Wound Management - VetNurse July Topic of the Month.

RE: Wound Management - VetNurse July Topic of the Month.

Cloudy Weather — Sat, 11 Nov 2017 08:53:27 GMT

Hi there,

I was wondering if anyone could explain in a bit more detail why honey should not be used on healthy granulating wounds - I know it shouldn't be but I was just looking for more detail to justify my answers. I know as it lowers the PH and draws out moisture but how exactly does a lowered PH affect the wound healing. I have always read that a wound heals much better when the PH is low as normal skin is slightly acidic and a lowered PH will cause the fibroblasts to proliferate more actively and prevent elevation of proteases. Is it just a case of moisture of is there more to it on the PH level and the effect it will have on proteases etc.

Thank you

RE: Wound Management - VetNurse July Topic of the Month.

Amelia Sherwood — Sat, 04 Nov 2017 08:28:04 GMT

Great to hear it’s helped Edel :-)

If anyone is interested in attending our conference in a few weeks check out the info at www.vetwoundlibrary.com and follow the conference link... only a few places left so book quick - it’s going to be great!

If funds are a bit tight with only a few weeks to go message me at amelia@bandagingangels.com and I will see if I can get you a little discount as contributors to this group!

RE: Wound Management - VetNurse July Topic of the Month.

Edel Burke — Mon, 30 Oct 2017 09:55:17 GMT

This is so useful, thanks so much. in articular to learn that jar honey can cause harm.

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Wed, 02 Aug 2017 19:03:46 GMT

)[quote user="Frances Bell"]

[quote user="Georgie Hollis"]Frances that is awesome! ... could you present this as a case study do you think? [/quote]

would love to - need to get some extra details first but can do.

[/quote] YES! ... You just got yourself a free pass to the Wound management Extravaganza - make sure you are free 24-25 November this year :-

RE: Wound Management - VetNurse July Topic of the Month.

Gizmo — Wed, 02 Aug 2017 15:39:00 GMT

[quote user="Georgie Hollis"]Frances that is awesome! ... could you present this as a case study do you think? [/quote]

would love to - need to get some extra details first but can do.

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Sun, 30 Jul 2017 08:24:52 GMT

[quote user="Georgie Hollis"]

[quote user="Jodie Hoare"]

What is your protocol on documenting wound progress, particularly if multiple staff are dealing with the patient? Do you write a care plan that can be accessed by others, or do you write a plan of action in the notes detailing exactly what should be done at each wound check, which product should be used at each healing phase, client funds etc? How often should the wound be measured or photographed?

I absolutely love this thread, and have booked a place on the Wound Extravaganza CPD weekend in November!

[/quote]

Hi Jodie and everyone enjoying the thread, its so good to hear and there is SO much that nurses can do to get involved with wound management. Really happy you'll be coming to the Wound Conference its booking up well and there will be loads of good things to learn - alongside vets, not split into vet and nurse streams - Wounds heal the same if you are a vet or a nurse and you work alongside each other in practice so what is the point of you learning different things... (just my view on that one - sorry this whole thread is a bit of a rant-fest for me!! .... )

To be completely honest your protocol is up to you. I've seen some lovely ones done by nurses on the BVNA wound course, but they are all different and usually adapted from human forms. Photography is key and being able to identify what stage the wound is in and a little knowledge of how it should progress if all is going well. I've attached a wound / dressing guide that we have done that you can put in your dressing cupboard - the products are as generic as possible so you can choose the brands you like.

Measuring is really helpful - it seems a little like OCD at the time, but you'll be amazed how much information it will give you when you look back on the images. From my point of view if everyone took pictures with a measure next to it the information we would have to collate for the future would be extremely powerful (ie. what works and what doesnt, what rate of healing is normal and what decisions are good and which are bad) then we could really start refining wound care in animals much faster than we can at the moment...

In terms of intervals - each dressing change is reasonable and i'd suggest that once a wound is granulating then as a nurse you can turn to your vet and ask how they would like to proceed - do they want to close surgically? reconstruct? or allow you continue with second intention management. .... the time to decide what is the fastest route to closure is when you have healthy granulation tissue. (unless the wound is less than 6 hours old and there is tissue available to close - then closure might be feasible) ...

[/quote][quote user="Georgie Hollis"]

[quote user="Jodie Hoare"]

I absolutely love this thread, and have booked a place on the Wound Extravaganza CPD weekend in November!

[/quote]

PS... just another tip... when taking photos - make sure you, or whoever's hand is in the image has gloves on. 1 - its best practice - 2. if you go on to write it up as a case study you'll be demonstrating best practice to others. I realise it can be a pain in the a***e when you've had to fiddle with the camera - get a colleague to help if you can :-)

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Sun, 30 Jul 2017 08:17:27 GMT

[quote user="Jodie Hoare"]

I absolutely love this thread, and have booked a place on the Wound Extravaganza CPD weekend in November!

[/quote]

RE: Wound Management - VetNurse July Topic of the Month.

Jodie Hoare — Sat, 29 Jul 2017 23:52:53 GMT

I absolutely love this thread, and have booked a place on the Wound Extravaganza CPD weekend in November!

