JSTA December 2010 - Australian Association of Stomal Therapy ...

achieve the desired patient outcomes without costing the patient
any money. Of course, in many cases compromises had to be
made so teaching principles became important.
Figure 4. Modified parcel dressing.
This young man had been an IV injecting drug user. The wound
was a result of debridement of a necrotic and infected groin, his
Stage 4 wound is in a difficult position adjacent to his scrotum.
Within the wound bed are two ligated blood vessels which
need protection. Students doing the programme were unused
to having to touch male genitals to provide effective wound
management.
Other types of wounds encountered during the clinical
practice included large pressure ulcers, fungating tumours,
acute traumatic wounds, Fournier’s gangrene, compartment
syndrome, numerous diabetic foot wounds, fistulas and draining
wounds.
Figure 5. Stage 5 pressure ulcer.
28 Journal of Stomal therapy australia – Volume 30 Number 4
This poor, quadriplegic lady had pressure ulcers all over her
body in addition to ischaemic lesions on her lower limbs. Her
husband was her primary carer in the hospital and used to
get up on to the bed and turn her by himself. The bed had no
mechanism to raise or lower it and a pressure-relieving mattress
was unheard of. Patients all require a ‘sitter’ to care for them.
These sitters do most of the tasks we would consider to be
nursing, including performing basic hygiene, feeding, changing
bed linen and obtaining medications from the pharmacy. They
may also be required to do wound dressings and carry out
stoma care.
Figure 6. Diabetic foot ulcer following surgical debridement.
Students had plenty of exposure to lower limb ulcers. There
were numerous patients with diabetes and vascular lesions. The
students were fortunate to have Keryln Carville running the
debriding, lower limb assessment and compression bandaging
workshops which they all participated in. There was plenty of
opportunity for the students to develop and hone their skills.
Figure 7. Debriding workshop using lambs’ feet instead of pigs’ trotters.