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Hi,

Wondered what the general view here would be on using Chlorhexadine on DFU's.

A vascular consultant in a local acute hospital has recently written to me regarding our care of a patient that he also sees very occasionally (and it is only occasionally) complaining that we do not folow his recommended treatment for a patient with non-healing foot and leg ulcers.

The patient in question is 92, has been diabetic since the dawn of time and has had ulcers almost as long, lives in appalling conditions and refuses hospital admittance or any help from social services. She understands very little English. She is also non compliant.
In view of this, I think that myself, the other Pods involved with her care and the Community Nursing Team have done a pretty decent job keeping her mobile and with her legs and feet still in place and still living at home which is where she wants to be (even if we don't feel it is ideal).

The vascular consultant however insists that if we comply with his treatment regime she will be healed.

His regime - bed rest with legs elevated higher than her buttocks for 24 hours per day, all dressings should be discontinued and any open areas should be soaked twice daily in undiluted chlorhexadine solution!

The bed rest I could live with, provided we could persuade her to be admitted to hospital for a undetermined length of time and could guarantee that she wouldn't develop pressure sores or pick up any hospital acquired infections.

The discontinuation of dressings I take a great deal of issue with, but my main concern is the advice around Chlorhexadine.

Does any one else have any views regarding the use of undiluted chlorhexadine on diabetic ulceration or indeed on wounds of any description??
I was under the impression that it was not licensed for this (at least in the UK), and certainly would be detrimental to the wound healing process.

I would be grateful for any views on this and if anyone knows of any research papers (for or against) please let me know.

Many thanks,
Rie.

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If you stick this patient in bed with feet elevated for 24-7, they will end up with a sacral pressure sore unless on an alternating air matress!
There is plently of evidence around moist wound healing environment, and further evidence on the cytotoxic effects of many antiseptics.
This is from Chochrane

__________________
Stephen Tucker
Calvary Health Care

My location

I haven't used CHX for some time but do recall the outside of the container saying it must not be used undiluted on patients.It is contra-indicated for bladder washouts as this is associated with anaphylaxis and CHX causes a chemical meningitis and must not be introduced along the auditory canal or come into contact with the meninges.CHX is useful in antiseptic creams,hand disinfectants and in tulle-gras dressings.Undiluted on ulcers could have problems of systemic absorption.