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Case Study
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Use of polyacrylate gel pad as a debriding agent for chronic venous insufficiency wounds Kimberly J. Miner, RN, ND, CNS, CWCN, FAPWCA, Wound Care Associates, Englewood, CO. BEHAVIORAL OBJECTIVES:.Determine the efficacy of polyacrylate gel pad on chronic venous insufficiency ulcers that have not responded to other debridement techniques..Reduce pain in patient with chronic venous insufficiency ulcers CLINICAL PROBLEM: 85-year-old non-ambulatory woman with a 30-year history of venous insufficiency ulcers to BLEs. Patient with non-palpable pedal pulses and significant trophic changes. Serum albumin 4.3, appropriate for healing. ABI 0.98. Wound nurse contacted after 3 months of home health care to reduce SN visits due to pain with dressing changes and persistent necrotic tissue..DESCRIPTION OF PAST MANAGEMENT: Patient admitted to home care 12/2003. Treatment modalities previously BID silver sulfadiazine cream, daily papain-urea debriding ointment, TIW papain-urea-chlorophyllin copper complex sodium ointment, silver hydrofiber dressing and serial sharp debridement. Wound continued to deteriorate despite five months of treatments. Patient resistant to compression therapy. .CURRENT CLINICAL APPROACH: After discussing treatment options and lack of progress with family and HHA, it was determined that a two-week trial of polyacrylate gel pad (PGP) was indicated to facilitate autolytic debridement to eliminate necrotic tissue. Wounds measured 11.0x5.5x100% necrotic slough at onset of daily PGP treatment. The goal was to obtain a viable granulating woundbed..PATIENT OUTCOMES: After 7 days of treatment, wound measured 10.7x5.5x0.15 with a 50% slough base and mild periwound erythema. At 14 days of treatment, wound was 11.0x6.0x0.15 with a 95% granulation base. Patient tolerated treatment well .CONCLUSION: Despite aggressive wound care, chemical debriding agents proved ineffective. Two-week use of PGP autolytically debrided the wound base, enabling SN visits to be decreased to 2x week with traditional paste bandage and light compression. Four months after PGP treatment completed, patient wound was 0.8x0.5x0.05. Flemister B. The Use of a Super-absorbant Wound Dressing Pad For Interactive Moist Wound Healing. Presented at the SAWC, Dallas, Tex, 2000 Paustian C, Stegman MR. Preparing the Wound for Healing: the Effect of Activated Polyacrylate Dressing for Debridement. Ostomy Wound Manage. 2003;49(9):34Ð42 Sibbald R, Orsted H, Schultz, Coutts P, Keast D. Preparing the Wound Bed 2003: focus on infection and inflammation. Ostomy Wound Manage. 2003;49(11):24Ð51. |
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