Table 28.8 Open in new tab Common wound... | Oxford Academic

Table 28.8

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Common wound management problems

Problem	Management
Pain	Exclude infection; ensure the dressing is comfortable; limit frequency of dressing changes Ensure adequate background analgesia; consider additional analgesia for dressing changes and/or topical opioids on the dressing
Excessive exudate	Use high absorbency dressings with further packing on top ± plastic pads to protect clothing Change the top layer of the dressing as often as needed but avoid frequent changes of the dressing placed directly on the wound Protect the surrounding skin with a barrier cream/spray
Necrotic tissue	Use desloughing agents Referral for surgical debridement may be necessary
Bleeding	Prevent bleeding during dressing changes by: • Avoiding frequent dressing changes • Using non-adherent dressings or dressings which liquefy and can be washed off (e.g. Sorbsan®) and • Irrigating the wound with saline to remove dressings If there is surface bleeding—put pressure on the wound; if pressure is not working try: • Kaltostat® • Adrenaline—1mg/mL (or 1:1,000) on a gauze pad, or • Sucralfate liquid—place on a non-adherent dressing and apply firmly to the bleeding area Consider referral for radiotherapy or palliative surgery (e.g. cautery)
Odour	Treat with systemic and/or topical metronidazole Charcoal dressings can be helpful Seal the wound, e.g. with additional layer of cling film dressing Try disguising the smell with deodorizers (e.g. Nilodor®) used sparingly on top of the dressing—short-term measure. Long-term, the deodorant smell often becomes associated with the smell of the wound for the patient
Infection	Usually chronic and localized Irrigate the wound with warm saline or under running water in the shower/bath If the surrounding skin is inflamed—swab the wound and send for M,C&S then start oral antibiotics, e.g. flucloxacillin 250–500mg qds or erythromycin 250–500mg qds. Alter antibiotics depending on sensitivities of the organisms grown

Problem	Management
Pain	Exclude infection; ensure the dressing is comfortable; limit frequency of dressing changes Ensure adequate background analgesia; consider additional analgesia for dressing changes and/or topical opioids on the dressing
Excessive exudate	Use high absorbency dressings with further packing on top ± plastic pads to protect clothing Change the top layer of the dressing as often as needed but avoid frequent changes of the dressing placed directly on the wound Protect the surrounding skin with a barrier cream/spray
Necrotic tissue	Use desloughing agents Referral for surgical debridement may be necessary
Bleeding	Prevent bleeding during dressing changes by: • Avoiding frequent dressing changes • Using non-adherent dressings or dressings which liquefy and can be washed off (e.g. Sorbsan®) and • Irrigating the wound with saline to remove dressings If there is surface bleeding—put pressure on the wound; if pressure is not working try: • Kaltostat® • Adrenaline—1mg/mL (or 1:1,000) on a gauze pad, or • Sucralfate liquid—place on a non-adherent dressing and apply firmly to the bleeding area Consider referral for radiotherapy or palliative surgery (e.g. cautery)
Odour	Treat with systemic and/or topical metronidazole Charcoal dressings can be helpful Seal the wound, e.g. with additional layer of cling film dressing Try disguising the smell with deodorizers (e.g. Nilodor®) used sparingly on top of the dressing—short-term measure. Long-term, the deodorant smell often becomes associated with the smell of the wound for the patient
Infection	Usually chronic and localized Irrigate the wound with warm saline or under running water in the shower/bath If the surrounding skin is inflamed—swab the wound and send for M,C&S then start oral antibiotics, e.g. flucloxacillin 250–500mg qds or erythromycin 250–500mg qds. Alter antibiotics depending on sensitivities of the organisms grown