When a Band-Aid just won’t do; Wound Care Center on cutting edge of medicine

149
Clinical Nurse Manager Andrea Rachal, RN, prepares one of the eight hyperbaric chambers at The Wound Care Center. Non-healing wounds limit quality of life and even life expectancy. Delays in care have caused amputation rates to rise during the pandemic. Natchitoches is fortunate to have one of the top rated centers in the country. Photo by  Juanice Gray

Juanice Gray | Editor

When a toddler falls and scrapes his knee, a kiss, Band-Aid and some antibacterial cream usually takes care of the problem. Fast forward several decades and an 80-year-old falls. Same wound, but that scrape just won’t heal. Aging, as well as other factors such as diabetes, cause wounds to heal slower and sometimes, not at all. It doesn’t matter if it is a 6-year-old with a burn, a husband on the losing end of a skill saw or a father whose surgery incision just won’t get better, when it comes to your, or your loved one’s life, you want the best care for them.

This article published in the June 19-20, 2021, print edition
D&D Construction

Thankfully we have an award winning wound care center in Natchitoches. June is Wound Care Awareness Month, so we looked into The Wound Care Center at Natchitoches Regional Medical Center. They have more than Band-Aids. They have therapies and procedures not even dreamed of a decade ago.

This new part of the hospital, located next to the ambulance service, offers advanced therapies using state-of-the-art technology and equipment. The center has been in its current location one year. It is staffed by six RNs, one LPN, one EMT, a medic, a physical therapist and a panel of 10 physicians covering specialties from podiatry to pediatrics.

Some of the most common wounds they treat are related to diabetes, bedsores, delayed effects of radiation, burns and crush injuries.

The Wound Care Center at Natchitoches Regional Medical Center has won the Award for Center of Excellence for 5 years and the President’s Circle award 3 times. The president’s circle award recognizes the top 5% in the nation out over 600 centers. Shown is the state-of-the-art nurses station that has quick access to any of the patient rooms, on the right that utilize sliding, rather than swinging doors.
Photos by Juanice Gray

A patient’s individualized treatment plan may include specialized wound dressings, debridement, compression therapy, hyperbaric oxygen therapy, advanced cellular products and topical growth factors, edema management and/or non-invasive vascular assessment.

Okay, most people understood maybe five words in that last sentence, so Clinical Nurse Manager Andrea Rachal, RN, and Certified Hyperbaric Technician and Safety Director Dale Jordan, LPN, translated the medical terminology.

The “Tree of Life” on the wall across from the nurse’s station has the names of wound survivors on each leaf.

First, they said everything depends on blood flow. A wound deprived of adequate blood won’t heal. When dead or infected skin surrounds a wound, it has little or no blood flow. “We see a fair amount of burns because we can offer debridement like a lot of burn facilities,” Rachal said. “Debridement takes away all the necrotic (dead) tissue where bacteria lives and infection begins. Another way is by stimulating the wound by scraping or scratching on it. It makes the wound think it’s new and jump starts the healing process.”

“You have to manage all wounds specifically to determine what dressing you would use. Often the dressing you start with is very rarely what you end with because you have to adapt to how the wound environment is changing,” Jordan said. Advanced dressings are used to ensure correct moisture and PH balance. These are examples of conventional wound care.

The Wound Care Center conducts non-invasive vascular studies because swelling decreases blood flow. “We use the ankle breaking index and transcutaneous oxygen monitoring. It is a machine that pinpoints one area, like an EKG pinpoints the heart, and tells us how much oxygen is getting to the area,” said Andrea Rachal, RN.

An advanced form is hyperbaric oxygen therapy, which is the use of tanks, or chambers, of pressurized oxygen. The patient is fully encased in the clear chamber that increases oxygen in the blood by 100% and in tissue by 1,000%. “Diabetes damages the blood vessels in the lower extremities so then they’re not delivering adequate blood supply,” Jordan said. “Where you and I may have a scratch on our foot, our body heals it because we have the blood supply so your body can transport everything it needs. Well, they don’t have that, so if the wound doesn’t get smaller, the only option is for it to get bigger or worse.”

“Hyperbaric doesn’t work without conventional wound care,” Jordan said. “It also requires certain criteria to be eligible.” “We can also treat cystitis most often related to prostate, bladder and other cancers that don’t necessarily have wounds, but they have radiation related complications we can help with,” Rachal said.

A hyperbaric chamber is ready for the next patient

Patients with radiation injuries can immediately go to hyperbarics because it is the only treatment known to help. “Radiation doesn’t discriminate between good and bad tissues and often turns that tissue into scar tissue, and scar tissue doesn’t have a blood supply to it,” Jordan said. He also explained the phenomenon of angiogenesis, a combination of oxygen and pressure together that help grow new blood vessels.

Entrance to the hyperbaric chamber from a patient’s viewpoint

In layman’s terms, it transforms scar tissue to regular tissue. The chambers are a full body experience and Rachal said she is always asked “Why can’t we just stick the foot in the chamber?” Jordan explained, “Out here oxygen is 21% and in the chamber it is 100%.” There is a process that happens that is related to hemoglobin, platelets and blood but essentially, “You have to breathe the oxygen for that exchange to happen,” he said.

Advanced skin subs, or donor skin, and a new treatment involving platelet rich plasma, where the patient’s own blood is used to form a plasma are also used. “We actually apply that to the wound bed,” Rachal said. “We use your own blood as a sort of fertilizer.”

The hyperbaric chambers are clear so the patient doesn’t feel trapped and televisions are mounted atop each one so patients can watch their choice of programming while receiving treatment.

Rachal said their facility, which has very little turnover in staff, quadrupled their space, added exam rooms and allowed eight chambers. “The clinic opened six years ago in a small area and no one realized the need for wound care in this area was as great as it was,” Rachal said. She said she loves the job because, “Here, I get to see the difference we make every day, I get to see them get better as opposed to declining and we get to know the patients because we keep them for the life of the wound. It was just God’s plan for me.”

Jordan graduated college and took the first job offered. “Then (This job) found me.” He said he liked the people and the wealth of knowledge at the clinic. “It’s kind of niche and I wanted to be part of the elite.”

Their message to the public, “Do not delay getting treatment. The longer a wound is there, the longer it takes to heal,” Jordan said. “The earlier you intervene the better, because there are so many interventions we offer to save limbs and save lives,” Rachal said.