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A pressure ulcer is defined as a localized area of tissue destruction that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged period (Quigley & Curley, 1996). Pressure ulcer development factors include intensity and duration of pressure, and the tolerance of the skin and supporting surfaces to endure the effects of pressure without incidence.
This poster describes a case study of a 6 month old infant with a complex cardiac history. After being placed on ECMO, the infant developed a right hip pressure ulcer after lying on a wood surface for 10 days. The stage II pressure ulcer measured 2 cm x 2cm x 1cm. Treatment was silver alginate dressing daily. After 4 days, the wound became indurated and reddened. The open wound area was unchanged, however, an unusual indurated and hemmorhagic appearing area had developed measuring 5cm around the wound. After plastic surgery consultation, the child was taken to the Operating Room for surgical debridement and culture. The culture determined heavy Rhizopus fungal infection. In immunocompromised patients, the fungi produce a rapid, destructive, and potentially fatal infection. Treatments are aggressive antifungal pharmacotherapy and surgical intervention (Lee et. al 2007). A study has shown Rhizopus species cultured from wooden tongue depressors used as splints for intravenous and arterial cannnulation sites which had been in direct contact with skin had caused invasive cutaneous infections. There is also a link to other wooden objects used in health care. (Verweij et. al, 1997). Infectious disease teams from Johns Hopkins Hospital and the National Institute of Health were consulted. Maximum dosages of intravenous antifungal therapy and antifungal medication were instilled via Vac Therapy. There were several Operating room visits for debridement and allograft. The wound responded to therapy with positive healing and negative cultures.
Treatment goals included: 1. Evaluate effectiveness of therapy. 2. Determine daily progression of wound healing. 3. Reevaluate the need for further debridement and grafting.
Results of this case study reveal the need for education of wound care nurses and hospital staff for complex pediatric wounds. Inservices and educational courses can be targeted to meet the needs of the WOCN nurses and involved nursing staff.
This poster describes a case study of a 6 month old infant with a complex cardiac history. After being placed on ECMO, the infant developed a right hip pressure ulcer after lying on a wood surface for 10 days. The stage II pressure ulcer measured 2 cm x 2cm x 1cm. Treatment was silver alginate dressing daily. After 4 days, the wound became indurated and reddened. The open wound area was unchanged, however, an unusual indurated and hemmorhagic appearing area had developed measuring 5cm around the wound. After plastic surgery consultation, the child was taken to the Operating Room for surgical debridement and culture. The culture determined heavy Rhizopus fungal infection. In immunocompromised patients, the fungi produce a rapid, destructive, and potentially fatal infection. Treatments are aggressive antifungal pharmacotherapy and surgical intervention (Lee et. al 2007). A study has shown Rhizopus species cultured from wooden tongue depressors used as splints for intravenous and arterial cannnulation sites which had been in direct contact with skin had caused invasive cutaneous infections. There is also a link to other wooden objects used in health care. (Verweij et. al, 1997). Infectious disease teams from Johns Hopkins Hospital and the National Institute of Health were consulted. Maximum dosages of intravenous antifungal therapy and antifungal medication were instilled via Vac Therapy. There were several Operating room visits for debridement and allograft. The wound responded to therapy with positive healing and negative cultures.
Treatment goals included: 1. Evaluate effectiveness of therapy. 2. Determine daily progression of wound healing. 3. Reevaluate the need for further debridement and grafting.
Results of this case study reveal the need for education of wound care nurses and hospital staff for complex pediatric wounds. Inservices and educational courses can be targeted to meet the needs of the WOCN nurses and involved nursing staff.