Page 38 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Fungating/Malignant Wounds
Wound Care Need Fungating/Malignant Comments
Description May be primary cutaneous tumor, metastatic  Exudate, odor, and bleeding often
disease, or malignant transformation of contribute to psychosocial issues.
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wound  Healing is rare
 Marjolin ulcer: malignant
transformation of a chronic wound,
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occurs in 2% of chronic wounds
Cleanse  Normal saline or commercial wound cleanser Irrigate with 4‐15 psi:
 Irrigate instead of swabbing to minimize  Spray bottle: 1.2 psi (inadequate)
bleeding  Piston syringe: 4.2 psi
 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  Autolytic: transparent dressing, alginate; See Debridement Algorithm
hydrogel if wound is dry.
 Enzymatic: collagenase (Santyl®)
Dressing  Foam, alginate, hydrofiber based on wound  Protect periwound area with a skin
need barrier film if an adhesive is used
 Moisture is usually contraindicated
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 Avoid hydrating gels & hydrocolloids
Infection Topical: See Antimicrobials on Wound Care
 Mupirocin ointment Products chart, page 42.
 Silver dressing May treat empirically.
 Antiseptics* •MRSA: cadexomer iodine, mupirocin
Use topical antibiotics ≤ 14 days to reduce ointment, silver dressing
colonization risk •Pseudomonas: acetic acid 0.25%,
topical gentamicin
• VRE: hydrofera blue, silver dressing
•MSSA: cadexomer iodine,
chlorhexidine, hydrofera blue,
mupirocin, silver dressing
*Rinse wound bed with normal saline
after using any antiseptic cleanser to
minimize toxic effects.
Malodor  Metronidazole crushed tabs (Flagyl®) to  Wound cleansing & debridement aid
wound bed with dressing changes; use gel odor control.
(Metrogel®) only if wound bed is dry  Change dressing more often to
 Charcoal dressings manage odor and/or exudate.
 Honey  Environmental strategies:
 Increase frequency of dressing change  In room: kitty litter, vanilla
extract, coffee grounds, dryer
sheets
 On dressing: essential oils
(wintergreen or lavender)
Dead Space N/A
Pruritus Not usually associated with wound, assess If patient reports pruritus, evaluate for
surrounding skin. contact dermatitis, hypersensitivity, or
yeast dermatitis

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