Caution Urged with Negative Pressure Wound Therapy
I recently was called to consult on a man whose sternal wound was being treated with negative pressure wound therapy (NPWT). He had undergone a coronary artery bypass operation and his chest wound had opened up. His doctor prescribed NPWT but after the third day the canister was filling with blood and clots. The wound had started bleeding, and the NPWT device was sucking blood …Read More
Wound Care: What About Larval Therapy?
Myiasis is the medical term for infestation with the larvae of a fly, also known as maggots. The image of maggots in modern society is the exact opposite of health and cleanliness. Indeed, unintended myiasis in a healthcare facility is a frequent precursor of a negligence or malpractice lawsuit. Despite their repugnant image, there are companies that sell fly larvae for use in the care of …Read More
New Pocket Guide to Pressure Ulcers
A new wound guide written specifically for clinicians has just been released. The complete title is “Pocket Guide to Pressure Ulcers: How to Classify, Stage, and Document Pressure Ulcers and Other Common Wounds.” Written by me and Elizabeth Ayello RN, PhD, and published by the New Jersey Hospital Associa- tion, the guide has been over two years in development. It is intended to help clinicians stage pressure ulcers and …Read More
Peripheral Arterial Disease is Underdiagnosed in the Elderly
When ulcers of the lower extremity develop, it is important to find out why. Many ulcers develop over boney prominences which are subjected to pressure, and are therefore labeled as pressure ulcers. However, one common etiology of lower extremity wounds is frequently not considered, particularly in elderly persons. This is atherosclerotic disease of the lower limbs, also called peripheral arterial disease, or PAD. The term …Read More
Wound Odor: The View from Ancient Greece
The fascinating history of wound care dates back to the earliest human cultures, where prehistoric bones and cave paintings left hints of wound-healing knowledge. A major problem associated with wounds is odor, a phenomenon recognized for millennia. In today’s practice, when examining and documenting wounds, the standard of care requires noting the presence of odor. Odor associated with a wound can result from necrotic tissue …Read More
Skin Surveillance Under Medical Devices is a MUST
Most educational materials on pressure ulcer prevention tell you that the most common areas for pressure ulcers are under boney prominences such as the sacrum, ischium, and heels. However, an area that is frequently under-emphasized in pressure ulcer prevention education is skin breakdown under medical devices. Tissue damage under medical devices is therefore frequently overlooked when performing skin assessments, and this can result in devastating consequences of …Read More
Pressure Ulcer Regulations in the Nursing Home: Introduction to Revised F-Tag 314
Care delivered in nursing homes is highly regulated, particularly for pressure ulcers. Whatever your opinion of government regulation, laws governing nursing homes undoubtedly provide added protection for these vulnerable adults across America. This post will provide a basic explanation of regulations covering pressure ulcers in the nursing home which have been recently revised and expanded. But first I will provide some definitions of terms. Nursing …Read More
How CMS Views Pressure Ulcers in Hospitals
Since October 1, 2008 the Centers for Medicare and Medicaid Services (CMS) classified pressure ulcers as a preventable Hospital-Acquired Condition (HAC) that will no longer be reimbursed by current insurance guidelines. In order to understand how this works, I first need to provide some definitions: MS-DRG: Diagnosis Related Groups (DRG) is a system for classifying hospital cases into levels reflecting hospital resource utilization. MS-DRG stands …Read More
