Wound Care at Home
Wound care is a rapidly growing medical specialty, with many new developments and discoveries. Wound management has advanced far beyond applying a gauze dressing. I got to see some of this recently when my father fell and went to the ER with a 3.5 cm gash on the back of his head. My first surprise was that the staff seemed in no hurry to stitch it up. When asked, they said that they considered closing a wound like this up to 6 hours after the incident to be safe. When they did stop doing other tests and began caring for the wound, I was surprised that the Dr. didn’t apply any antiseptic. He just rinsed it thoroughly with saline water. He didn’t shave Dad’s head around the wound area, something I’d also seen done before. He simply administered numbing medication and then put in 8 staples to hold the skin together. No topical dressing/bandage was applied, and soaking in a tub was the only aftercare that was forbidden! We were given instructions to return in 7 – 10 days to have the staples removed.
Of course, not all wounds are as easy to manage as this one apparently was. Because wound care can be complicated, it is one of the fastest growing home care services. Dakota Travel Nurse Home Care frequently provides wound care services when that care requires nursing skills beyond those of family members. Some examples would be post-surgery, a wound that has difficulty healing, a skin graft, wounds on the legs and feet of diabetics, a wound that has been heavily contaminated, wounds on a joint that are constantly being irritated, and wounds that are especially painful.
Some “tools” only recently used for wound care include:
- Tissue Adhesives: “Skin glues” are specially formulated compounds that can be used to close a primary wound without the need for sutures or staples. Tissue adhesives are easy to apply, cause less pain for the patient, do not require a follow-up visit, and are extremely cost-effective. For best results, use them on uncomplicated linear wounds located away from joints. Tissue adhesives are now widely available over the counter for use by the general public.
- Growth Factors: Substances that enhance cell activity, size or proliferation have been isolated from healing wounds and are thought to aid in wound healing. In human studies, the addition of these substances to wounds results in significantly improved wound healing, compared to wounds treated with a placebo.
- Skin Substitutes and Biosynthetic Dressings: Biologic dressings and biosynthetic dressings are as close as we can currently get to the benefits of our own skin. These products are used to eliminate dead or dying cells and help to create a healthy wound bed for skin grafts & skin substitutes. They are very expensive.
New Norms in Wound Care
- Moist wound healing is now the norm in wound care, rather than the dry gauze dressings of old. Studies have shown that moisture actually speeds wound healing.
- Untreated pain may lead to not following wound care instructions. If pain is inadequately treated, the wound care giver should try to relieve pain to the greatest extent possible.
- Although solutions such as Betadine and hydrogen peroxide are extremely effective at removing debris and reducing bacterial contamination on intact skin (i.e., as surgical scrubs), they can be harmful when applied to wounds. Current research supports using normal saline water to cleanse wounds. Antiseptics are not required and can be detrimental.
Caregivers should be aware that there are many factors that can affect wound healing.
- Local Factors: Circulation, sensation, mechanical stress and other factors at the wound site can influence wound healing.
- Aging: Aging causes many changes that adversely affect the skin and its ability to heal and regenerate itself. The immune function deteriorates. The skin is thinner and drier. The ability to feel and respond to pain is often lessened. Older patients are more susceptible to infection.
- Inadequate Nutrition: Patients who eat an inadequate diet are at higher risk of infection and delayed wound healing. Adequate carbohydrates and protein are both required for wound repair and skin and tissue regeneration
- Lack of Oxygen: Tissues require oxygen to survive. Any disease process that interferes with the body’s ability to provide oxygen to the tissues will result in poor wound healing.
- Compromised Immunity: Immune compromise may be due to conditions such as diabetes or HIV/AIDS, or may be part of the normal process of aging. Chemotherapy and radiation can alter immune function, as can steroid use and poor nutrition.
- Decreased Ability to Move: A patient who is unable move may develop pressure ulcers. Patients who are unwilling to move (i.e., in severe pain or suffering from depression) also may be slow to heal.
- Medications: Some medications can affect wound healing. Steroids are one example. Chemotherapy destroys cells and is always detrimental to healing. NSAIDS are associated with a decrease in the tensile strength of wounds.
- Smoking: Smoking restricts blood vessels, causes platelets to stick together and leads to clot formation. The carbon monoxide inhaled reduces the amount of oxygen available to the tissues.
In order to help patients to heal their wounds, caregivers must ask questions regarding nutrition, medication and lifestyle factors that might adversely affect healing. Age also should be kept in mind. If the patient has been to the ER or had surgery, it is important to follow the home-care instructions that are given at the time of release. They will usually include symptoms to watch for that might indicate infection and a call to your healthcare provider.
We Can Help
Licensed DTN Home Care providers are trained in all aspects of wound care. If you or a loved one has a wound that requires specialized care, we can help you be more comfortable, change dressings, prevent complications and decrease healing time. For a free consultation, call us at 701.663.5373.