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Coccyx Pressure Sore Dressings Won't Stay On




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#1 hanguk

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Posted 30 March 2008 - 06:04 PM

I have a grade 4 pressure sore - not really on the sacrum - more the coccyx, actually pretty much in the butt crack. I'm certain it's because I tend to slide forward in my chair even though I have a custom-made chair and cushion to try to prevent that. I was in the hospital to take care of the infection. Now I go to the wound care doctor once a week, nurses come every other day to to the dressing. I do my work (I work at home on computers) from a hospital bed with an air mattress so I can stay off of it. I only get up for making dinner and the bathroom. But the sore is not really improving. The dressing they use is alginate (it's kind of a stuffing to pack the wound) with Tegasorb on top. The Tegasorb is supposed to form a seal that lasts at least 3 days and the packing is supposed to stay in. It is supposed to stay on through the bowel routine and showers too (you are supposed to be able to just wipe it clean). This is not happening. The bottom edge of it is right near the rectum and it starts peeling off a few hours after it's put on and that expensive packing is falling right out. After a day, and a BM and a shower only the top of the dressing is still sticking to me and I have to tape some gauze over it until the nurse comes. The bottom of the dressing can't be taped on better because it would cover the rectum and skin around it. The nurses and doctors don't understand. They say all the other SCI patients who have a sore like this in the same area manage to have their dressings stick. Some of them are blaming it on my transfers. They say I don't lift high enough and the sliding is causing the dressing to come off. But the dressing starts to come off even before I have made a transfer. Or when I get on the toilet, it starts coming off and there is no sliding onto the toilet, that's a complete lift. They use a butterfly shaped dressing. I can see from the picture on the package it's good for the sacrum but with a sore that's really more in the crack, I don't see how it can stick. Last doctor's visit (2nd visit) he was looking at the sore and saying "I don't know what else to do for you." He also asked strange questions like how did I get this and do I get up and walk around.. (he asked me the same questions when he saw me the first time in the hospital). This is supposed to be a really great wound care center. Does anyone else have a problem with a sore in this area and the dressing not staying on? The nurse thought about a wound VAC but the doctor says it's too close to the rectum for that. I asked about an operation but he said no.

#2 edlee

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Posted 30 March 2008 - 07:09 PM

Sorry to hear you're having so much trouble with that sore. Mine was a little farther back than your's , I guess,, cause the wound vac worked well for me.

My thought is that if the doctor and nurses you are seeing now " don't know what else to do",,,,maybe it's time to find a new doctor. It's been my experience with the home care ( traveling) nurses, that they aren't exactly the cream of the crop. Their supervisers are more concerned with the paperwork ( billing) than with the patient care.

I went thru three different agencies before deciding to toss them all. My wife easily learned to do the needed application procedure, and did it better, in my opinion.

The adhesive barrior that is used with the wound vac , I found to be VERY good. I don't know why the same material couldn't be used to adhere your dressing/packing. If there is room for whatever tape they are using, there will be room for this .

I found it better to change the dressing every second day, after my bm and shower. MY doctor said that washing the sore with soap and water wouldn't hurt anything, so I did. Then let it air dry before redressing.

With the vac system, it still took over a year for the thing to heal. It was 7cmx9cm and 3cm deep,,,exposing a bit of my tailbone ,,,when I threw the nurses out.

It may have taken longer for me because I never stayed off of it. In the chair 12 to 14 hours and sleeping on my back every night. ( Yeah,, I'm one of those a**hole patients you hear about)

If they won't go for the vac,, you might suggest using a skin prep. It's what I use on my keister before putting on my condom catheter. The adhesive DOES hold better with it than without,,,I have found out the hard way.

