Palliative Wound Care

Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

In the past two blogs I have discussed a controversial topic, skin failure. We all have strong feelings on this topic and have experienced different cases in our practice. Dispute the controversial feelings on KTUs and skin failure; I would like to now just address the viewpoint of the family and how to approach these difficult conversations.

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Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 2 in a series on skin failure
For Part 1, Click Here

In March of 1989 the National Pressure Ulcer Advisory Panel (NPUAP) convened, during which Karen Lou Kennedy first described the Kennedy Terminal Ulcer (KTU) phenomenon. A KTU is an unavoidable skin breakdown or skin failure that is thought to be a perfusion problem exacerbated by vascular/profusion insufficiency, organ failure, and/or the dying process. A KTU is a visible sign, an explanation, of what is transpiring within the patient.

Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 1 in a series on skin failure

A few years ago, a panel of experts gathered to evaluate the nature of skin changes at life's end (SCALE) and to discuss the Kennedy Terminal Ulcer (KTU). The panel concluded that there are observable changes in the skin at the end of life and that these situations are complex. It should be noted that the skin is an organ and it can fail. The skin can also demonstrate what is happening internally, such as multisystem organ failure.

Aletha Tippett MD's picture

By Aletha Tippett MD

In considering this question as to whether amputation can be palliative, let’s keep clear that these are two separate subjects that sometimes interact. It is key to always keep our goals in mind. What is the goal in palliative care? The goals are to provide comfort, relieve pain, prevent infection, and improve or maintain quality of life. These goals are always to be in concert with the desires and wishes of the individual patient.

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Aletha Tippett MD's picture

By Aletha Tippett MD

What a wonderful time we had in Indianapolis in mid-May at the 4th Annual Palliative Wound Care Conference. 150 people from as far away as Turkey were there for two and a half days to learn and share about palliative wound care. We had two full days, Thursday and Friday, with high quality excellent lectures.

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By Aletha Tippett MD

For over a decade now I have treated wounds in palliative care patients and non-palliative care patients. The “funny” thing is that there is no difference in how I treat these wounds, all are approached the same way, with similar treatments used. As I teach more and more about palliative wound care, it seems obvious to me that all wounds and all people deserve this approach. Who does not deserve less pain? Who deserves to be embarrassed by wound odor? Who deserves to have an infection? Who deserves a lesser quality of life? When asked these questions I would think the answer would be NO ONE.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Aletha Tippett MD's picture

By Aletha Tippett MD

Assessment of the individual for palliative wound care is not much different from the assessment for any wound patient. Initial questions that that should be asked in your assessment include:

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Jonathan Rosenfeld's picture

By Jonathan Rosenfeld, JD

Whether the development of a bedsore, also commonly referred to as a pressure ulcer, is the fault of the nursing home or an existing medical condition, the actions taken by the health care facility after the sore is discovered can have a large impact in a lawsuit if the patient suffers from complications arising from the sore. How a nursing home treats patients with pressure sores is just as important during litigation as whether the home is responsible for the development of the sores to begin with. For this reason, nursing facilities should not implement treatment protocol that gives the impression that they are killing the patient or doing nothing to prevent the patient’s death.

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Ron Sherman's picture

By Ron Sherman MD, MSC, DTM&H

This week I was asked about using maggot therapy for treating a tumor that eroded through the skin, causing a foul-smelling, necrotic draining wound. This is not an uncommon question, and it touches upon several important elements of biotherapy, as well as palliative wound care in general. This is also a timely subject because of the upcoming (third) Annual Palliative Wound Care Conference.