RE: Wound Management - VetNurse July Topic of the Month.

sara roberts — Thu, 27 Jul 2017 21:49:55 GMT

[quote user="Georgie Hollis"]

[quote user="sara wyn roberts"]

We dont tend to use splints, although we have them in stock it isnt the first thing we reach for.

depending on the problem, if it is fracture related one of our vets prefers to leave it open if it is relative stable and closed, to allow it to swell without the added pressure of a bandage if a decision on further treatment is to be done in the next 24-48Hrs. if we had to bandage it i would prefer not to use a splint and just use bandaging as i think we'd have less issues with soars and such. Refferal or an op the next day is usually the outcome so we donr often need to bandage them.

If there is a wound related to the hock, we extend the leg as much as possible to prevent flexing, with the added support of donut bandages on the appropritae points (depending on the animal) and bandage to a level thickness. Usually do this under sedation as can be painfull for the animal to strech the leg out.

Works 9/10 times, some cats can seem to wriggle out of it no matter what you do

Not exactly imobilisation but related. We had a dog with a relativly large back wound. She was a very sweet girl who loved to greet you by rolling onto her back! as you can imagine not ideal when it comes to not traumatizing the wound further so we had try and come up with a way to stop her from doing this, in the end we used 2 inflatable buster collares, one placed around her chest and the other around her abdo, so either side of the actual wound. Everytime she tried to roll she would just kind of rest sideways on the collars, worked a treat but she did look a bit funny bless her.

[/quote]

Great info, and glad to hear you are using do-nuts.

Brilliant use of the inflatable collars.... i guess you could stitch similar to a medical pet shirt too? (assuming you don't puncture them - the inflatable collar not the dog!!)

[/quote]She had a pet shirt on aswell She was fully covered bless her. once healed fully one of the vets did knit a melolin onto the pet shirt as an added protecter for a little while just in case.

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Wed, 26 Jul 2017 18:30:08 GMT

[quote user="Frances Bell"]

[quote user="Georgie Hollis"]

I'd like to change tack a bit and ask everyone how they manage to immobilise limbs (ie. with a hock wound) - this is bandaging related but we (Bandaging Angels) are getting so many questions about how to immobilise and everyone seems to do it differently - RJB, green splints, modified robert jones? What do you use and why and do you manage to avoid issues?

[/quote]

With hock wounds in penguins we create a splint/boot from that stuff that has the thin layer of metal covered with foam - name of the product escapes me at the moment - put extra gauze next to the skin to stop any friction wounds and then vetwrap in place. It can be a long drawn out process but we've successfully managed septic arthritis and had penguins walking again - and released - after what was an initially dire prognosis. Key thing is getting the positioning exactly right, and very gentle passive ROM every couple of days at bandage change.

[/quote]

Frances that is awesome! ... could you present this as a case study do you think?

RE: Wound Management - VetNurse July Topic of the Month.

molladog — Wed, 26 Jul 2017 15:40:46 GMT

[quote user="Frances Bell"]With hock wounds in penguins we create a splint/boot from that stuff that has the thin layer of metal covered with foam - name of the product escapes me at the moment [/quote]

Zimmer.....

RE: Wound Management - VetNurse July Topic of the Month.

Gizmo — Wed, 26 Jul 2017 15:31:37 GMT

[quote user="Georgie Hollis"]

[/quote]

RE: Wound Management - VetNurse July Topic of the Month.

Gizmo — Wed, 26 Jul 2017 15:25:24 GMT

[quote user="Amelia Sherwood"]

[quote user="Georgie Hollis"]

[quote user="Frances Bell"]Have also had success with granuflex in a penguin with a nasty and extensive seal bite wound - following 2 or 3 surgical debridements we sutured some granuflex in place to remove the last of the infected/necrotic material and had amazing results. [/quote]

Granuflex is brilliant stuff - its like a concentrated form of intrasite and the same stuff you get in Compeed® blister plasters. It works brilliantly on birds, reptiles and excoriation ..but not great at sticking to fur. If you go to www.worldwidewounds.co.uk (i think it is .co.uk) there are some lovely wildlife cases on there - mostly featuring granuflex. (i'm sure you have found them already!)

[/quote]

Frances, I LOVE that you have used these on a penguin! I am so jealous that you can get up close and personal with these guys!! I used it successfully on a pigeon but penguin definitely trumps!

[/quote]

Yep penguins are pretty cool and they can always use a vet nurse at the rehab centre where I did this. If you'd like further details please feel free to PM me.

RE: Wound Management - VetNurse July Topic of the Month.

Gizmo — Wed, 26 Jul 2017 15:17:51 GMT

[quote user="molladog"]

Good to see someone else is a laser/light therapy fan, we need to get more people to try it

[/quote]

We used it on birds who had mobility issues in wings/feet - together with passive ROM, worked really well.

RE: Wound Management - VetNurse July Topic of the Month.

Gizmo — Wed, 26 Jul 2017 15:14:09 GMT

Thanks Georgie,

Haha, doesn't stick too well to penguin feathers either, which is why we used stay sutures. I hadn't found the worldwidewounds site but I'll be all over it now :)

RE: Wound Management - VetNurse July Topic of the Month.

