Page 30 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Arterial or Ischemic Ulcers
Wound Care Need Arterial Ulcer/Ischemic Ulcer Comments
Description Shallow well‐defined borders, pale Usually on tips of toes or between toes but
wound bed may also be on lateral malleolus
Cleanse Normal saline or commercial wound Irrigate with 4‐15 psi:
cleanser  Spray bottle: 1.2 psi (inadequate)
If stable eschar is present, paint with  Piston syringe: 4.2 psi
povidone‐iodine (Betadine®).  Squeeze bottle with irrigation cap: 4.5 psi
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 35 mL syringe and 18 gauge needle: 8 psi
o Proper sharps precautions required if using
this method

Debridement Debridement not recommended unless  See Debridement Algorithm
perfusion status is determined, i.e. toe
pressures and transcutaneous oxygen
measurements
•Autolytic: Hydrogel, alginate,
hydrocolloid. 8
If dry, intact, non‐infected eschar do not
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remove
Dressing  Hydrogel  Protect periwound area with a skin barrier
 Hydrocolloid (do not use if infection is film if an adhesive is used
present)  Usually minimal exudate
 Foam
 If stable eschar is present, leave open
to air.
Infection  Silver impregnated dressing See Antimicrobials on Wound Care Products
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 Consider systemic antibiotic therapy chart, page 42.
 Use topical antibiotics ≤ 14 days to May treat empirically.
reduce colonization risk •MRSA: cadexomer iodine, mupirocin
ointment, silver dressing
•Pseudomonas: acetic acid
• VRE: hydrofera blue, silver dressing
• MSSA: cadexomer iodine, chlorhexidine,
hydrofera blue, mupirocin, silver dressing
Malodor  Metronidazole crushed tabs (Flagyl®)  Wound cleansing aids odor control
to wound bed with dressing changes;  Change dressing more often to manage odor
use gel (Metrogel®) only if wound bed and/or exudate
is dry  Hydrocolloid dressings tend to create odor
 Charcoal dressing (doesn't mean infection is present)
 Honey  Environmental strategies:
 Change hydrocolloid dressing every 24‐  In room: kitty litter, vanilla extract,
48 hours. coffee grounds, dryer sheets
 On dressing: essential oils (wintergreen
or lavender)
Dead Space Alginate roping, pastes or powders, Dressing materials placed into open wounds to
collagen eliminate dead space, absorb exudate, or
maintain moisture.
Pruritus Not usually associated with wound, If patient reports pruritus, evaluate for contact
assess surrounding skin. dermatitis, hypersensitivity, or yeast dermatitis

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