THE EFFECTIVE MANAGEMENT OF A STAGE 3 WOUND USING

EAKIN COHESIVE & EAKIN FISTULA AND WOUND POUCHES

By Barbara Dickson, Bridgetown Hospital, Western Australia.

This case study describes a lady returning to hospital following angioplasty, who had
developed wound breakdown of the right femoral area. Large amounts of fluid were
being produced and there were problems containing them in the daily dressing. It
was decided to use the Eakin Fistula & Wound Pouches with a picture frame of Eakin
Cohesive creating a secure fit.

When presenting on 12/7/01 at the A & E of the local hospital, the wound was initially
dressed with kaltostat, release, combine and fixomul.

18/7/01
On assessment the wound was a stage 3 wound breakdown, held together with tension
sutures inserted into the wound, prior to her discharge home to the country.

A swab was taken = NAD.

Measurements
3cm x 2.4cm
2cm x 1cm
Suture line = 10cm in length.

The wound was very sloughy and even though not infected, the client was distressed
by the odour she could smell issuing beneath her clothing and in the bedlinen. The
wound was producing a large amount of fluid, which was not being contained by the
daily dressings, instigated at the local hospital.

MAJOR PRESENTING PROBLEMS

Odour was of a primary concern to the client, causing her to be extremely self-
conscious.

The high exudate, which was unable to be contained by the original dressings, thus
causing soiling of the clothing and bedclothes as well as interfering with her sleep.

CRITERIA USED FOR THE SELECTION OF DRESSING

Containment of odour & exudate

Comfort
Cost-effective and time-efficient for nursing staff.

It was decided to use an Eakin F8 Wound & Fistula Pouch (ref: 839211). The wound was
cleaned with normal saline and the wound bed filled with gauze impregnated with
gel, to act as a mechanical and autolytic debiding agent. The surrounding edges
were picture framed using a large Eakin Cohesive Seal (ref: 839001). The seal was
moulded up to and around the tension sutures thereby creating a level wound bed.
The template was used to ensure an accurate cut for a very irregular shaped wound.
The Eakin pouch was then moulded onto the Eakin seal - creating a secure fit.

The wound was inspected daily - nil leakage or odour was present, and the patient was
very comfortable.

20/7/01
A window was cut into the pouch to enable the wound to be cleaned with N/Saline
and the gel impregnate gauze re-applied. The wound bed was healthy, nil odour or
pain was present. The sloughy areas were reduced markedly. The Eakin pouch was re-
sealed with a film dressing.

22/7/01
The pouch was removed and the wound cleaned with N/Saline. Minimal slough was
present. The surrounding skin was healthy. The suture line union was intact. Moist areas
were noted at the tension suture entrance sites, skin sutures were removed. The wound
bed was healthy and granulating. The dressing was reapplied as above, again using
the Eakin pouch and seals.

The healing process is impressive in just 4 days!

24/7/01
Odema of the thigh was markedly reduced. The pouch was removed and gel
impregnated Gauze + opsite applied to allow the patient to shower. This was changed
daily until the wound was healed.

The wound continued to heal very well and was reviewed in the City at the hospital
where the original procedure was performed. Here the doctor removed the opsite
dressing and created more wounds with epidermal stripping!! This distressed the client,
who had been very impressed with the success of the Eakin pouch method, had
insisted on taking her charts with the treatment listed to the hospital to show the doctor,
who unfortunately showed little interest.
CONCLUSION

The patient improved psychologically and was less distressed with the use of the Eakin
pouch, due to the containment of the odour and exudate.

It was comfortable to wear and didnt impede her normal activities.

It was cost-effective and time-efficient for the nursing staff.

It was possible to visualize the wound and access the wound bed via the film dressing.

A marked and rapid healing process was observed.