Arlo Guthrie — Wed, 26 Jul 2017 14:44:14 GMT

[quote user="Alison Clare Hickman"]Arlo, a thought... 'Save Bank' - in the CPD / Information section?[/quote]

Hmmm, yes, think I can do something like that. Create a new section where finished Topic of the Month discussions can go, and be found easily.

If you want to keep a record yourself, using the 'Claim CPD' button not only allows you to put the time spent reading/contributing towards the annual requirement but also keeps a record of the url So you can refer back to it. What I haven't checked yet is what happens to that url if I move the discussion to a new section of stored stuff...

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Wed, 26 Jul 2017 08:05:58 GMT

[quote user="sara wyn roberts"]

We dont tend to use splints, although we have them in stock it isnt the first thing we reach for.

Works 9/10 times, some cats can seem to wriggle out of it no matter what you do

[/quote]

Great info, and glad to hear you are using do-nuts.

Brilliant use of the inflatable collars.... i guess you could stitch similar to a medical pet shirt too? (assuming you don't puncture them - the inflatable collar not the dog!!)

RE: Wound Management - VetNurse July Topic of the Month.

sara roberts — Wed, 26 Jul 2017 06:42:48 GMT

We dont tend to use splints, although we have them in stock it isnt the first thing we reach for.

Works 9/10 times, some cats can seem to wriggle out of it no matter what you do

RE: Wound Management - VetNurse July Topic of the Month.

Alison Clare Hickman — Tue, 25 Jul 2017 09:13:04 GMT

Arlo Guthrie

Arlo, a thought... 'Save Bank' - in the CPD / Information section?

This thread is so interesting and informative. So, instead of it disappearing into history, like all threads can do as time elapses, would it be feasible to have a 'save bank' to put these discussions in? Or create a link in the save bank to them, for ease of access for all?

I realise methodologies, equipment etc change overtime so I would expect updates from time to time on it - it should continue to be a 'live' information source.

Impossible? Do-able? Already thought of?!

Cheers for listening.

Ali h

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Tue, 25 Jul 2017 09:11:32 GMT

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Tue, 25 Jul 2017 09:09:07 GMT

[quote user="molladog"]

Hi, The main problem I have had is trying to stop the vets using antibiotics for some of the wounds as Laser therapy inhibits the growth of bacteria so trialling without antibiotics has been a bit of an issue. Obviously you need client compliance for a non antibiotic trial as everybody wants the 'magic tablets'. With horses I have had great success without antibiotics as a lot of horse owners are not keen to keep pumping a/b's into their animal for several weeks. The lasered wounds do seem to contract up faster and the end result is more cosmetically appealing.

[/quote]

Hard one to comment on in terms of antimicrobial effect. I have seen some details that suggest evidence for this but not looked deeply at it. We will do in the next couple of months. I suppose from my regulatory knowledge the issue here might be that if Laser is being used/promoted for its antimicrobial effect there may be some VMD issues as this would be considered 'treatment' and would require a marketing authorisation. its a really grey area. Personally i feel lavage and good wound bed prep is underused and as important at reducing the need for antibiotics and Laser - i'd not be in favour of one versus the other, but totally get what you say about over-use of antibiotics in cases that don't necessarily need them.Very difficult one to rationalise as there will always be the 'what if' question and that one case that goes wrong because you didn't use them could be devastating.

RE: Wound Management - VetNurse July Topic of the Month.

molladog — Tue, 25 Jul 2017 08:46:15 GMT

RE: Wound Management - VetNurse July Topic of the Month.

Lorna Parker — Sun, 23 Jul 2017 08:54:13 GMT

Cheers

I used wet to dry after a dog had been attacked by a badger and it healed great, we sedated the dog for dressing changes. unfortunately the leg had to be removed at a later date as one of the other wounds went round the entire circumfence of the leg and the lower skin started to die off.

RE: Wound Management - VetNurse July Topic of the Month.

Lorna Parker — Sun, 23 Jul 2017 08:49:48 GMT

hi sorry for late reply doing my main job of being mummy. The reason we were using Allevyn was to mop up exudate. As the Dog was dragged under a trailer there was a lot of skin damage.

RE: Wound Management - VetNurse July Topic of the Month.

Georgie Hollis — Fri, 21 Jul 2017 21:51:19 GMT

[quote user="molladog"]

[quote user="sara wyn roberts"]

I was going to post a question in regards to using laser therapy in wound management, not just for traumatic wounds but post surgical wounds.... I've since read the post from other forum goers amd it seems a mixed response.

Has anyone seen the benefit of it for post surgical healing??

[/quote]

Hi,

yes I have used it straight after surgery on op sites to minimise post surgical trauma in cats with FAD that we have spayed, I then repeat laser daily for 5 days and have found they do not lick the wound as it helps with healing and seems to alleviate the irritation of the itchy skin. I also laser the hot spots/lesions of FAD.

[/quote]

Based on your experience with laser do you have any ideas how we could design a study to show that laser achieves a result/benefit sooner than 'standard' management (or nothing at all?)?