How (Not) To Drain A Blister

[santaremhostel]

Hope it will help you:
http://www.blisterprevention.com.au/blister-blog/how-to-drain-a-blister

Bom Caminho
Mario

 

[VNwalking]

This site is a treasure trove of accurate information and (be warned) sometimes gory pictures. The peregrino's version of Driver's Ed movies: don't do this or you could die!
Humor aside--blisters and the infections that can come form them must be taken seriously!

 

[peregrina2000]

What I don't understand is why the skin area under my blister would be any more prone to infection than the skin that gets exposed to the air when I cut myself -- on caminos I've cut my hands, feet, etc on sharp objects, fences, etc, and I wash the area and bandage it with antibacterial cream on the bandage. For years, I have been puncturing my blisters and treating them the same way. Is that not sufficient to prevent infection?

 

[VNwalking]

I'm in no way a pro, Laurie--check the website, it's certainly more reliable--but obviously this works for you.
As I understand, it's the sepsis that can happen when organisms are introduced into a closed environment (with a thread, for example) that's a real problem.
Here's from the end of that article linked above:

1. The blister threading method of draining a blister is fraught with infection risk.
2. Lancing a blister with a sterile scalpel blade or hypodermic needle is a better alternative.
3. Lancing a blister opens it up to infection so it should only be done if appropriate equipment is on hand. If in doubt, do not lance it. Read this article for blister treatment recommendations.

 

[David]

Great article! So wish I had written it. Rebecca does exactly what I do - and tells the 'victim' the same about cleanliness and plaster changing. Only difference is that I put another plaster on top, cut from a long strip, to add extra cushioning as the pilgrim will most likely be chafing that particular spot for the rest of their Camino..

The infection thing .. blisters versus a cut on the arm. The pilgrim carries on walking every day, for hours and hours ... the foot gets hot and moist, is covered by a sweaty sock that is full of microbes - this is a perfect breeding ground, a Petrie dish scenario - something that doesn't happen on a wound elsewhere on the open areas of the body ... that is why absolute hygiene is so important ... from before lancing the blister to the after care until the skin is healed .... and that is why 'threading' is so fraught with danger of infection.

I also agree with her about Compeeds, I no longer use them ... even if they are put on properly they are the devil to remove without damage so if there is infection this a real problem.

Silly me though - it has never occurred to me that all I need is the No. 11 scalpel blades, without the handle, don't know why .... should save some weight and bulk!

 

[peregrina2000]

Thanks for the info. I am by no means qualified to comment on the medical aspect of any of this, just what I've seen over years on the Camino. Some of Viranani's and David's comments about closed environments may explain the practice I've seen among some Dutch/Belgian/German peregrinos -- they actually remove all of the overlapping blister skin, disinfect and add antibiotic cream and then cover with gauze and tape. But they do it as soon as the blister is detected, so the underlying skin doesn't look anything like some of the pictures on the website. I just can't bring myself to do that, though!

I've seen many infected blisters on many caminos, but I have to say none of them had been treated with the needle and thread method. I'm not trying to be a contrarian and I'm certainly not saying that infections don't happen with the needle and thread. I appreciate that there is a risk of infection with any open wound, but I think that in some instances depending on the placement of the blister, an early needle and thread intervention may be the best of several not ideal options. And I agree with all the strong warnings about absolute cleanliness -- for me the silver lining of getting a blister is that I can easily rationalize the need to get out of an albergue with its questionable conditions, particularly in shower areas. Talk about petrie dishes for infection -- a lukewarm shower that drains slowly leaving your feet bathing in the accumulated crud from a long line of sweaty pilgrims. Buen camino, Laurie

 

[Deleted member 3000]

The medical community has counseled against the needle and thread blister treatment for decades, but it refuses to die. The thread does not really wick away fluid that would not drain anyway, and it keeps the blister skin open for bacteria. If the area is kept clean, infection can be prevented. Using wet-wound technology like Compeed on clean skin provides a cover that keeps out bacteria and the fluid creates a cushion as it is absorbed into the Compeed material. Compeed must be used correctly, and removing it prematurely is likely to remove good skin along with the dead skin. Pilgrims who use Compeed as they would a bandaid are in for trouble! Don't change Compeed until it falls off...

 

[VNwalking]

a lukewarm shower that drains slowly leaving your feet bathing in the accumulated crud from a long line of sweaty pilgrims

Eyeeew. Thanks Laurie.
Rubber shower sandals are de rigeur here for exactly that reason.
Another topic for the shower thread?

 

[zzotte]

here is how I fix my occasional blisters its actually two methods to my madness all depends on the blister (I'm not a medical professional)

1. Its best not to drain a blister it avoid infections but if one must....
1a using a syringe and needle drain the blister starting from the top when you are done inject (without the needle) with compound tincture of benzoin apply pressure to the blister that kind of glues the skin together (it hurts like mad)
2. Using a nail clipper cut two v shape into the lower part of the blister (one sometimes will do) and drain all the fluid and inject with compound tincture of benzoin and follow the instructions from 1a
3. apply a thin layer of triple antiB and tape it over.

