Page 34 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Venous Ulcers
Wound Care Need Venous Ulcer Comments
Pruritus Topical:  Due to skin changes with chronic venous
 Apply unscented, lanolin free insufficiency, dermatitis and pruritus are
hydrophilic moisturizers: Lubriderm®, common.
11
Eucerin®, Keri®, Aquaphor®  Skin changes may mimic cellulitis. Avoid
 Corticosteroid creams (start with OTC antibiotics unless known bacterial infection is
first): Cortaid®, Kenalog® present.
 Stasis dermatitis usually responds to
moisturizer
 Corticosteroids may be needed to reduce
pruritus, usually topical. May use burst of
oral corticosteroids if severe.
Bleeding Dressing strategies:  Consider checking: platelet count, PT/INR,
 Calcium alginate (silver alginate is not vitamin K deficiency
hemostatic)  Ask: Is transfusion appropriate? Is patient on
 Non‐adherent dressing warfarin?
 Coagulants: gelatin sponge, thrombin
Topical/local strategies:
 Sclerosing agent: silver nitrate
 Antifibrinolytic agent: tranexamic acid
 Astringents: Alum solution, sucralfate
Support Surface N/A. Only pressure ulcers determine use Medicare reimbursement is based on presence
of support surfaces of pressure ulcers, not other wound types.
Pain  Usually a dull aching pain or heaviness  Allow procedural time‐outs.
that is relieved as edema decreases  Use moisture‐balanced dressing.
 Elevation of the extremity may decrease  Use appropriate irrigation force.
pain even without presence of edema  Avoid adherent dressings.
 Pre‐medicate with appropriate agent for  Use warm saline irrigation to remove
pain and/or anxiety prior to dressing dressing.
change  Complementary therapies, such as music,
 Neuropathic pain (burning, stabbing, relaxation, aromatherapy, visualization,
stinging, shooting pain): tricyclic meditation, can be helpful.
antidepressant, anticonvulsant
 Nociceptive pain (gnawing, throbbing,
tenderness): opioid or corticosteroid
Other  Shallow wound base with granulation Compression therapy is usually part of venous
tissue‐rarely necrotic ulcer management. For additional information
 Edema is one of the early signs see Special Topics, page 52.
 Hyperpigmentation of calves

30