Wound Care Question - My dressing is stuck-please help!
I have a dressing on a fairly large wound that will not come off. I put it on 2 days ago, and had covered the sticky dressing in a bandage and then a pressure bandage to hold the first bandage up, as I was going out today.
It started soaking through all 3 layers this morning, but as I was just about to go out I didn't have time to change it so just shoved a wad of tissue under the pressure bandage to soak it up.
When I got home I went to change the dressing- the bandages have come off, but the sticky dresssing will not. It's supposed to be a non stick dressing, and I have tried dampening the dressing-I am sitting here with a towel, a cup of water and a sponge as we speak, but the thing still will not come off.
Normally I'd have a bath, but as my Mum is in, and we have no lock on our bathroom, I am really reluctant to in case she finds out. Is there anything else I can do to try and get it off, aside from just ripping it off? I really don't want to do that, as it is so sore.
Thank you for your advice-itseems to be stuck to the sides of the wound though. When it was leaking, it wasn't bleeding much, there was more of that yellowly sticky clear stuff-plasma? But thanks for the advice for future dressing, I have some mepitel so will use that next time! I was going to use some sort of barrier between the dressing and the wound, I also have paranet and inadine sheets, would they be better than the mepitel or worse? I have collected them after previous visits to different doctors/nurses, they always give me something different so I never know which is best.
Thank you for your advice everyone. I did eventually manage to have a bath after everyone had gone to sleep. I was hoping the dressing would kinda float off, but it took me a while gently pulling at it. Was painful, but I think the heat of the water helped. Have redressed with with mepitel, then a sticky dressing over, hopefully this time it won't stick!
If you change them daily they're much less likely to stick; if they're producing a large amount of discharge then twice a day. Really trying to peel them off and soak them as you do them is the best but really the only good way is to stop them sticking in the first place by changing them regularly. A pressure bandage will not make it easy as that constantly pushes it into the wound and also puts pressure on it so more fluid may be forced out into it if it is too tight; as well as this it can cause further problems problems down the limb if it is too tight by reducing blood supply. Any bandage in place, unless for a pretty short time to stop bleeding whilst you get it seen to and it removed periodically, need to be loose enough so you can fit 2 fingers under it; if it's not then you need to loosen it.
Really, in the future if you cut like that again so that you are having to use this many layers of bandage it does have to be looked at to ensure that it doesn't need stitching as though some bandaging material may be the same as what a hospital uses, often stitches are needed and if you don't get these then it can cause problems with wounds taking months to heal as well as infection as letting them leak through the layers itself means that any infection can get in. As well as that they can ensure no further damage is done and the risks of things like this are reduced as each time a dressing is stuck it does not only cause pain to remove them but does also damage the tissue underneath that's very fragile so just because they may help with healing and some have found them "better than sutures" doesn't mean it's a replacement. As well as this, different dressings are needed for different types of wounds and different methods of bandaging so it could also be that you're using the wrong one for each problem so it is something that you need to look into as all this does increase infection really and can cause further damage.
Yes, there are ways, even antiseptic cream, can reduce the chance of it sticking however these are all different. However, unless you're checking it frequently and know the dangers of methods other than anti-septics then they can cause more problems and worsen any infection that may develop if not cared for properly but if they are then they can make a big difference. A lot of useage of anti-septics also has it's own problems but with SH the benefits of reducing the infection often outways the bad things about them.
But yeh, going to the hospital isn't just about getting sutures, it is so they can assess the size of the wound, the problems it may have caused or may do in the future and them finding the best way to look after it which could be anything from a simple melolin or iodine dressing, to a wet-to-dry dressing, to a hydrocolloid dressing, through to steri-strips, staples, sutures and even reconstructive surgery/ skin grafting as well as also seeing if there is damage to the below. So what I'm saying is it may well be you have different dressings but often they can be used in the wrong way causing problems such as this as well as reducing healing or increasing likelihood of infection. Sorry to be preachy, I'm just thinking more about the future if you carry on SHin that you do need to take this into account. Also, as your wounds are getting deep and causing problems it is a major sign that SH isn't really working for you anymore so if you've not got emotional support I'd try and sort this out and between now and then or if you're struggling with whatever feel free to also contact the supporters via Live Help or firstname.lastname@example.org.
Wow, thank you for your long reply! I do realise now that the pressure bandage was probably what made it stick, as I had the pressure bandge around the bottom half of my leg, and the dressing didn't stick above where the pressure bandage was sitting. I did need to use it though, as I didn't want my family finding out, and normal bandages always slip down on my legs.
I really also probably have gone to the hospital for stitches, the last time I went with a similar size wound they sent me all the way to London for a skin graft, only to be told they wouldn't give me one when I had got there as I was still self harming. I don't normally go to the hospital though unless my parents find out, and that is only if they find out in time for stitches. I cut on Tuesday, so it is a bit late now.
