The Use of Cutimed Sorbact to Manage Malodour and Eilidh ...€¦ · Eilidh Henderson Tissue...
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Introduction Malodour associated with infected wounds can be distressing for a patient (Powell, 2009). The patient in this case study is a 73 year old female who presented with chronic, bilateral, mixed aetiology leg ulcers of more than one years’ duration. Whilst compression therapy was suitable, the patient found it intolerable and reported high pain levels, making dressing changes very challenging. The ulcers produced high levels of malodourous, purulent exudate, which was distressing for the patient. In an attempt to mask the odour, the patient regularly sprayed perfume directly onto her leg wounds. The patient’s past medical history included atrial fibrillation, osteoarthritis, hypertension, previous stroke - and whilst in hospital suffered a further right-sided cerebrovascular accident (CVA) - and bilateral leg ulcers with suspected cellulitis. At the start of treatment, the ulcers were the length and circumference of both lower legs, with extremely high exudate levels causing frequent leakage (Figures 1 & 2). Previous care plans included compression therapy and honey products which further increased the amount of exudate produced. The patient was also treated with appropriate analgesia for pain management (Freedman et al, 2003) as a result of the chronic wounds and pre- existing conditions. Methodology Initially, wound healing was not considered an immediate goal because of the severity of the wounds; instead the objective of care was to manage the symptoms of infection (malodour, high exudate and pain) in order to give the patient a better quality of life. Treatment Cutimed Sorbact was chosen to treat the infection in conjunction with a super-absorbent secondary dressing to manage the high exudate levels, secured with toe to knee bandaging. Cutimed Sorbact DACC-coated swabs were chosen as they offer a different approach to managing infected wounds (Powell, 2009), irreversibly binding bacteria and fungi to the dressing and away from the wound bed (Butcher, 2011). As there are no donating agents in Cutimed Sorbact, it is deemed a safe dressing that can be used longer than the two week review as discussed in the Wounds UK Best Practice Statement (2013). The Use of Cutimed ® Sorbact ® to Manage Malodour and Promote Healing in a Chronic Wound ® Registered trade mark Eilidh Henderson Tissue Viability Nurse Specialist Gartnavel General Hospital 1053, Great Western Road Glasgow G12 0YN. Tel: 0141 211 (5) 0138 Email: [email protected] Initially the Cutimed Sorbact dressing was changed every four days and the super-absorbent secondary dressing and bandaging, daily. However, as the bioburden in the wound bed reduced, so did the exudate levels, allowing dressing changes to be reduced to every two days. Results Within a week of starting treatment, the malodour had reduced significantly, which disappeared completely after just under a month of Cutimed Sorbact use. With the reduction in malodour, the patient started to comply with the treatment regime and also reported no wound pain at dressing change. With the exudate levels reduced and appropriately managed with secondary dressings, the peri-wound skin was less macerated. It was possible to change the secondary dressing from a super-absorbent dressing to a non-adhesive foam dressing, which the patient found more comfortable. As the initial objectives were achieved and the wounds became clean and granulating (Figures 3 & 4), the plan of care changed to include promoting wound healing, which was previously not thought possible. (Figures 5 & 6). Discussion Chronic wounds present challenges to healthcare professionals (Vowden, 2011), and have a major impact on the quality of life of patients for various reasons, including long standing pain issues, infection that could lead to sepsis and mobility issues, (Hurd, 2013). In this case, treatment was more challenging by patient non-compliance and malodour, resulting in distress for both the patient and their family. Conclusion Using Cutimed Sorbact as an antimicrobial dressing in the management of these chronic, complex wounds offered a non-painful dressing regime, eliminated the issue of malodour and high exudate levels, giving the patient an improved quality of life. Patient compliance was increased and ultimately the promotion of healing, which had previously not been thought possible. References 1. Best Practice Statement: The use of topical antimicrobial agents in wound management. Wounds UK 3rd Edition 2013. Available at: http://www.woundsinternational.com/pdf/ content_10964.pdf 2. Butcher M (2011) DACC antimicrobial technology: a new paradigm in bioburden management. MA Healthcare 3. Freedman G, Cean C, Duron V, Tarnovskaya A, Brem H (2003) Pathogenesis and treatment of pain in patients with chronic wounds. Surgical Technology International. 11: 168- 179 4. Hurd T (2013) Understanding the financial benefits of optimising wellbeing in patients living with a wound. Wounds International. Volume 4, Issue 2. Available at www. woundsinternational.com/pdf/content_10892.pdf 5. Powell G (2009) Evaluating Cutimed Sorbact: using a case study approach. British Journal of Nursing; 18: 15: S30- 36 6. Vowden P (2011) Hard to heal wounds made easy. Wounds International. Volume 2, Issue 4. Available at: www.woundsinternational.com/pdf/content_10140.pdf Figures 1 & 2 - Circumferential leg ulcers prior to treatment with Cutimed Sorbact Figure 3 & 4 - Clean wound beds with evidence of granulation tissue Figure 5 & 6 - Wounds progressing to healing, which was not thought possible prior to treatment
Transcript of The Use of Cutimed Sorbact to Manage Malodour and Eilidh ...€¦ · Eilidh Henderson Tissue...