I hope you get something to work for you,,,these things are a real pain in the a**,,,feeling or not.
ed

#3 hanguk

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Posted 30 March 2008 - 08:07 PM

Thanks Edlee. They are using some kind of skin barrier stuff, it's called Santyl. I notice that the do-it-myself gauze and tape thing I put on today myself is still in place, transfers notwithstanding. But I don't suppose it's doing anything for the sore because it's not packed. The home care nurses aren't too bad, it's the wound care center that I'm worried about (the nurses that come from the house are not from there). I went there before 3 years ago for a sore in the approximate same location. They just used wet-to-drys and it healed in 10 months (I did not stay off it at that time except for sleeping). But this one is worse. 3.5 cm deep (they call feel the bone in there but no osteomyelitis). The other dimensions I'm not sure of they are a little smaller than the one you had. Well I hope something helps. The wound care center is the only option in this area and only 1 of the doctors there now takes Medicaid (the last time I had a different doctor, I think he was better, but he no longer takes Medicaid). When I go to the wound care center it takes 4 or 5 hours including the transport, about 10 minutes is with the doctor and maybe only 1 hour of it that I'm not sitting on the sore. What do you think is a good cushion? I kind of liked the Jay cushion but they need to be replaced a lot or they bottom out and start leaking gel.

#4 rjs

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Posted 01 April 2008 - 07:36 PM

Thanks Edlee. They are using some kind of skin barrier stuff, it's called Santyl. I notice that the do-it-myself gauze and tape thing I put on today myself is still in place, transfers notwithstanding. But I don't suppose it's doing anything for the sore because it's not packed. The home care nurses aren't too bad, it's the wound care center that I'm worried about (the nurses that come from the house are not from there). I went there before 3 years ago for a sore in the approximate same location. They just used wet-to-drys and it healed in 10 months (I did not stay off it at that time except for sleeping). But this one is worse. 3.5 cm deep (they call feel the bone in there but no osteomyelitis). The other dimensions I'm not sure of they are a little smaller than the one you had. Well I hope something helps. The wound care center is the only option in this area and only 1 of the doctors there now takes Medicaid (the last time I had a different doctor, I think he was better, but he no longer takes Medicaid). When I go to the wound care center it takes 4 or 5 hours including the transport, about 10 minutes is with the doctor and maybe only 1 hour of it that I'm not sitting on the sore. What do you think is a good cushion? I kind of liked the Jay cushion but they need to be replaced a lot or they bottom out and start leaking gel.



check this website out www.aquilacorp.com
its a new kind of cushion

#5 LuckyinKentucky

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Posted 02 April 2008 - 03:50 PM

Sounds like you've already started using tape. Although I've never had a sore as intense as yours. My uncle informd me of some cream that he puts on his horses and I'll be damned if it doesn't blow everything I've ever been prescribed out of the water. It consists of 3 ingredients in equal parts. - antibacterial cream, Zinc oxide(cream), and Nylantin(cream...possibly misspelled). I put it on without a dressing at night and during the day I put it on and cut a patch out of Duoderm that is slightly bigger than the wound. I cut a strip of plain old masking tape and put the duoderm face up stuck right in the middle. After this it kinda looks like a trumped up band-aid, which you just stick on. When you put it on you have to be careful to not crease it and make sure it smoothly is stuck on. As this wound is on your butt i would recommend putting it on sideways making sure that the tape is in contact with the "canyon walls" the whole way down to the site.

#6 amyW

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Posted 02 April 2008 - 11:38 PM

After much trial and error (mostly error) in dealing with trying to keep wounds covered, we found Cavilon Durable Barrier Cream.

http://solutions.3m....5beB385P3RT67gl

I put a medicated cream on the wound itself, then put on a very thin layer of Cavilon to the areas where the paper tape will touch my DH's skin. You have to let the Cavilon dry all the way before you do anything else. It takes a few minutes. Then I use paper tape to apply dry gauze. (His wounds are in the general area yours are, so I know exactly what you're talking about with transferring pulling the dressings off.)

Cavilon allows the tape to stick very well to his skin, but also somehow makes it easier to remove the tape when it's time to change the dressing. (We do it twice a day). DH's skin is very fragile, and in the past the adhesive from paper tape would actually pull his skin off! Cavilon changed all that.

I've also found that different brands of paper tape adhere differently. If you are using paper tape, maybe trying another brand will help solve your problem.

