Is the Velcro strap going to cause any circulation problems
as it could be fastened too tight?
There are rectangles on the strap
that indicate when it is too tight. They should not become square or further distorted
otherwise circulation could become compromised. Kerraboot does not have to be
totally ‘air-tight’ to work it only needs to be comfortable and secure
below the knee.
Patients do not
normally develop a rash with Kerraboot but sometimes rashes have been observed.
The action to take depends upon the type of rash and its site, e.g. papular rash
around the top of the lower leg.
As with all medical devices, in rare
cases a patient may be allergic to one of the components of Kerraboot and if this
is the case, stop usage.
Rashes are probably due to either:
A pre-existing
condition e.g. psoriasis.
Clinical infection (cellulitis).
Topical infection (tina corporis – fungus/yeast).
A response to the slightly raised temperature within the boot.
If a rash
develops and the causation is:
A
pre-existing condition – treat the condition presenting and stop Kerraboot
if not improving. Kerraboot can be tried again when the pre-existing condition
has cleared.
Clinical infection – requires antibiotics. Continue with Kerraboot.
Topical infection
– treat the condition presenting and stop Kerraboot temporarily if not improving.
A response to
the slightly raised temperature - changes in skin and ulcer appearance are usually
an indicator that the product is having an effect. There is normally a clear progression
of changes in appearance of the ulcer from reduction of slough, and increased
granulation throughout the healing process. If, as a response to the slightly
raised temperature, there is a definite heat rash, a break from Kerraboot of 12-24
hours should result in the rash disappearing; once treatment is restarted it is
unlikely to reappear as the patient’s skin should have adjusted to the treatment.
There is no evidence in clinical trials to date that Kerraboot causes an
increase in infection. All ulcers are colonised to their maximum potential i.e.
the entire surface is covered with bacteria. It is an imbalance in colonisation
and the invasion of bacteria that leads to clinical infection. Most conventional
dressings are held against the wound and, whilst a sterile procedure may have
been maintained, the ulcer surface and indeed the peri-wound surface are not sterile.
Therefore, with conventional dressings, bacteria are trapped against the wound,
skin and the dressing. Kerraboot is non contact and offers the benefit of allowing
the ulcer to drain freely with the exudate being locked away due to the properties
of the absorbent pad. Whilst clinical infection may occur with any dressing regime,
it is often promoted by the patient’s state of health, wound site or type
of invasive bacteria. If infection occurs, treat it in the normal way. See also
Q2.
Generally Kerraboot should be changed once a day to minimise the
risk of any infection. Kerraboot is a sterile product.
If used properly and changed with the correct frequency, it does not. Kerraboot
creates a warm environment that increases lower limb circulation in many patients
and this can result in increased exudate production in the first few days. This
is good evidence of Kerraboot beginning to work as it removes the exudute from
the wound surface that is inhibiting the healing process. This is also why we
recommend that over the first three days, the wound should be checked at least
daily so that the correct frequency of dressing change can be established. Increased
exudate can also be due to an infection and clinical signs of infection should
be assessed and if necessary appropriate antibiotic therapy initiated.
The extra-absorbent pad in the base of Kerraboot helps to maintain a ‘moist’
environment and Kerraboot often ‘steams up’ with vapour condensing on
the plastic. This is quite normal but when Kerraboot’s absorbent pad stops
retaining moisture/appears full, it must be changed otherwise the leg will become
too wet.
As a guide in highly exudative ulcers, two and in extreme cases
(over 800mls of exudates a day) three boots a day may be needed for the first
few days and the number then reduced according to clinical progress to one a day
or once every other day. Ceasing Kerraboot earlier is likely to result in a loss
of the benefit gained and early cessation is not recommended.
Possibly but in these cases there should be vascular intervention first.
The patient requires full vascular assessment i.e. arterial duplex scan/ angiogramme
and intervention if necessary such as angioplasty/bypass and amputation/debridement
of necrotic tissue.
If there is microvascular involvement with no macrovascular
complications (PVD/PAD) then the wound requires debridement to healthy tissue.
The patient is then suitable for management with Kerraboot until the ulcer has
fully healed.
There
is no inset indicator for wetness but it becomes obvious when the absorbent pad
is full and Kerraboot needs changing. The consistency of the pad will change to
become less compact, Kerraboot bag will appear ‘too heavy’ and commonly
the absorbent pad will begin to ‘yellow’ with exudate. Clearly surplus
fluid outside the pad is evidence that change is overdue.
