Long-Term Care Survey Alert
Check Out This Sample Wound Care Protocol
PDF
Stage III Pressure Ulcer/Full Thickness Skin Loss into Sub-Q
Wound Preparation:
1. Cleanse with normal saline or dermal wound cleanser.
2. Apply skin prep to periwound skin to protect and help dressing to adhere.
3. Apply appropriate dressing (see chart below)
4. Date and initial dressing.
Calcium alginate has hemostatic properties. Hydrofibers become a gel when they have reached their absorptive capacity (ease of removal, maintains moist wound environment).
For necrotic wounds an enzymatic debriding agent may also be considered (i.e. collagenase (Santyl).)
Necrotic wounds with evidence of infection may require the use of an antimicrobial agent along with the enzymatic debrider, such as Hydrofera Blue, Sulfamylon, Bactroban, or Polysporin powder. Do not use silvadene cream or silver foam dressings with collagenase (Santyl) because metals will inactivate the debriding action of this product.
* Manufacturer's Insert
Source: Developed by Jenny Hurlow, GNP, CWOCN, a wound-care specialist in Memphis, Tenn. Used by written permission.
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