Wound Care Management

Initial Assessment and Monitoring

The home health nurse should perform daily monitoring of the wound site, keeping it clean and dry using aseptic wound care techniques until the stoma tract is fully formed (usually 5-7 days post-procedure), then reduce dressing changes to 1-2 times weekly once healing occurs 1, 2
Monitor the wound site daily for signs of bleeding, pain, erythema, induration, leakage, and inflammation 1
Cleanse the wound to remove debris using 0.9% sodium chloride, sterile water, or freshly boiled and cooled water 1

Apply a sterile Y dressing under the external disc plate, followed by a skin-friendly, solvent-free breathable dressing 1
Avoid occlusive dressings as they promote moisture and can lead to skin maceration 1
Consider using a glycerin hydrogel or glycogel dressing as an alternative to classical aseptic wound care, which has shown significant reduction in infection scores 1, 3
Reduce dressing changes to once or twice weekly after initial healing 2, 3

Follow the five basic principles of wound treatment, including offload pressure from plantar ulcerations, debride necrotic, nonviable tissue, revascularize ischemic wounds when necessary, manage infection, and use physiologic, topical dressings 4, 5, 6
Offload pressure from plantar ulcerations 4
Debride necrotic, nonviable tissue 5
Revascularize ischemic wounds when necessary 4
Manage infection (soft tissue or bone) 6
Use physiologic, topical dressings 4

Once the stoma tract has healed (after about one week), rotate the tube daily 3
Move the tube inwards at least once weekly (at least 2 cm, up to 10 cm) to prevent buried bumper syndrome 3

For peristomal leakage of gastric contents, protect surrounding skin using zinc oxide-based skin protectants 3
Monitor for signs of infection: increasing pain, redness, swelling, warmth, or purulent discharge 5, 7
Obtain appropriate wound specimens for culture before initiating antibiotics if infection is suspected 6
Cleanse and debride the lesion before obtaining specimens for culture 6

Contact physician immediately for signs of infection, significant wound deterioration, or complications 5
If wound fails to show reduction of 50% or more after 4 weeks of appropriate wound management, consider advanced wound therapy 5

Avoid using negative pressure wound therapy following orthopedic surgery until safety in this population is established 8
Consider patient preferences and relative benefits when selecting dressing types 8
For patients with diabetes, ensure proper offloading and more frequent monitoring 5