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Welcome to the CarePartners Wound Care Team! In the pages of this booklet we will tell you about how we can help you to help your wound. This booklet is full of information to help you to understand what is going on with your body when you have a wound and what your body needs to heal the wound or, if it can’t heal, to feel better.
Sometimes we have to use medical terms, so words in italics and underlined will be defined in the glossary at the end of the booklet. Some information will have web links. This means that there is more information either on the internet or on the CarePartners website. You can either click on the link or go to www.carepartners.ca and click on the Health Information tab.
A Cancer Related Wound is an open or closed cancerous lesion of the skin. It could be a primary cancer such as Melanoma or it could be the spread of cancer from another site. Some cancers that sometimes spread to the skin include breast cancer, rectal cancer, bowel cancer and lymphoma. If you don’t have cancer elsewhere in your body, you may have developed this cancerous wound from a chronic wound that has been present and unhealed for many years. Sometimes the wound will appear as a growth. This is referred to as a tumor. Sometimes these are called malignant tumors. It may look like a bump, or irregular growth on the skin surface, or it could be an open lesion that looks like a crater. Sometimes they can be quite large.
Cancer Related Wounds can be difficult to deal with because cancer cells have invaded the skin including lymph and blood vessels. This causes tissue to die leading to the possibility of increased risk of infection and bleeding. Sometimes these wounds can drain quite a lot and have a foul odor. Pain and itchiness are often associated with these wounds.
Cancer Related Wounds can be very distressing. Although these wounds usually cannot be healed, the bothersome side effects can be managed.
Our nurses will work with you to help you live your life to the fullest by controlling the symptoms from the wound, especially pain. They will know how to use dressings to control odor and drainage and manage bleeding if it occurs.
Management may include helping you to improve your nutrition, increasing your mobility and activity, removing sources of pressure or friction, and suggestions for good hygiene and environmental measures to reduce odor.
If your wound is a large growth (tumor) and the bulk of it is painful or interfering with your daily activities, talk to your nurse or doctor to determine what medical management options might help you to be more comfortable: Shrinking the wound through surgery, chemotherapy, radiation or hormone therapy may be options for you.
Wound care includes all the activities of managing your wound including what you and your nurse will do to help your wound heal. The nurse will assess you and your wound to determine if your body is ready to heal and will apply dressings to support your wound. Your nurse may need to take pictures of your wound. They will ask you to consent to this.
Wound care also includes teaching you and your significant other to be as independent as possible with caring for your wound.
The management of a Cancer Related Wound depends on the type of cancer, where the wound or tumor is located, how much tissue is involved and the symptoms that you are experiencing. Although a Cancer Related Wound cannot be cured, it can be managed to reduce unpleasant side effects.
At each visit your nurse will assess your wound to see how well the symptoms are being managed. Be sure to talk to her about how you are feeling and what symptoms you are having.
Your nurse may need to contact your doctor or other health professionals to discuss your wound or to get you a special referral if needed.
If you have received radiation for your cancer, your skin can become either dry or can be irritated and weepy. The Cancer Centre may have given you a tip sheet on how to manage your skin. Be sure to follow their instructions. If you did not get a tip sheet here are some skin care suggestions:
Your Cancer Related Wound could be quite painful or could cause the tissues around it to be painful. Pain can interfere with your daily activities, reduce your appetite and make it hard to sleep. It can even slow the healing process. Most pain can be treated effectively with medication or other therapy.
If you have pain from your wound talk to your nurse so that they can suggest medications or other therapy to reduce your pain. They may need to contact your doctor for a prescription.
If your doctor prescribes medication for your pain, please take it as prescribed. Sometimes people stop taking their medications because they feel better, but the reason they were feeling better is they were taking their pain medication! Follow the instructions; don’t take the medication more often than prescribed. If you aren’t on routine pain medications, have medicine that you can take when you need it. If you are having dressing changes, take your medicine about an hour before you are going to have your dressing changed so that it has a chance to get working.
Complete this with your nurse. Check off as many of the things you think you can try to do to help keep yourself healthy and help manage your wound.
