Mistake by Nurse - advice please

💐good plan, get that appointment with the GP and ask to see the wound clinic if you’re not satisfied.

Tap water contains a lot of bacteria. I think you should use distilled water. Hope you improve soon.

I understand why some of you think I should be taking a complaint further and if I were advising someone I'd probably say the same. But right now, it's difficult to see further than managing the pain and moving forward with the treatment. I'm so debilitated by it all I just can't add another layer of something else to deal with.

I did do some research into using tap water as I was quite surprised when one of the nurses told me it was perfectly ok to use it. This is from The Wounds UK Journal and is a conclusion to a review undertaken by a Tissue Viability Specialist and a Plastic Surgeon (Leeds General Infirmary) -

Several recent trials report that tap water (TW) of drinkable quality is as safe and effective as normal saline for the cleansing of acute traumatic wounds.

The findings are backed up by several others, published in the BMJ and suchlike.

We apparently don't have Tissue Viability Specialists in my part of the country, which is why the next step is probably vascular.

ferry23 I think you've made the right decision. The important thing is that you focus on getting better. It seems as though you're now moving forward and, hopefully going to get the best treatment available. Any apology from the nurse or the practice wouldn't improve your care.

I am sorry you are suffering so badly. I do feel for you. I think you should go ahead and make an appointment yourself with a senior partner at the surgery to discuss the issues you have described here. There is your wound which is not healing, the pain being caused by saline and now by this compression stocking or bandage. It needs medical review by a doctor and as people have suggested perhaps a specialist referral. You are worthy of and deserve medical care. With so many conditions there is often not much they can do, especially as we get older. But you deserve their best shot.

It is up to you whether you pursue a complaint against this nurse. But if you decide you want to take it further, I would not discuss it with her in the first place but speak to someone in a senior position, either the senior nurse, the practice manager or a doctor. I would favour the practice manager myself. That is their job.

I would probably see how this appointment goes first.

From reading this, it sounds like you are a bit timid.

Saline is only salt water, but yes salt does sting a little, but it is helping. Nurse has done nothing medically wrong, but yes she did ignore your wishes, which is not acceptable.

Have you actually had a skin graft? By now I would have thought this would have been in place? Certainly you need some kind of help to heal regime, not just dressings.

Are you eating well and drinking plenty? Hubby had zinc and iron for a leg wound - we ladies are well known for being low in iron.

Your GP should be organising home help too, not just nursing care.

Time to do a little tub thumping to get what you deserve. If you do not feel up to this, contact your local hospital PALS service and get them to do this for you.

FranP

From reading this, it sounds like you are a bit timid.

Saline is only salt water, but yes salt does sting a little, but it is helping. Nurse has done nothing medically wrong, but yes she did ignore your wishes, which is not acceptable.

Have you actually had a skin graft? By now I would have thought this would have been in place? Certainly you need some kind of help to heal regime, not just dressings.

Are you eating well and drinking plenty? Hubby had zinc and iron for a leg wound - we ladies are well known for being low in iron.

Your GP should be organising home help too, not just nursing care.

Time to do a little tub thumping to get what you deserve. If you do not feel up to this, contact your local hospital PALS service and get them to do this for you.

If any of my family and friends heard someone calling me "timid" I think they'd laugh until they cried!

I know saline is salt water - I also know my own body (and mind).

I used to be known as Ms. Rottweiler in my professional life. I also used to voluntarily advocate for hospital patients, having done successfully for my Dad and an Aunt.

I may be many things, but timid I am most definitely not.

I’m a doctor and I agree. Normal saline should have been much less painful than water. If you inject someone with plain water, it’s extremely painful; if you inject them with saline it’s not. This is because saline is the same composition as body fluids. This is what we give people in a drip. We would never give them plain water.
I don’t think it’s fair to make a complaint about the nurse because of this, as she has used the most gentle and appropriate treatment.
This is why we wash peoples eyes out with saline not water.
Burns and wounds are washed with saline, not water.
I’m really sorry you’re so sad and having such a hard time struggling with this problem alone. Do you have extreme swelling of the lower limbs which makes wounds incredibly difficult to heal?

