Page 39 - 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
Bleeding Radiation therapy (short course) may be  Tissue is friable and predisposed to
appropriate for bleeding tumors of the breast bleeding
or skin  Prepare patient/caregivers for possible
Dressing strategies: hemorrhage (dark towels & bed linens)
 Calcium alginate (silver alginate is not  Consider checking: platelet count,
hemostatic) PT/INR, vitamin K deficiency
 Non‐adherent dressing  Ask: Is transfusion appropriate? Is
 Coagulants: gelatin sponge, thrombin patient on warfarin?
 Acute event dressings: Quikclot®, Celox®
Topical/local strategies:
 Sclerosing agent: silver nitrate
 Antifibrinolytic agent: tranexamic acid
 Astringents: Alum solution, sucralfate
 Epinephrine (1:1000) spray
 Topical thrombin
 Oxymetalozine (Afrin®) spray
Oral: Tranexamic acid
Support Surface N/A. Only pressure ulcers determine use of Medicare reimbursement is based on
support surfaces presence of pressure ulcers, not other
wound types.
Pain Topical:  Allow procedural time‐outs.
 2% lidocaine or EMLA® cream 30‐60 min  Use moisture‐balanced dressing.
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before dressing change  Use appropriate irrigation force.
 Ketamine (see Other Therapies, p53)  Avoid adherent dressings.
 Morphine in hydrogel (only for  Use warm saline irrigation to remove
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open/inflamed wounds) dressing.
Systemic:  Contact layer protects wound bed.
 Pre‐medicate with appropriate agent for pain  Complementary therapies, such as
and/or anxiety prior to dressing change music, relaxation, aromatherapy,
 Neuropathic pain (burning, stabbing, stinging, visualization, meditation, can be
shooting pain): tricyclic antidepressant, helpful.
anticonvulsant
 Nociceptive pain (gnawing, throbbing,
tenderness): opioid or corticosteroid

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