Drainage: Your wound may produce a large amount of drainage. Infection can also cause more drainage from the wound.
❍ Your nurse will assess your wound for infection and if it is infected will ask your doctor for antibiotics. If antibiotics are ordered be sure to take them all.
❍ If your wound is draining, your nurse will choose an outer dressing that can absorb large amounts of drainage while holding the drainage away from your skin. They will teach you and your significant other how to change this dressing in between visits.
❍ Your nurse will show you how to put a protectant on the skin around the wound to protect it from caustic drainage.
❍ If drainage is excessive, a consultation to a specialty nurse can be made to see if a pouch, to contain the drainage, is possible.
Itching: Cancer Related Wounds and the skin around them can become very itchy. This can be from your skin stretching as the tumor grows or from drainage sitting on your skin. Antihistamines may not work, but removing or altering the source of the itchiness can help.
❍ Gently cleanse drainage off the skin around the wound, you can shower if there is no other reason not to.
❍ Review the dressing choices with your nurse.
❍ Change the dressing more frequently if it becomes moist. Apply refrigerated menthol or anti-itch creams around the wound. Talk to your pharmacist or you doctor about topical products to relieve itching.
❍ Different kinds of dressings can keep the skin around the wound cool. An example is a hydrogel sheet dressing.
❍ A TENS machine (transcutaneous electrical nerve stimulation) may help reduce the itching. Talk to your doctor about this because electrical stimulation can sometimes increase cancer cell growth.
Odour: Odour from the wound can increase and become smelly from dead tissue, bacteria and/or stale drainage.
❍ Gently cleanse your wound often. You can shower.
❍ Your nurse can select a dressing that has antimicrobial properties, or charcoal in it to reduce odour.
❍ Your nurse will assess your wound to determine if odour could be reduced by removing the non-viable tissue through debridement.
❍ Change your dressing often so that smelly drainage does not build up.
❍ Mask the odour. Put mentholated ointment like “Vicks” or essential oils at the base of your nostrils to help mask the odor at dressing changes. You can also use cat litter, odour eaters or charcoal in the environment to help absorb odor.
❍ Remove the source of the odour. Bag soiled dressings as soon as the dressing is changed and place in outdoor garbage.
❍ Talk to your doctor about topical or oral antibiotics to control odor from bacteria. A topical antibiotic called Flagyl can be helpful.
Bleeding: Tumor growth can injure small blood vessels causing bleeding. The bleeding can be an oozing continuously or there could be sudden bleeding. This can be frightening when you don’t expect it. Try to remain calm and contact your nurse or doctor if your wound starts to bleed. If the bleeding is sudden and seems like a lot, roll up a clean towel and press it against the bleeding area. Keep the pressure on continuously, don’t lift the towel at all. If the blood is leaking, don’t lift it up but reinforce it with another towel. Go to your local Hospital Emergency Department
❍ For oozing, gently cleanse the wound. You can shower. Try reducing the force of the spray, or do not spray the right on the wound.
❍ If bleeding is caused by dressings that stick when changed, soak the dressing off in clean water in the shower or with bottled saline for 10-15 minutes before gently removing.
❍ To prevent sticking ask your nurse to select a non-stick dressing.
❍ If bleeding happens with each dressing change, even if your dressing does not stick, your nurse can apply a specialized dressing (calcium alginate) under your dressing to help promote clotting
Sometimes a list of tasks can seem easy to do and because of that we can easily over commit. Look through the list and really think about the tasks you committed to. Ask yourself these questions;
If your confidence score is less than 7, you might want to consider removing a ✓ mark or two. If your score is 7 or higher – give it a try!
After 2 weeks of trying to do these things reassess the list using the same process and if you feel confident enough, add a new task or two. Choose the tasks that are most important to you and you are most confident that you can complete. Remember - you do not need to accomplish this all on the first day – this is a journey!
It is very important to prevent your wound from developing an infection.
There are many ways to reduce the risk of infection. Your nurse will teach you how:
Your nurse has been trained to recognize the signs of infection. Some kinds of wound infection are called Superficial Infections.