As a general
guide, other than in highly exudative ulcers, where two and in extreme cases (over
800mls of exudates a day) three boots a day may be needed, Kerraboot should be
routinely changed once a day or once every other day until the ulcer is healed/resolved.
Ceasing Kerraboot earlier is likely to result in a loss of the benefit gained
and early cessation is not recommended.
No. Kerraboot is not a tailored shape, so contours are not in constant contact
with any one point of the foot. On the whole, the toe and heel of the boot sit
some way from the foot. The only time there may be problems is with ambulant patients
using pressure-relieving devices. Then it is important to check that Kerraboot
is not folded against the foot.
As a general
guide and according to the clinical situation, patients should be maintained on
Kerraboot with regular changes;
Until
the ulcer is fully healed/resolved.
.
At point of granulation where skin grafting is desirable and achievable.
If Kerraboot cannot be tolerated e.g. allergy.
Cessation of management before the above is not recommended as ulcers can
regress and the benefits of using Kerraboot can be lost.
No. The absorbent pad
is covered with a porous mesh, which remains stable in use. The super-absorbent
pad itself does not denature inside Kerraboot even when full.
Clarify what the protocol means
by ‘infected’? If they are talking about deep sepsis, then daily irrigation
is necessary until the infection clears – in these cases, the amount of exudate
may well be large (400-1500ml) and Kerraboot will need changing more than once
a day allowing at least twice daily irrigation if needed. Otherwise it is recommended
Kerraboot be routinely changed every day or every other day with regular irrigation
of the ulceration between changes.
Yes. However, antibiotic therapy should be initiated and review x-rays taken
to assess the osteomyelitis and whether surgical intervention is necessary. Basically,
follow normal protocol for osteomyelitis and use Kerraboot as usual and closely
monitor the progress of these more complicated patients.
Again, the cellulitis and its cause should be addressed – antibiotics, swabs
etc. Kerraboot is suitable in these cases but as with all more complicated patients
their progress should be monitored carefully making sure Kerraboot is changed
with the correct frequency see Q6.
The usual cause for maceration is not changing the Kerraboot frequently enough,
possibly in the first few days when a temporary increase in exudate can occur.
See Q4 and Q6. Maceration is only really problematic if it occurs at the actual
wound site. If the rest of the skin is intact there shouldn't be a problem with
integrity.
It has been seen previously (anecdotally) that condensation
can drip onto the leg/foot especially if the leg is kept horizontal. Holding (or)
hanging the leg vertically will cause run-off into the pad and prevent condensation
build-up.
There
is a possibility that anything applied topically may be washed off by condensation.
This could reduce the potency of any topical treatment. If topical treatment is
applied on or around the wound then this should be allowed to be absorbed before
re-applying Kerraboot.
- Patients should rest plantar ulcers and/or have off-loading using a suitable
device e.g. Air-cast. For non-weight-bearing ulcers aetiology is important: venous
ulceration or any type of ulcer involving oedema – patients should elevate
their legs as often as possible. For ischaemic ulcers, patients should be encouraged
to walk and rest with their legs slightly dependent i.e. legs lower than trunk
(e.g. may involve raising the head of the bed).
– No specific clinical trial
has been conducted to date with Kerraboot and maggot therapy. It is possible that
reduced oxygen at the wound surface under Kerraboot may reduce the effectiveness
of the larvae, but this has not been investigated to date.
- If MRSA is presented as a colonising organism, Kerraboot can still
be used. If MRSA is presented in a clinical infection, it should be treated with
appropriate antibiotics, but Kerraboot can still be used.
No specific work
has been done on reducing the risk of spreading infection but the structure and
function of Kerraboot has the following benefits:
Containment of any acquired or existing infection to the wound i.e. isolation
compared with other commonly used dressings and bandages.
Because the wound can be observed through the transparent film without removing
the dressing, there is a reduced opportunity for contamination. Exudating wounds
can be a major source of MRSA infections and hands a major vector for transmission.
Similarly, the easy removal of the dressing
reduces the contact with the wound by the healthcare professional and therefore
the risk of either spreading the infection or contaminating the wound.
Revised January 2005
Ark Therapeutics Ltd
