Managing MDT Complications

Step
Action
1

NOTE: Someone must be on-call and available at all times during treatment to answer questions and address problems with maggot debridement therapy patients.  The name and contact number must be clearly identifiable on the patient’s chart and should be made known to the nursing staff and to the patient and/or family.

2 Staff must notify the wound specialist on-call for maggot debridement therapy patients if the maggots are escaping, if the dressing comes loose, if the patient is not tolerating the therapy, or if there are other non-routine problems.
3 If the patient does not tolerate the presence of maggots because of uncontrolled pain (usually after 30 hours), then the dressing should be removed immediately and replaced with a normal saline moist-to-moist dressing that is changed every shift until a new dressing can be ordered.
4 IF MAGGOTS ARE SEEN TO ESCAPE from the dressing, inspect the area and notify the wound care specialist on-call.  Loose maggots can be double-bagged and discarded with infectious waste.  If the dressing has a small defect or opening, it may be resealed; however, if the escape is due to the maggots being mature and leaving the wound, or due to too many larvae within the cage, which is now bursting open, then the dressing should be removed and the wound inspected.  The dressing can be replaced with a normal saline moist-to-moist dressing, changed every shift until a new dressing can be ordered.
5 If the patient expires, contact the wound specialist on call and immediately remove the dressing.

Instant feedback:

If the patient receiving maggot debridement therapy has intolerable pain unrelieved by analgesia, the dressing and maggots should be removed.
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