First, evaluate the eschar. Is it dry, stable, non-odorous? Or, is it mushy, draining, and/or smelly? If it is not dry and stable, you need to treat it like any other eschar. That is, assess for infection, debride it, then use appropriate dressings to provide moist wound healing. Infection prevention is essential!
If the eschar is dry and stable, you do nothing. Well, not really nothing. You teach pressure relief by using pillows or a foam boot, or whatever your favorite method is for making sure there is NO pressure on the heel. Then you observe and assess for infection or changes every visit, and you teach the caregivers what to watch for: boggyness (spell checker says "boggyness" is not a word :-)), drainage, odor, pain, periwound erythema, warmth, etc. and tell them to report any such changes immediately.
Nurses seem to be uncomfortable when I tell them not to treat stable black eschar on heels, but really, the wound WILL heal. It just takes a really long time. While it is healing, it is protected by the body's own way of keeping bacteria out of the wound. You are not really doing nothing. You are observing and assessing, and you are teaching caregivers what to watch for and how to prevent pressure on the area. Those things are important!
I'm standing with you for quality patient care. Sue
Sue Hull, RN, MSN, CWOCN lives and works in Western Washington State as a clinical support nurse for Homeline. As such, she is available by phone during business hours as someone to turn to when you have problem wounds or you have simply run out of ideas. Call her at 360-581-0173 or email email@example.com The Wound Healing Partners Division of Homeline also offers written wound consultations using photos and verbal report. These are for agencies that don't have a certified wound nurse to call on for help, and for remote, out of the way agencies who can't afford to have a certified wound nurse do wound consults for them.
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