Decubitus ulcer and the oil dispersion bath
Casuistry
Empirical report of an oil dispersion footbath as a treatment for decubitus ulcer on the heels.
General information
Patient data: 91 years old single man, living ”independently” in his own room in a care facility. He has three children, all living in Brazil. His greatest wish was to return to his children (and grandchildren), to walk there along the beach and to die there. The man is aided by a nephew, who helps him with administrative business and household affairs.
Previous history
The man was admitted in 2005, because of heart and breathing complaints; The biggest problem was that he was retaining too much fluid. In March 2006 he was admitted because of intestinal complaints and haemorrhoids. During this stay he developed decubitus ulcer wounds on both heels. The man had been in a Japanese prison camp during the Second World War where he was treated in an inadequate way for varicose veins.
Anamneses
The man has infected decubitus ulcers on both heels, along with serious oedema in his lower legs. The wounds developed during his period of hospitalisation in March 2006.
Treatment so far: several treatments, prescribed by a hospital specialist connected to an outpatient clinic phlebology. The treatments were without success and the patient was in considerable pain.
ADL, nursing problems
The normal pressure on the wounds was very painful both with ambulation and while lying (despite the use of an anti decubitus bed). Walking was therefore hardly possible and sleep was disturbed to such an extent that he spend most of the night sitting at the table.
Dermatological examination
Open wounds on both heels, approximately 2 cm in diameter, both with yellow puss. Both feet and lower legs are badly swollen.
Diagnosis
Infected decubitus ulcers on both heels.
Treatment
Daily (7 days a week!)arnica oil dispersion footbaths were given, the lower legs being immersed in a plastic barrel. In order to mix the WALA arnica 5% oil with water, the Jungebad oil dispersion apparatus was used. Duration of the bath: 15-20 minutes. Water temperature: 35-36 degrees Celsius.
After 10 minutes the lower legs (from the ankles to the knees) were rubbed (brushed) with a special Jungebad brush. At the end the patient was assisted (half carried, using his walker) to a bed, was wrapped up in a blanket and rested for half an hour. His heels rested on a separate clean cloth and were relieved from pressure by a roll under his Achilles tendon.
After half an hour the heels were taped with a dressing and a natural cream ( Zeller balsam). This remained in place until the following bath. To relieve pressure on the heels while walking, loose fitting slippers were used.
Further nursing interventions: none; these were stopped at the start of this treatment.
Results
After 1 week the first heel wound was closed. After 2 weeks the second was also closed. The yellow infection fluid quickly changed into transparent wound moisture.
Twice, through bumping, he injured the wounds, but they quickly healed with the baths. At the end of the treatment period, the oedema in his lower legs had also decreased.
Total duration of the oil dispersion footbath treatment: the first three weeks daily and twice during the fourth week. The treatment took place from May 31st until June 24th, 2006.
Chris Vree is a physical therapist, also trained in the oil dispersion bath therapy, and works in Bergen (Netherlands).
Published in Derma Novum, magazine for skin care (Netherlands, tijdschrift voor huidzorg), 8th year of publication, Juny 2nd 2007
Functioning of the Jungebad oil dispersion apparatus:
Tap water spirals through a retort, made by a glassblower. Through a vacuum effect the oil is sucked out of the oil reservoir, becoming a fine mist and forming a thin oil coating around miniscule drops of water that float in the bathwater. This water-oil mix remains stable for a long time.