This means that the germs are only on the surface of the wound. They won’t make you sick, but they can slow wound healing. You may see an increase in drainage, odour, pain or some redness around the wound, but you won’t have chills or fever because of it.
Superficial infection is managed with specialized antimicrobial dressings. Your nurse may decide to use one of these if they think your wound needs it. Your nurse will not take a swab when they determine that you have a superficial infection as swabs do not tell us if the wound is infected. We don’t use antibiotics for superficial infections.
Another, more serious kind of infection, is called Deep Tissue Infection. In this case the germs have spread to your body and are making you sick.
You may see redness and swelling spreading beyond the wound. The pain may increase, and you might have a temperature or have chills. This kind of infection needs a prescription for antibiotics. Your nurse will take a swab if they think that you have a Deep Tissue Infection so that your doctor will know what antibiotics will be effective. If you are given antibiotics be sure to take them as prescribed and finish them.
If you think you have Deep Tissue Infection you should see your doctor right away or go to the nearest Hospital Emergency.
At this time in your life your body needs extra protein and vitamins and minerals. Even though you may find that you have decreased appetite and you may even find the smell of food unappealing here are some general guidelines to consider:
Discuss these with your nurse. Identify the foods you will try to eat more often:
Trauma can be anything that causes harm or injury to the area of the wound. Try to avoid:
Check out this video that will show you how a simple dressing change is done. Your dressing change won’t be exactly the same, but it will be similar.
You may be asked to purchase a few items for the nurse to use when doing your wound care and to keep these items clean. You will need to purchase disposable gloves for your care. To reduce the risk of infection to you, nurses do not carry scissors for use in your home as there is a risk that they may carry germs between patients.
Your nurse will provide you with sterile instruments that you will then keep clean for your use. This may include forceps, scissors and a probe. Be sure that you or your nurse only use these instruments for your dressings. Your nurse will show you how to change your dressing and tell you how long to keep the dressing on between changes. They will recommend specific products.
Alcohol based hand cleaner for your hands
Non-sterile gloves (at least 2 pair)
Adhesive remover
Gauze pads
Sterile normal saline cleanser
No sting barrier film nor skin prep
Tape
Plastic sealable trash bag
Clean towel to absorb cleansing solution
Scissors
Dressings
Each time after wound care is completed, follow these directions to clean the instruments:
If any of the following occur:
You and your nurse have agreed that it is time to discharge you because you have a routine to care for your wound and because you now have the knowledge and skill to look after it yourself or with help from your significant other. Always protect the area from pressure, trauma and other forms of injury. If you are doing your dressing changes, follow your nurse’s instructions. See the section on How to Change my Dressing above.
Antimicrobial dressings: are used to reduce the number of micro-organisms in the wound which reduces the risk of infection.
Autolytic debridement: uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar (scab) and slough (wet dead tissue) in the wound. Only dead tissue is liquefied. It is virtually painless for the patient.
Conservative sharps debridement: conservative sharp wound debridement (CSWD) is the removal of loose avascular tissue without pain or bleeding.
Deep tissue infection: infection in a wound that has reached the deeper layers of the body. A deep infection means that the whole body is infected, not just the wound and oral or IV antibiotics are needed for healing.
Germs: microorganism, especially one that causes disease.
Hand hygiene: cleaning hands to remove soil, dirt, and germs. If water and soap are not available, hands can be cleaned with alcohol based hand rub.
Healable wound: a wound that is ready to heal and all the patient factors make it able to heal; these factors include circulation, diet, devices etc.
Maintenance wound: a wound where healing has stalled due to factors that need to be corrected such as blood sugars in the person with diabetes or the purchase of specific equipment or perhaps remedial surgery.
Non-healable wound: a wound that cannot heal due to factors that cannot be corrected such as poor circulation.
Offload: Removing pressure from an area that is at risk of wounding or has a wound
Superficial infection: A wound infection that is localized to just the wound. The body is not infected and the patient does not need systemic antibiotics to heal.
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