Successful Management of a Non-Healing- Large Venous Leg Ulcer Using a Pulsed Irrigation Wound Therapy System in the SNF Setting

Topics: 

Lead Presenter

Supporting Presenters

Tina Brouillet, OTR/L, WTA, FSAOE
Donna Mcelroy-Routhier, RN, WTA

Presented At

Abstract

Background
Venous stasis ulcers are a common and costly problem that can affect patient’s quality of life. Venous stasis ulcers account for 80-90% of lower extremity ulcers. Healing time is unpredictable, therefore, treatment costs can be substantial
Frequent irrigation is considered standard practice for most contaminated wounds to debride bacteria, necrotic tissue, and debris. The “biophysical” approach to biofilm management disrupts and debrides both planktonic and biofilm bacteria to stimulate the wound bed without over-debridement of healthy tissue.

Purpose
59 year old community dwelling male with chronic 4 year non-healing venous stasis ulcer who had been followed by outpatient wound clinic.
Admitted to SNF setting for structured wound healing in supervised environment.
On admission wound presented 12.0 cm x 35.5 cm with .5 cm depth and 50% slough with persistent pain and low-grade cellulitis

Methods
Underwent 101 daily CPI* treatments delivered by physical therapy 6x/week.
Wound dressing initially was daily foam based* dressings for 2 weeks and then dressing changed to sodium Carboxymethylcellulose* daily dressings.
Once wound had healed underwent 1 week of ultrasound over healed epithelial tissue for improved collagen formation prior to discharge back to community setting.

CPI®
Non-Invasive, Self-Contained Selective Hydro-Mechanical Debridement

CPI® = Effective debridement, without anesthesia
CPI® = Bedside POC with infection control
CPI® = Faster healing, lower cost, better outcome
CPI® = Easy to use, disposable
CPI® = no transportation of patient

Conclusion
The clinical results show daily CPI* with daily dressing changes as well as therapeutic whirlpools for improved skin hydration successfully treats non-healing, chronic venous leg wounds by providing more frequent and reliable non-invasive debridement of bioburden and biofilm.
This case study demonstrates daily CPI* transformed a non-healing wound bed into a granulating and epithelizing wound bed that resulted in complete healing by secondary intention after years of conventional treatment.

Clinical Implications
A multidisciplinary approach including nursing, therapy, and dietary in a controlled setting led to more successful wound healing in this chronic non-healing wound.
Weekly wound rounds to measure wound size and assess appearance of wound bed allowed continued assessment of wound to maximize healing

References
Olin J, Beusterien K, Childs MB, et al, Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study, Vascular Medicine. 1999; 4:1-7.
Morgan D, Hoelsher J, Pulse Lavage: Promoting Comfort and Healing in Home Care, Ostomy Wound Manage. 2000; Apr 46(4): 44-9.
Mak SS, Lee MY, Chueng JS, Choi KC et al. Pressurised irrigation versus swabbing method in cleansing wounds healed by secondary intention: A randomised controlled trial with cost-effectiveness analysis. International Journal of Nursing Studies. 2015; 52:88–101.
Ho CA, Benistel T, Wang X, Bogie KM. Pulsatile Lavage for the Enhancement of Pressure Ulcer Healing: A Randomized Controlled Trial. Physical Therapy. 2012; 92: 38-48.
Angabaldo J, Sanger C, Marks M, Prevention of Aerosol Contamination during Pulsatile Lavage Irrigation Using a Wound Irrigation Bag. Wounds. 2008; 20 (56): 167-170.
Granick MS, Tenehaus M, Knox K, Ulm JP. Comparison of Wound Irrigation and Tangential Hydro-Dissection in Bacterial Clearance of Contaminated Wounds: Results of a Randomized Controlled Clinical Study. Ostomy Wound Management. 2007; 53(4): 64-72.
Marasco PV, Sanger C, Gordon SE, Simpson J, Morykwas M, Marks M, Prevention of Aerosol Contamination During Pulsatile Lavage. Plastic and Reconstructive Surgery. 2005; (Abstract Supplement): 32. 2005 Annual Meeting Competition.
Stewart PS. Biophysics of biofilm infection. Pathog and Dis. 2014; 70(3):212-218.