#7 hanguk

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Posted 04 April 2008 - 11:40 AM

Thanks for ideas. I am using Medipore tape. It sticks extremely well. The top and sides of the dressing stay on, it's the very bottom edge that comes off, and then the wound packing falls out. I'd have to put the tape covering the rectum. This dressing is supposed to stay on 3-4 days. But it's impossible to have it undisturbed by the bowel routine. I can't poop every 3 to 4 days, I have to do it at least every other day. And there is no one to change it for me and I can't do it myself (not the packing part). Nurses come 2-3 times a week.

#8 amyW

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Posted 04 April 2008 - 01:51 PM

I had another thought about why only the bottom edge is coming off. I'm making lots of assumptions here, so I may be totally off base. Maybe it's because the dressing is put on while you're lying down, but then when you sit/transfer, your skin is stretching a little, and the bandage is not stretching so it comes off. Maybe if the bandage isn't put on so "flat" when you're lying down, it can wind up "flat" once you're sitting?

#9 edlee

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Posted 04 April 2008 - 09:08 PM

As I said earlier,, my wife became quite adept at affixing the adhesive covering,,and mine was pretty close to the rectum, too. That's why I finially kicked the visiting nurses out.

The problem, I think, is with the application, not the product. Like Amy said,, they need to consider what problems you are having and work to correct it,,, not blame you for causing them.

I would also reccomend having it changed every second day. That would alleviate the problem of disturbing it during your bowel program or while bathing.

Sure hope you get it sorted out soon,,, I know how depressing it gets when the Drs and nurses refuse to listen. Sometimes you need to be very insistant to get any thing done right.
ed

#10 Irenec

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Posted 05 April 2008 - 07:12 AM

I have a grade 4 pressure sore - not really on the sacrum - more the coccyx, actually pretty much in the butt crack. I'm certain it's because I tend to slide forward in my chair even though I have a custom-made chair and cushion to try to prevent that. I was in the hospital to take care of the infection. Now I go to the wound care doctor once a week, nurses come every other day to to the dressing. I do my work (I work at home on computers) from a hospital bed with an air mattress so I can stay off of it. I only get up for making dinner and the bathroom. But the sore is not really improving. The dressing they use is alginate (it's kind of a stuffing to pack the wound) with Tegasorb on top. The Tegasorb is supposed to form a seal that lasts at least 3 days and the packing is supposed to stay in. It is supposed to stay on through the bowel routine and showers too (you are supposed to be able to just wipe it clean). This is not happening. The bottom edge of it is right near the rectum and it starts peeling off a few hours after it's put on and that expensive packing is falling right out. After a day, and a BM and a shower only the top of the dressing is still sticking to me and I have to tape some gauze over it until the nurse comes. The bottom of the dressing can't be taped on better because it would cover the rectum and skin around it. The nurses and doctors don't understand. They say all the other SCI patients who have a sore like this in the same area manage to have their dressings stick. Some of them are blaming it on my transfers. They say I don't lift high enough and the sliding is causing the dressing to come off. But the dressing starts to come off even before I have made a transfer. Or when I get on the toilet, it starts coming off and there is no sliding onto the toilet, that's a complete lift. They use a butterfly shaped dressing. I can see from the picture on the package it's good for the sacrum but with a sore that's really more in the crack, I don't see how it can stick. Last doctor's visit (2nd visit) he was looking at the sore and saying "I don't know what else to do for you." He also asked strange questions like how did I get this and do I get up and walk around.. (he asked me the same questions when he saw me the first time in the hospital). This is supposed to be a really great wound care center. Does anyone else have a problem with a sore in this area and the dressing not staying on? The nurse thought about a wound VAC but the doctor says it's too close to the rectum for that. I asked about an operation but he said no.

Look at the ISCH DISH made by SPAN AMERICA. Check out there website.They proclaim that you can sit up on this even with a sore.It is fantastic!
Irenec

Edited by Irenec, 05 April 2008 - 07:13 AM.


#11 qbounce

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Posted 05 April 2008 - 05:21 PM

I too had a stage 3 on my coccyx, Hanguk. It was a HUGE problem keeping the dressing in the wound for me also. . . so much that we tried skin bond, shaving the area (yes, I've got a hairy one, but it never stopped me from getting dates,,hehe), etc. Nothing really worked due to the shape of the openning.

