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Nursing Implications

While every medical treatment involves risk, MDT appears to be very safe and effective. To minimize risk and ensure proper use of its FDA approved Medical Maggots™, Monarch Labs has included "Clinical Indications" and "Contraindications" in the product insert. Read the product insert thoroughly before administering "Medical Maggot™."

The product insert contains valuable information but it does not substitute for MDT trained professional nursing care and MDT specific institutional policies and procedures. The Bio-Therapeutics Education & Research Foundation has developed an MDT Policies and Procedure template for use by individuals and single institutions. For more info, contact Monarch Labs at sales@MonarchLabs.com.

Indications:

MDT is indicated for the debridement of open, necrotic, soft tissue wounds that are confined within viable tissue.

Contraindication to MDT:

Emotionally immature or unstable patients
Damaged seal or opened maggot vial
Inability to ensure maggot removal and wound assessment within 72 hours of application.
Inability to eliminate weight bearing on wounds
Allergy to MDT bandage materials, fly larvae or the soy and brewers yeast used in their manufacture.
Treatment of necrotic wounds that are closed or could close, precluding the removal of all maggots
Primary treatment of necrotic bone or tendon
Treatment of deep organs or structures
Treatment of limbs or structure compromised by vascular insufficiency
Wounds that require surgical intervention or frequent inspection
Proximity to major blood vessel which could be breached by maggot debridement
Coagulopathy
MDT related pain, uncontrolled by systemic analgesics
Treatment of Pseudomonas aerugenosa, E. coli, Proteus spp. or other maggot resistant infections without organism specific antibiosis

Dosage

Recommended dose is 5-8 per square centimeter.

Complications:

Overdose - patients should not be treated with more than 3,000 maggots at a time. Overloading a wound could increase pressure under the bandage causing pain and tissue ischemia. Patients with high numbers of maggots who develop fever or altered mental states should be tested for elevated serum ammonia levels
Allergy - Patients may be allergic to fly larvae, soy or brewer's yeast. Allergy to fly larvae necessitates immediate removal and treatment. Allergy to soy and brewer's yeast does not preclude MDT, flies cultured on alternative preparations are available.
Pain - MDT can cause discomfort or pain, usually for patients who are already having wound pain. MDT pain usually occurs about 24-36 hours into treatment. Local anesthetics are contraindicated, if systemic analgesics do not work, removing the maggot is usually immediately effective. Anti-anxiety medications should be readily available.
Infection - Each batch of fly eggs are sterilized and cultured to minimize the risk of nosocomial infection. Dead larva can become a nidus of infection, remove all larvae within 72 hours. Saturated dressings need to be changed; they can inhibit aeration, causing larvae death. Patients with fever or changes in mental status need to be assessed for spreading infection and bacteremia.
Bleeding - Minor bleeding and blood tinged drainage is to be expected during MDT. Frank bleeding must be reported immediately.

Instant feedback:

Local anesthetics are contraindicated for MDT related pain relief.