MirandaIV

I’m a doctor and I agree. Normal saline should have been much less painful than water. If you inject someone with plain water, it’s extremely painful; if you inject them with saline it’s not. This is because saline is the same composition as body fluids. This is what we give people in a drip. We would never give them plain water.
I don’t think it’s fair to make a complaint about the nurse because of this, as she has used the most gentle and appropriate treatment.
This is why we wash peoples eyes out with saline not water.
Burns and wounds are washed with saline, not water.
I’m really sorry you’re so sad and having such a hard time struggling with this problem alone. Do you have extreme swelling of the lower limbs which makes wounds incredibly difficult to heal?

Thanks for your response Miranda. Yes I do have swelling of the lower limbs - quite significant in the leg with the wound, not so much so in the other leg - some days it can look almost "normal". However, I've had the swelling in the bad leg for over 5 years now.

I really do understand the rationale behind saline - v - water. I cannot explain why I have such an adverse reaction - the stinging is extreme and it doesn't just last a few minutes - it was constant from one appointment to the next. The only way I can describe it is that it was as if my leg had been plunged into a nettle bush and left there.

Today the wound was cleaned with water. Apart from maybe 3 or 4 seconds of slight stinging it's been fine and I've had no discomfort since it was done this morning. In fact the swab was more painful.

I also understand that the nurse in question was doing what she thought was in my best interests - however, my wishes were clearly documented and the fact that she ignored those wishes is the problem here.

However, I considered the whole situation and whilst I did feel she had acted incorrectly in ignoring my wishes, no amount of complaining is going to heal me better or quicker which is why I chose to take a less official route. I can only reiterate my previous comments in that I have found her to be a competent, knowledgeable and usually conscientious nurse. She has acknowledged her mistake in ignoring my wishes and at this stage I don't feel there is any mileage for either of us if I escalate this further.

I would add that we did talk about continuity of care today and we agreed that dressings should only be applied by a qualified nurse - hopefully jut two of them - and not left to healthcare assistants at this stage. The two nurses in question work closely together and can agree suitable treatment as well as looking at alternative types of dressings if applicable for my ridiculously sensitive and rather randomly awkward skin.

NHS Employee here.

Use PALS - Complain, this will open and enquiry. This will protect you in the future. There is a no blame policy in the NHS, so don't worry about the nurse.

It is the NHs responsibility to discover why you are not healing and to treat accordingly.

This is URGENT, you need appropriate treatment, NOW.

Please don't hesitate to ask for help with this from your practice and let them know it is with PALS.

Good luck.

Also the saline would have been specifically for wounds and would have been sterile unlike tap water which could have introduced infection, so I honestly think the nurse had your best interest at heart.

Hopefully, you're in less pain than before. This is an awful situation.
My advice, for what it's worth, would be to ask forcefully to be referred to the wound clinic at your hospital. I had a wound which wouldn't heal, but eventually the senior nurse at the wound clinic got it better. She listened to me and paid attention to what I had observed, then expertly chose the dressing from the many types available.
I am grateful to her.

I would ring up and ask for another nurse. Make sure they read the notes and treat you accordingly. I would think about complaining as this nurse doesn't read notes properly. Everyone is an individual and treatment the same. Sorry you're in pain

All my life I've used honey on open wounds. Even my husband's infected scar from his bypass cleared up fast and now the scar is all but gone. You can buy tubes of medicinal honey for topical use. Worth a try maybe xx

letmein

All my life I've used honey on open wounds. Even my husband's infected scar from his bypass cleared up fast and now the scar is all but gone. You can buy tubes of medicinal honey for topical use. Worth a try maybe xx

Interesting - I have been looking into this.

Medicinal honey is used for wound care by the NHS. Obviously it's use is bound by it's suitability to the wound. I'm going to mention it when I go on Monday.