After a year of dressing changes and not much progress in the wound's healing, I was finally directed to a plastic surgeon for the flap. . . and I've never looked back ever since!! (well, sort of)

Good luck to you, but remember if frustrations continue, the option for surgery isn't always the worst.

Edited by qbounce, 05 April 2008 - 05:25 PM.

When we remember we are all mad, the mysteries disappear and life stands explained. - Mark Twain

#12 City Girl

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Posted 05 April 2008 - 09:35 PM

I had a stage two coccyx pressure sore (just above the asshole) and tried so many different dressings and applications...with every new nurse/doctor it was a new dressing and covering. What finally worked for me, as mine is finally completely covered over and I just have pink skin there now, is they burned it with silver nitrate to kick-start the regrowth of new cells and then applied acticoat (silver side down) and the dressing I used was mepilex. I would use opsite to tack down the sides onto my butt cheeks. And it worked. For the record, mine never stayed on in the shower. I had to reduce my showers to every other day and then change the dressing right after showering...but it worked. I also slept on my stomach and my sides for a month or so and tried to spend a few hours in a standing frame every day. I do work, however, and sitting at my desk I would just sit on the very edge of my wheelchair and lean forward toward my computer. Good luck!!!
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#13 hanguk

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Posted 16 April 2008 - 12:08 PM

Nurses are now coming every day because they have realized that nothing will make the dressing stay on. The doctor is going to do a procedure calledl "saucerization" which he says may make the wound look bigger but he thinks will help and may make it possible to get a wound VAC. Meanwhile they have given up on the expensive dressings and are just using wet to dries. I think those stay on a little better anyway. I can even do that myself though not that well. I am going to run these other suggestions by the nurses and doctor.

I work at a computer too, right now I am doing it from a bed but I can see that leaning may be an answer to not sitting directly on the coccyx.

I think the doctor has a little trouble connecting the butt wounds to the patient. I think he's getting it straight now but the 2nd time I saw him he asked some weird questions... it went like this:
Doctor: I'm going to change this dressing order to wet to dry and have the nurses change it twice a day and after every bowel movement.
Me: But the nurses only come every other day.
Doctor (surprised): You're at home? You don't live alone do you?
Me: I live with my son. He's 13.
Doctor: How on earth do you take care of a 13-year-old?
Me: Well, I make his dinner, wake him up for school....
Doctor: How did you get this sore? Do you get up and walk around?
Me : No (wondering if he read my chart).

But they say he's the best at healing wounds!

#14 Brad Tate

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Posted 01 February 2013 - 11:26 PM

How do you make that cream lucky in Kentucky talked about

#15 Irenec

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Posted 02 February 2013 - 06:47 AM

Look at the ISCH_DISH cushion from Span America using this i am sure your sore will heel.

 

Irenec



#16 NancyE

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Posted 08 March 2013 - 09:47 AM

I have a stage three on sacrum that won't heal. I actually live in care facility. The wound care nurse is a bit special tho. She resents she has my bandage changes written down as MWF. , but I shower TThS, and mepilex claims to be waterproof...it's not. So the bandage comes off and I request another. She says, isn't my dressing day, I point out we decided to change it to on shower day. She grudgingly does it. I had a blowout, aids said bandage was filthy, I requested a change....she was pissed. I gently pointed out I didn't want an infection from feces soaked bandage. ( it's not the mepilex I have used before, it's like a white piece of foam). Anyway, have had it several months, not seeing any progress. The reason I started this thread, sorry for pointless bitching, is some of the nurses say wound is from bed, I should stay in chair more to let it heal. I did get wound from laying in crappy bed in hospital. Conventional wisdom says stay in bed and go side to side. Right now I get up two hours a day, mostly to take care of business and keep from losing my mind. What do y'all think?
Reality continues to ruin my life. - Calvin and Hobbes

#17 Tetracyclone

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Posted 08 March 2013 - 02:35 PM

Cannot get shower days changed?

