Clinical Problem: Vascular ulcers can be painful during and after dressing changes. Fifteen male residents between the ages of 61 and 83, all with either arterial or venous ulcers, were chosen to evaluate pain management in conjunction with the use of a composite ionic silver dressing*. All had narcotic pain management one hour before dressing change and prn after their dressing change. All had used NSS to soak off the old dressings. Silvadene was used on 11 residents and a collagen-alginate** was used on 4 residents. Using the Wong-Baker Faces rating scale to establish baseline ratings(used since dementia was a factor), 6 residents elicited a score of five (actual crying), 6 a score of four (significant grimacing), 3 a score of three (facial frowning), 0 a score of two (look of surprise), 0 a score of one (rapid eye movement) and 0 a score of zero (no pain). Current Clinical Approach: After cleansing, the composite silver dressing* was applied print side up and then covered with gauze and tape then left intact for three days. All were medicated one hour prior to removal. Patient Outcomes: Zero residents scored a five, zero scored a four, 4 a three, 8 a two, zero a one, and 3 a zero. Four hours post dressing change, zero residents scored a five, zero a four, zero a three, zero a two, 2 a one, and 13 a zero. Conclusion: The composite ionic silver* provided pain relief post dressing change as well as ease of removal with less pain. * SilverDerm 7 Plus, DermaRite Industries ** Fibracol, Johnson & Johnson Medical References: 1. Wong, DL, Essentials of Pediatric Nursing, 2001, page 1301; 2. Krasner, Rodheaver, Chronic Wound Care, 2001, pages 591-594; 3. DermaRite Industries and Milliken Labs, 2005, FDA product insert.