My wounds are normally always on my lower leg, and all of them leak a lot of that sticky yellowy clear stuff. I don't normally have any other problems with them, but doctors/nurses have given me all sorts in the past, mepitel, inadine, paranet, intrasite gel, gauze dressing packs, non stick dressing packs, melolin dressings, mepore tape, mepore dressings, medical tape, a tonne of various types of bandages etc. They don't explain why they use them for each specific wound, and google tells me they are all used for basically the same thing-to promote wound healing. I've managed to get all these different things from different people, no one seems to have the same way of dressing the same wound. Hospitals use non stick dressings and medical tape, and maybe a bandage. Dressing clinics gave me inadine and mepore dressings. One nurse at my local surgery gives me dressing packs, with intrasite gel and bandages. Another gives me mepore dressings with mepitel. I dunno why they use so many different things.
Hospitals are normally the ones least concerned with dressing my wounds well, in the few times i've been they've stitched me up, and stuck a non stick or even a gauze pad on with medical tape. Then maybe they might bandage it. I've been to my local surgery to get dressing prescriptions, and after i've been through the "you need to go to hospital" bit, they are always unsure what to do with dressing the wounds-one nurse I have asked for the type of dressing myself, and she actually let me dress it as she said I was better than she was.
I don't know, it's all really confusing. But to be fair, I don't normally bother with dressings that often, mainly just to hide a wound, or to stop it bleeding. I have a problem with letting wounds heal, I actually don't like them healing too fast. Which is why I have a huge stash of all the random things they do give me.
Have you tried mepilex dressings they are amazing they have a system that draws fluid away and how they stick I don't know but they come off so easily. They use safetec whatever that is. I get them on prescription and I would never use anything else now! Just a thought.
The Intrasite gel is something you said that took my notice. It was something I thought about mentioning, or it's form that you can now buy in pharmacies as "Savlon Advanced Healing Gel" (or something to that effect). That will stop the dressing from sticking. However, the wound does have to be thouoghly cleaned before it's useage and really it depends how deep you're cutting. If it's to the fat then though it's best to get it checked out and I will stick by that (the fact that you're cutting into this and damaging the tissue as well as potentially going deeper is likely to be why you're getting so much fluid out), you could use that, if it's any deeper then you can't and really then it is imperative you do get it checked; the reason doctors wouldn't give you skin grafts in the past is that they are SO easily damaged that even a small movement of the area or a dressing not applied in the totally right way causing your skin to be put under a different kind of strain is likely to make the graft lose it's blood supply and therefore fail which opens you more likely to become infected as you basically then have dying tissue there, it also means further surgery is likely to be needed and as well as that, the surgery to perform these is long-winded, can be quite difficult and the area they take your skin from (usually the top of your thigh) will be REALLY painful after. There worry would be that if you're still self harming a lot that it is more likely the wound will not be given the chance to heal properly and then will break down. The fact that you've said you don't like healing to be fast sort of brings that to mind as though healing won't be fast with a graft, it may mean that if it worked and you saw it starting to take then you may damage it in an attempt to slow it. The also mean long hospital stays in a lot of cases. Really, if you're cutting to that depth or through the fat layer (really into it though) it DOES need to get checked out, whether your parents find out or not as one day the area will become infected and it could mean you end up losing your leg or it could be really deep and you loose feeling in your foot. And of course there's always the risk of damaging an artery or a vein. This needs to be taken into account so I think it really would be worthwhile you getting help for the emotions behind why you cut and if you are doing then be truthful to them, if it's not working then tell them that but if SH is that severe then it is a strong sign that it isn't working for you anymore to properly improve your emotions and one of these days you are going to cause yourself severe harm.
The reason I say Intrasite is that this is a gel that will stop dressings from slipping. However, like I say, it can't be used on everything. Before you use it you do have to ensure that the wound is REALLY clean and then cover the underside of a dressing with it and apply the dressing to it. This, not only helps it not stick but it does help the wound to heal really well with less scarring and quicker. The dressings should be changed daily with more intrasite used each time; if it starts looking infected STOP using the intrasite, clean the wound up and then use antiseptic cream. If using intrasite (or even Manuka Honey) you could cover a really oozy cut with a type of dressing called Allevyn. This is probably the best in the market for absorbing liquid though it would still have to be changed every day really. You could use a non-stick dressing under that if you're not wanting to use anything else. And like I say, Intrasite gel can only be use on NON-INFECTED, clean cuts. You can by bandages known as "cohesive bandages" apply this around the dressing with a layer of cotton wool (or softban which is a cotton wool like bandage material) beneath it, between the dressing and the bandage just because it itches. That will hold it in place though make sure this isn't too tight; you've got to be able to fit two fingers under it the whole time. If that doesn't hold it completely then you could maybe buy one of the long lengths of "fabric plaster" that come in a roll. This does have a pad in the centre but is sticky on either side of it or even similar tape that will be marketed as "Sports Support" or "Fabric sports strapping" which is just like these but without the dressing pad in the centre. These will stick to your skin though you shouldn't need to use it with a couple of layers of cohesive bandage over the dressing. This sort of bandage sticks to itself, not to your skin, and is reusable but slips less often than most and as it sticks to itself well you may be able to bandage it in a way where it is less likely to slip.
