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Clinical Case Study Demonstrating Effective Removal
of Eschar of a Heel Pressure Ulcer
Clinicians: Ruth Anderson, RN, CWS and Char Wilkening, RN, CWS
Boone County Hospital, Boone, IA
The heel ulcer is a common problem faced by most nurses dealing with patient care in the hospital, nursing home, home care, or many other patient care facilities. Preventing pressure sores in the operating room, ICU, or CCU presents a particular challenge because of the long periods of immobility.
Heel ulcers are a serious problem for patients who are on an operating table for as little as 2 hours or for the bed bound patient, even if they are confined for just a few days. It is well established that as we age, our circulatory system is less efficient even in he healthiest of patients. Heels are particularly susceptible to pressure ulcers and skin breakdown for the bed bound patient, due to the pressure on the heel when in the prone position. Patients with a compromised immune system, such as a diabetic or otherwise diseased patient, are even more likely to develop pressure ulcers in a short period of time.
It is generally recommended that heels with intact dry black eschar be undisturbed. However, sometimes one is faced with an open wound on such patients. These wounds have a high rate of infection.
This case study demonstrates the use of a special dressing that assists in the healing process and reduces the chance of infection in a heel ulcer in which the black eschar was surgically debrided. The inhibition of bacterial growth under a glycerine-based gel sheet*both in the laboratory and in animal wounds has been reported. In addition, the safety of glycerine solutions for the preservation of cadaver skin for use as a temporary graft for burn patients is preferred by the European Skin Bank because of the bacteriocidal, fungicidal, and virucidal properties of these
glycerine solutions. Based on these reports and the many years of experience with using the glycerine-based gel sheet* for other wounds, the glycerine-based gel sheet* was chosen to cover this debrided heel ulcer. In addition to the protection from infection, the soft gel sheet gave protection to the wound against shear and friction and provided pressure relief. This dressing was used in conjunction with a pressure-relieving boot to maximize the chance for healing. After using the gel sheet protocol for 4 weeks, a fully granulating wound bed developed. The patient was released to an acute care facility where the protocol was recommended to final outcome.
Presented at the15th Annual Clinical Symposium on Wound Care
October 6-8, 2000
Nashville, TN
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