Thanks for the prompt!

I’m sorry to read about the situation you’re experiencing ferry23
Have you or the nurses tried silver dressings on the wound? After I had varicose vein surgery one wound site, on my shin just above the ankle, became infected and failed to close.
Like you I had numerous trips to have it dressed/ cleaned and then we found the silver dressings helped a lot.
This was about 20 years ago, have been left with a very thin patch of skin which I’ve been warned to keep an eye on, so please be careful when it does close.

Yes, they've used silver and it was successful at first. I'm not sure why they haven't used it again - there is a reason but I can't remember what it is.

I had a new type of dressing yesterday - part of the problem is we cannot risk using anything adhesive as that was what caused much of the problem to start with. So if the wound does start to dry between visits it means the dressings can start sliding about as they have nothing to cling to. Even though they have tried various types of bandaging and protection over the dressings they never seem to stay in the same place.

I'm so sorry that this has happened to you.
I agree with Allira -you need your condition to be investigated further.
Saline shouldn't hurt,
but it sounds as though you have an intolerance.
Plain tap water concerns me. It's not clean.
I use tap water for my Neti pot after boiling for a full ten minutes and allowing it to cool to blood temperature.

The nurse behaved in an unprofessional way -a patient's preference is paramount.
I would write a letter of complaint.

We tolerated months of my father's respiratory nurse being rude,moody and sulky and finally after she stormed off in an
in one of her many moods -
I asked for a replacement and she was so nice . I had expected to be asked as to why I wasn't happy with the former one,but I wasn't.
You can ask for her not to be sent to your house again.

I have always sworn by white of egg for anything which is sore or weepy or looks inflamed. Messy to apply with cotton wool but the albumen in it is soothing and drying. (Sounds silly I know but it was a nurse who mentioned it to me. )

Would not do any harm at least !

Thank you Esmay. You will see upthread that I posted an extract from a review by a Tissue Viability Specialist and a Plastic Surgeon published in the Wounds UK Journal regarding the use of tap water.

The nurse doesn't come to my house, I have to get to the surgery twice a week. Demands on the practice nurses are high, and I count myself lucky that they've seen me twice a week and not tried to fob me off with longer gaps between dressing changes. I am now usually seeing the same two nurses but now with summer holidays coming up I don't doubt there'll be some changes.

I am following this thread with interest- a wide variety of responses.
Regarding the water v saline issue I has surgery on my hand over a year ago now.
When the dressing was removed the nurse washed it under a running tap- I was surprised but it actually felt really good and she was very gentle. However, the wound did get infected and took ages to heal.
I had already been covered with oral anti-biotics and a dose of high level Vit C which I was told was essential for wound healing.
I would suggest that diet and exercise also play an essential part in healing, it isn't just about dressings or being kept clean, other factors are also involved including age and general debility, especially if there is a risk of diabetes too.
OP don't get bogged down in some of the messages here- continue to work with the professionals assigned to you and please keep us informed as you go along- this is a very interesting and important topic to know about- thankyou.

I've heard of Manuka honey being of use?

Not medically trained though.

Normal saline is exactly the same degree of saltiness as your blood, and is the first choice for irrigating a wound .

Your "rubbing salt into a wound" is therefore not appropriate to the use of normal saline.

The nurse perhaps warned you that plain water would be less comfortable than normal saline and nevertheless she should have given in to your request. It's your body, your choice.

Ferry wrote:

"The only way I can describe it is that it was as if my leg had been plunged into a nettle bush and left there."

If I were your nurse I'd report to her superior about your reaction to the saline irrigation. Perhaps the saline had preservative in it and you are allergic to the preservative.

If the nursing hierarchy is not taking you seriously about the "stinging nettles" pain you should consult a doctor and then if you choose ask for a second opinion.

I am so sorry that you are having to fight your corner alone when you are already not very well. You have a lot of moral support here, anyway, Ferry.