Really though, I would urge you to seek hospital attention for your wounds. That can either be at A&E or a Minor Injuries Unit; some walk-in centres may also deal with it and they can assess it, suture it if necessary. If it's really deep then A&E may be your best bet as it may mean you need sutures internal and in the skin as well as the skin 'loosened' from it's attachments underneath and maybe special suture patterns to enable it to close properly. If you can get to A&E/ an MIU without your parents taking you then it would be a good idea going whatever if your wound is deep (which refers to it going into fat/ deeper), you don't necessarily have to tell them where you're going but even if they were to know I'm sure they'd prefer that than you having further problems in the future like you are now, which would have damaged the healing of the wound, or worse than you not, however angry or whatever they may seem at the time.
Hah- that shows how crappy the nurses at my surgery are, they never even bother trying to clean the wound before they put the gel on. And they put it straight into the wound, and told me to do that same. >.<
I have recently been discharged my my mental health people(whatever they are called), as I can't talk (at all, not just about feelings) to anyone outside immediate family, and they couldn't be bothered dealing with me. So getting help is virtually impossible for me. This also means I can't even go to a doctors/hopsital by myself, as I cannot talk to anyone, which is why my family wold need to take me, and I am hoping they don't find out. Last time my mum found out I had cut she admitted herself to the pyschiatric ward, and obviously I don't want to trigger into that again.
It's too late to suture it now anyway, as I made the cut on tuesday. It's not too deep, it only goes to fat [removed size]. As I am morbidly obese it would be tricky to get to a deeper layer. I did cut a small vein and a tiny arteriole though- should I be concerned about cutting too many blood vessels? I seem to hit at least one every time I cut, there seem to be quite a few near the surface on my legs. Will they heal up, or do they just die after you cut them? And if they do die/whatever, will that be a problem if you hit x amount?
Last edited by Animad : 07-02-2010 at 04:28 PM.
Reason: Removed size of the wound
Yeah, you can put it straight on the wound if you like and I'd do that if I were dealling with a very large wound/ I was going to be using the whole lot in one go but if not if you put it on the dressing then it stops the end getting contaminated and so doesn't transfer any debris from that wound to the next you use it on. But yeh, the wound does have to be clean. I think I've seen it's use also on infected wounds but that was when used alongside effective antibiotics and we ALWAYS clean the wound up well and that comes from me, what I've been taught as well as other people who use it who actually don't know much about it. But yeh, it does in itself create an environment great for the wound to heal but alongside that it's also a perfect environment for bacteria to grow so yeh, you do have to be careful with that and dressings that produce a 'moist environment' to enhance healing.
That size cut is large and should really be checked, yes if possible. The blood vessels in that layer are mainly capillaries, some are arterioles, some venules (small veins) but the bigger ones are deeper. Really you do have to apply pressure and try and stop them as soon as possible, not only because of the blood loss but whilst ever a blood vessel is open the chances of bacteria getting in it are quite high from SH and that can lead to infection straight into your bloodstream; septicaemia (AKA blood poisoning) which can kill so yeh, it is still dangerous. The worry is that if the areas get infected though the infection will go straight into your fat causing a cellulitis and can go deeper and spread; that's what can cause huge problems and with cuts that size, the amount of time it takes for them to close you do need to take that on board. If you can't talk then if possible write it down and go and get cuts that size checked out as they really could do with being; the fact that they've wanted to do skin grafts before is a sign of that and the others would be VERY hard to close without some work which does have to be taken on board but not only that but you also need to to remember that cutting that deeply and having widespread scarring can also potentially cause problems in the future as the scarred areas will be tighter and so reduce movement and so any closure possible will not only help now but will help with that.
And yeh, I meant future ones could do with being sutured. Though they can do it later than what is often recommended if needed, I definately wouldn't be happy tackling one that late on without other work done to it before (or a lot of surgical work done at the time but the risks that'll leave with infection and wound breakdown are high and thats only with regards to small wounds) and don't know anyone that would, especially because of the size of it and position.
Also, we cannot give how many vessels it would take to cause a lot of damage; really the answer is any potentially can; they're all supplying blood to the skin anf fat in that area and so if any of them are damaged it can have a knock on effect and some are more important. As well as being an ideal way for bacteria to get into your blood stream. You really do have to try and reudce the depth you're cutting to as though you're saying they're not deep, imagine if you'd not been doing it too long then you'd be scared stiff. After a while you begin to lose that and get a new sense of what deep is and so long as it's not your deepest people generally associate them themselves as not being too bad. Anything that goes through your skin (which is anything that goes into or to the fat layer or further), is generally classed as a deep cut