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PU Case Study: Vernon, T

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IntraSite Conformable in the treatment of a pressure ulcer on a newborn baby.

Introduction
The management of babies with wounds can prove to be a challenge for nurses. This challenge is greater when the aetiology of the wound is initially unclear.

 

The Patient
Baby P is a twin who was born 5 weeks premature. Twelve hours following the birth of Baby P an area of discoloration was noted on the nape of his neck (see figure 1). The nursing staff referred the patient to the Clinical Nurse Specialist as they had concerns as to how to manage the area of tissue damage. After lengthy discussions with numerous health care professionals it was agreed that the area was due to pressure damage caused by the position of Baby P's twin brother prior to their birth.

 

The Challenge
Manage a pressure ulcer in a difficult area on a pre-term baby.

 

Aims

  • To use a dressing which would rehydrate hard black eschar.
  • To use a wound care product which would stay in contact with the wound.
  • To provide the optimum environment for wound healing.
  • To use a dressing which would be easy to remove.
  • To use a dressing which would not cause any further damage to the baby's fragile skin.
  • To select a secondary dressing which would enhance the properties of the primary dressing.

 

Fig 1

 

Fig 2

 

Interventions
Initially a hydrocolloid dressing was applied to the area of pressure damage as per the Trust's wound care protocol. Despite using the dressing as per the manufacturer's instructions the wound presented with a hard black eschar when the dressing was removed by the Clinical Nurse Specialist a week later (see figure 2).

Having assessed the wound it was felt that the most appropriate dressing to use was a hydrogel. IntraSite Conformable was selected as the dressing of choice. IntraSite Conformable was laid over the area of eschar and was covered with non adhesive Allevyn*. The aim of this dressing combination was to ensure that a moist wound environment can be created, which in turn would promote natural debridement through autolysis by gently rehydrating necrotic tissue.

 

Outcome
Because of the unusual nature of the pressure ulcer the dressing was removed on the following day by the Clinical Nurse Specialist (see figure 3). The eschar had been rehydrated by the hydrogel and had undertaken a colour change. Five days later the wound was showing signs of granulation (see figure 4). Figure 5 shows the wound two weeks later when the pressure ulcer had nearly healed, the decision was made to discontinue the IntraSite Conformable and use non-adhesive Allevyn until the wound had completely healed.

 

Fig 3

 

Fig 4

 

Fig 5