Thursday, February 16, 2012

Dressings Feb 16

We received the minutes from the team meeting and the dressing notes were all messed up.
So I'll describe the process here then resend for our Dermatologist and Plastic Surgeon.

First is the layering of Viscopaste (zinc paste bandage) at the webbing and around the high abrasion areas.  Then small tapered cuts of Mepilex for the top & bottom of foot (a slight adaptation to what I saw from Casey's parents).  If there is an issue near her heal I'll put another square across there too.

Then, I've restarted putting strips of the Derma Silk around the shin and forearm.  When lazy or when she's not cooperating it's much easier to just restart overlapping the Viscopaste up the leg or arm to just before the joint.

It's a little more of a art to remember which way to wrap the silk so that when the conform goes over top that they are going the same direction and smooth.  Today Raquel was a star for the nurse and I when we put on the conforming bandage.  The result a flat smooth finish.
Back at Christmas I tried having tubes sewn but the seam became an issue and it bunched or was difficult to pull on if there was too much Aquafor on her leg and get stuck.  Which resulted in freaky moments when you're pulling at something wrapped around her leg and you can see what appears as a large area of skin being pulled at.  The pulling never did create a blister, but I'm sure the bunching at her wrist or ankle did.
Again she's not had very very few blisters at the top edge of her bandaging because of her bandaging.
The silk under layer then just folds over as seen on leg in back ground.

Same on hand and arm.  I leave the thumb in two layers of Viscopaste.  The conform goes around her fingers like a mitt then up her forearm to below her elbow.  That is the silks going further up her arm.  Never a bad thing to have another layer of clothing at her elbow.  If the visco paste somehow works it's way off in the day or two between dressings, it's not a big deal.  We often leave it as long as there is the tube sock and her silks between her skin and the carpet or other scary abrasive objects.
This has been a very good wrap for some time and has had very little change since way back when I was fretting about hand splints.  Her hands stay weeks and weeks on end without a blister or issue.  Actually she has one very small blister at the underside of her wrist from Simona's exercise yesterday.  She wanted so badly to see Raquel's hands and play in coarse sugar (?).  I had to pipe up once I looked at how much like 50 grit sand paper it looked like and mentioned it be down graded the granular size to flour (~1500 grit), but by then they'd moved on to other things.
In the end Raquel got bored and irritated and it was a mild panic for me to get her hands wrapped up again.  Especially when the fingers went unguarded into her mouth and it appeared she was chewing on them.  It was then I could feel my edge angulating into a sharp point.
Last time I got my edge, it took Simona two months to come back.  Yesterday was two months or so.
BUT YES IT WAS ABSOLUTELY WORTH IT!!! (the small blister on her wrist and showing Simona her beautiful hands).  My edge never did appear (I don't think).....  I see it may have started when Cordelia nearly elbowed Raquel in the forehead.
 Notice her moose, bear, rabbit patch is now almost gone..
Her eyes are just too cute not to add these last two images.

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