy-Evans.

She and her colleagues came up with the name Kennedy terminal ulcer in 1983 at the Byron Health Center in Fort Wayne, Ind.

The term specifically refers to a pear, butterfly or horseshoe-shaped wound ranging in color from red to yellow to black.

These wounds typically appear over the coccyx and sacral area of patients who are near death.

The wounds also have been noted to occur in other areas of the body, such as the heels, posterior calves, arms and elbows.

Named by Kennedy at the time, she and her colleagues formally presented their subsequent observational research on the topic, which was published in 1989. 

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Retained surgical bodies can lead to serious wounds

November 19th, 2019
A surgeon checks a wound for retained surgical bodies.

Retained surgical bodies in a patient postop is not an unfamiliar occurrence.

One literature review indicated that with more than 28 million operations in the U.S. nationwide, 1,500 estimated cases per year of retained surgical bodies left in patients take place.

In the 2016 case of Thompson v. Mangham Home Care, Inc., who left gauze in a patient’s surgical wound was at issue.

The patient saw her primary care physician for boils/sores on both of her buttocks in 2008.

The primary doctor prescribed antibiotics without success, and the patient was referred to a general surgeon who treated the condition with antibiotics and warm soaks.

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Sharp debridement: Cutting through the confusion

November 13th, 2019
Tools to perform sharp debridement rest on a surgical tray.

I have been training wound care clinicians in sharp debridement for more than 16 years, yet questions and confusion still abound about this practice.

Many clinicians have either received no education or incorrect education regarding sharp debridement and its use in wound care. 

This often leads to infrequent use of sharp debridement or worse, the inappropriate use of the practice. This is a skilled procedure and one should be properly trained before engaging in it.

My hope is to cut through the confusion and offer a solid explanation of this highly effective treatment for managing wounds.

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Some hospital-acquired pressure injuries are unavoidable, says study

November 5th, 2019
A clinician measures a patient's hospital-acquired pressure injuries on his backside.

Pressure injuries are the bane of wound care clinicians and other healthcare professionals who work diligently to provide the best patient care.

When patients develop hospital-acquired pressure injuries, financial penalties are placed on the organization by the federal government.

And high rates of hospital-acquired pressure injuries are perceived as a negative indicator on the quality of nursing care — the more hospital-acquired pressure injuries, the lower the quality of care is the consensus.

However, a new study revealed that sometimes even if everything is done right for a patient, a pressure injury can still form, and especially in critical care patients, said Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, a nurse practitioner and coordinator in the wound/ostomy department at Indiana University Health Academic Health Center in Indianapolis, and associate professor at the University of South Alabama in Mobile.

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Where to find negative pressure wound therapy photos and videos

October 30th, 2019
Clinicians try a negative pressure wound therapy device at our Wild on Wounds conference.

When treating patients with negative pressure wound therapy systems, the effective use of photographs can play an important part in providing optimum care.

“The reason photos are so integral is there are more wound patients than there are wound care clinicians,” said Beth Hawkins-Bradley, MN, RN, CWN, principal clinical educator in medical affairs at Cardinal Health in Dublin, Ohio. “For many patients, the reality is they may have a nurse assigned to manage their wound via a negative pressure wound therapy system who is not a wound care expert.”

One example of how resources can be valuable for negative pressure wound therapy system users is V.A.C. Therapy.

It’s a multi-step process that can be hard to describe in words, but is much simpler to visually demonstrate with photos, said Ron Silverman, MD, FACS, chief medical officer at KCI, an Acelity Company based in San Antonio.

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Buzz Report recaps wound care news from past year

October 23rd, 2019
Clinicians sitting on the subway read the latest about wound care news.

The wildly popular Buzz Report is one of the main attractions of our annual Wild On Wounds (WOW) conference.

Wound care clinicians from across the U.S. look forward to attending our Buzz Report session each year to learn the latest about wound care news, research and products that came out.

The Buzz Report is the brainchild of Donna Sardina, MHA, RN, WCC, CWCMS, DWC, OMS, co-founder of WCEI and the WOW conference.

Sardina said she created the first Buzz Report in 2004 as an overview for clinicians, in response to WCEI student requests on how to stay current on the latest developments in the world of wound care news.

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Wound photos can help determine a clinician’s legal liability

October 16th, 2019
A clinician documents wound photos on a company phone.

In many instances, wound care involves pressure wounds, such as decubiti and poor vascular conditions, such as diabetic foot wounds.

In the following case, the improper administration of chemotherapy agents through an IV line caused a wound that resulted in severe pain and limited the use of two fingers on the patient’s non-dominant hand.

Key evidence in the trial were wound photos of the open wound that occurred because of the negligent administration of chemotherapy by two nurses who were named defendants in the suit — Iacano v. St. Peter’s Medical Center.

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How to treat diabetic foot ulcers with a total contact cast

October 10th, 2019
A man sits with his total contact cast elevated on a chair.

There are times when clinicians and patients have done all they can to prevent diabetic foot ulcers, and they still develop.

“The patients who develop a diabetic foot ulcer are the ones who fell through the cracks,” said Don Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery.

Wollheim has 25 years of experience in general/vascular surgery and 13 years as a wound care specialist and educator. He also is a medical-legal consultant, college science instructor and clinical instructor for the Wound Care Education Institute.

“Once a diabetic foot ulcer develops, it’s essential it is treated aggressively with proven, standardized methods, as 85% of the amputations performed on diabetic patients began as a diabetic foot ulcer,” Wollheim said.

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