As usual your thinking is sound.  The nurse is clearly mentally impaired but you do manage to get service from her- nice work, cudos for the self control.  Nothing quite like living in a hostile environment to sharpen one's survival skills.

 

I mean, a nurse who says you should stay in your chair more??!!  

 

Keep an even keel and maybe your keel will mend.  Wound vac?



#18 NancyE

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Posted 08 March 2013 - 10:12 PM


Tried to get shower day changed...this apparently involved the whole nursing home shower schedule....she asked why, I said there was slight conflict with days I showered and wound care schedule. She said she would talk to wound care nurse....hoping I haven't made it worse. I have been killing everybody here with kindness so far...wound care nurse might have special needs tho.
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Reality continues to ruin my life. - Calvin and Hobbes

#19 edlee

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Posted 09 March 2013 - 08:31 PM

Consider a Roho, Nanc,, and taping the right cells.  You can avoid pressure on any place you like, that way.  Mine might have been a half inch or so farther back,, and  my guy said the same thing about the cause being the bed.  I also have one of those matresses that alternate the air between the adjacent cells, every 15 minutes or so.  I know that helped,, because as hard as I tried,, I couldn't/can't stop sleeping belly up.

ed



#20 NancyE

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Posted 09 March 2013 - 08:48 PM

Got a roho high profile quatro....I switch it between the two chairs...what is this taping cells you speak of?
Reality continues to ruin my life. - Calvin and Hobbes

#21 isobar

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Posted 13 March 2013 - 03:19 AM

if you can once you change the dressing lay on it for a hour or two so the dressing can get a chance to really seal to your skin and shower every other day , just wash up on the other days. maybe the packing is keeping the wound too wet and how is your appetite? hope you find a solution.


LITUT = "Life Is The Ultimate Teacher"

#22 Jared Tucker

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Posted 15 May 2013 - 09:42 PM

I have a grade 4 pressure sore - not really on the sacrum - more the coccyx, actually pretty much in the butt crack. I'm certain it's because I tend to slide forward in my chair even though I have a custom-made chair and cushion to try to prevent that. I was in the hospital to take care of the infection. Now I go to the wound care doctor once a week, nurses come every other day to to the dressing. I do my work (I work at home on computers) from a hospital bed with an air mattress so I can stay off of it. I only get up for making dinner and the bathroom. But the sore is not really improving. The dressing they use is alginate (it's kind of a stuffing to pack the wound) with Tegasorb on top. The Tegasorb is supposed to form a seal that lasts at least 3 days and the packing is supposed to stay in. It is supposed to stay on through the bowel routine and showers too (you are supposed to be able to just wipe it clean). This is not happening. The bottom edge of it is right near the rectum and it starts peeling off a few hours after it's put on and that expensive packing is falling right out. After a day, and a BM and a shower only the top of the dressing is still sticking to me and I have to tape some gauze over it until the nurse comes. The bottom of the dressing can't be taped on better because it would cover the rectum and skin around it. The nurses and doctors don't understand. They say all the other SCI patients who have a sore like this in the same area manage to have their dressings stick. Some of them are blaming it on my transfers. They say I don't lift high enough and the sliding is causing the dressing to come off. But the dressing starts to come off even before I have made a transfer. Or when I get on the toilet, it starts coming off and there is no sliding onto the toilet, that's a complete lift. They use a butterfly shaped dressing. I can see from the picture on the package it's good for the sacrum but with a sore that's really more in the crack, I don't see how it can stick. Last doctor's visit (2nd visit) he was looking at the sore and saying "I don't know what else to do for you." He also asked strange questions like how did I get this and do I get up and walk around.. (he asked me the same questions when he saw me the first time in the hospital). This is supposed to be a really great wound care center. Does anyone else have a problem with a sore in this area and the dressing not staying on? The nurse thought about a wound VAC but the doctor says it's too close to the rectum for that. I asked about an operation but he said no.

hey, I'm curious about your job... I'm trying to get back to work myself, and a work-at-home job on the computer would be an answer to my prayers.  What do you do, and can I apply?


"Take time out of your day to really enjoy your life, and may God Bless." -Steve Stucker, meteorologist, KOB Eyewitness News 4


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