IntroductionMalodour associated with infected wounds can be distressing for a patient (Powell, 2009).
The patient in this case study is a 73 year old female who presented with chronic, bilateral, mixed aetiology leg ulcers of more than one years’ duration. Whilst compression therapy was suitable, the patient found it intolerable and reported high pain levels, making dressing changes very challenging. The ulcers produced high levels of malodourous, purulent exudate, which was distressing for the patient. In an attempt to mask the odour, the patient regularly sprayed perfume directly onto her leg wounds.
The patient’s past medical history included atrial fi brillation, osteoarthritis, hypertension, previous stroke - and whilst in hospital suffered a further right-sided cerebrovascular accident (CVA) - and bilateral leg ulcers with suspected cellulitis.
At the start of treatment, the ulcers were the length and circumference of both lower legs, with extremely high exudate levels causing frequent leakage (Figures 1 & 2).
Previous care plans included compression therapy and honey products which further increased the amount of exudate produced. The patient was also treated with appropriate analgesia for pain management (Freedman et al, 2003) as a result of the chronic wounds and pre-existing conditions.
MethodologyInitially, wound healing was not considered an immediate goal because of the severity of the wounds; instead the objective of care was to manage the symptoms of infection (malodour, high exudate and pain) in order to give the patient a better quality of life.
TreatmentCutimed Sorbact was chosen to treat the infection in conjunction with a super-absorbent secondary dressing to manage the high exudate levels, secured with toe to knee bandaging. Cutimed Sorbact DACC-coated swabs were chosen as they offer a different approach to managing infected wounds (Powell, 2009), irreversibly binding bacteria and fungi to the dressing and away from the wound bed (Butcher, 2011). As there are no donating agents in Cutimed Sorbact, it is deemed a safe dressing that can be used longer than the two week review as discussed in the Wounds UK Best Practice Statement (2013).
The Use of Cutimed® Sorbact® to Manage Malodour and Promote Healing in a Chronic Wound
® Registered trade mark
Eilidh HendersonTissue Viability Nurse SpecialistGartnavel General Hospital 1053, Great Western Road Glasgow G12 0YN.
Tel: 0141 211 (5) 0138Email: [email protected]
Initially the Cutimed Sorbact dressing was changed every four days and the super-absorbent secondary dressing and bandaging, daily. However, as the bioburden in the wound bed reduced, so did the exudate levels, allowing dressing changes to be reduced to every two days.
ResultsWithin a week of starting treatment, the malodour had reduced signifi cantly, which disappeared completely after just under a month of Cutimed Sorbact use. With the reduction in malodour, the patient started to comply with the treatment regime and also reported no wound pain at dressing change.
With the exudate levels reduced and appropriately managed with secondary dressings, the peri-wound skin was less macerated. It was possible to change the secondary dressing from a super-absorbent dressing to a non-adhesive foam dressing, which the patient found more comfortable.
As the initial objectives were achieved and the wounds became clean and granulating (Figures 3 & 4), the plan of care changed to include promoting wound healing, which was previously not thought possible. (Figures 5 & 6).
DiscussionChronic wounds present challenges to healthcare professionals (Vowden, 2011), and have a major impact on the quality of life of patients for various reasons, including long standing pain issues, infection that could lead to sepsis and mobility issues, (Hurd, 2013). In this case, treatment was more challenging by patient non-compliance and malodour, resulting in distress for both the patient and their family.
Conclusion Using Cutimed Sorbact as an antimicrobial dressing in the management of these chronic, complex wounds offered a non-painful dressing regime, eliminated the issue of malodour and high exudate levels, giving the patient an improved quality of life. Patient compliance was increased and ultimately the promotion of healing, which had previously not been thought possible.
References1. Best Practice Statement: The use of topical antimicrobial agents in wound management.
Wounds UK 3rd Edition 2013. Available at: http://www.woundsinternational.com/pdf/content_10964.pdf
2. Butcher M (2011) DACC antimicrobial technology: a new paradigm in bioburden management. MA Healthcare
3. Freedman G, Cean C, Duron V, Tarnovskaya A, Brem H (2003) Pathogenesis and treatment of pain in patients with chronic wounds. Surgical Technology International. 11: 168- 179
4. Hurd T (2013) Understanding the fi nancial benefi ts of optimising wellbeing in patients living with a wound. Wounds International. Volume 4, Issue 2. Available at www.woundsinternational.com/pdf/content_10892.pdf
5. Powell G (2009) Evaluating Cutimed Sorbact: using a case study approach. British Journal of Nursing; 18: 15: S30- 36
6. Vowden P (2011) Hard to heal wounds made easy. Wounds International. Volume 2, Issue 4. Available at: www.woundsinternational.com/pdf/content_10140.pdf
Figures 1 & 2 - Circumferential leg ulcers prior to treatment with Cutimed Sorbact
Figure 3 & 4 - Clean wound beds with evidence of granulation tissue
Figure 5 & 6 - Wounds progressing to healing, which was not thought possible prior to treatment