It works for me


Years ago I read a book Fixing your Feet by John Vonhof if you are hiker or runner its the best book you can read about taking care of your feet

zzotte

 

[peregrina2000]

The medical community has counseled against the needle and thread blister treatment for decades, but it refuses to die. The thread does not really wick away fluid that would not drain anyway, and it keeps the blister skin open for bacteria. If the area is kept clean, infection can be prevented. Using wet-wound technology like Compeed on clean skin provides a cover that keeps out bacteria and the fluid creates a cushion as it is absorbed into the Compeed material. Compeed must be used correctly, and removing it prematurely is likely to remove good skin along with the dead skin. Pilgrims who use Compeed as they would a bandaid are in for trouble! Don't change Compeed until it falls off...

Hi, falcon, my experience is consistent with yours, that the thread itself is not big enough to keep the liquid draining, so I cut off a square of the skin before washing, putting on ointment and bandaging. Change the bandage every day. I used to use compeed but found that I had to tape it on to keep it from starting to fall off before the optimum time.

Rubber shower sandals are de rigeur here for exactly that reason.

In my experience, shower sandals are frequently inadequate to keep your feet out of the gunk. You would need rain boots.

 

[gracethepilgrim]

I’ve hesitated posting on this thread as it’s a bit like the shoe/boot debate. Not a one-size-fits-all and everyone is different
As a veteran camino-ist I've seen all sorts of blister-attention-methods used by others. The worst cases have been with compeed on large blisters. layers of skin pulled away (not pretty)
I personally use the needle and thread (soaked in betadine) left intact for a day or so and covered with fine tape ‘method'.
Because I never let blisters get big, I have only had to use this method on small ones. I always travel with a small bottle of betadine. It’s magic. So, for me, this method is quick, simple and effective. I have to say that I rarely get blisters now, occasionally a tiny one around my toes. My prevention method is to use pawpaw lotion on my feet every morning.

 

[David]

Nooo .. don't hesitate, we are all amateurs on here!

 

[peregrina2000]

I never let blisters get big

I'm completely with you, grace, when I get a blister I attend to it immediately while it is still small. I think that's a very important point about this somewhat savage method we use.

 

[AJ]

Some of Viranani's and David's comments about closed environments may explain the practice I've seen among some Dutch/Belgian/German peregrinos -- they actually remove all of the overlapping blister skin, disinfect and add antibiotic cream and then cover with gauze and tape. But they do it as soon as the blister is detected,

I met a Latvian nurse on the VdlP who did this every day after her shower.

 

[gracethepilgrim]

I'm completely with you, grace, when I get a blister I attend to it immediately while it is still small. I think that's a very important point about this somewhat savage method we use.

Yes Laurie, I agree. Common sense really. I was actually taught this method by my dad many years ago. He’s a retired builder and they used it on blood blisters after hammer accidents

 

[Siobhan02]

I was a bit barbaric with my blisters. Kind of following some suggestions above, I hacked into mine with nail clippers, leaving a decent sized hole, stung like mad, meh, what doesn't kill you makes you stronger!...allowing the serum to seep. I soaked my feet in salt water and lay in the sun to let my feet 'breathe' at the end of the day and then put compeed on. The instructions for Compeed state not to remove it but essentially let it fall off, it will look disgusting by the time it does but if you take it off too early you will rip skin off. Some serum would form in some of my blisters so I would just peel the Compeed back to the easily accessible hole and let it drain. Thread doesn't work because it does not follow the same principles of the simplest surgically implanted drain (in the vet world called a 'penrose drain) where serous fluid drains out around the drain not through it like a thread or 'drinking straw'. I saw a human doctor get great infection from threading and had to explain the simple principle he was trying to employ but failing dismally due to the mechanics of the thread...

 

[DavidsRetired]

In for a penny, in for a pound!

I’m not a fan of the needle-thread method, as I was once told by a doctor, that the thread introduces foreign bodies (thread fibres) into the wound, which can cause infection, regardless of a quick sterilisation. But I understand that many are comfortable with this method.

As others have stated, prevention is the best option, but when faced with a blister, dealing with it immediately is the next best choice.

I found the following method works extremely well for me:

- I ensure my hands are clean and use a hand sanitiser gel;
- Clean the blister and surrounding area with an alcohol pad (I carry several single packets);
- Using a pre-sanitised needle, I pierce a hole into the base of the blister, only going in as far as necessary to allow the serum to seep out;
- Gently push the serum out with a small sterile pad, until the blister is drained completely;

NOTE: I never remove the skin of the blister, and keep it as intake/whole as possible.

- Once the blister is drained I re-wipe the blister and surrounding area clean, wiping away from the hole;
- Apply an antibacterial gel on the blister;
- Place a large compeed patch over the blister, and push outwards to ensure the patch seals properly to the surrounding skin; then
- I cover the patch with Omnifix (http://www.woundsource.com/product/omnifix). I apply the Omnifix so it wraps the area in its entirety (overlapping) and has no wrinkles; ends of the Omnifix usually at the top of my foot, to avoid any chance of additional friction. A Spanish pharmacist informed me on this product, and it works great.

Contrary to others experiences, I remove the compeed patch after my shower at the end of the day’s walk. By applying the antibacterial cream to the blister, prior to putting on the patch, it poses no threat of peeling the excess blister skin away.

It may seem like a lot, but it’s rather easy and fast, and works extremely well for me.

On my last Camino, I had a hot spot while coming down into Molinaseca and had about 2km to go. I normally stop immediately and deal with such issues, but was tired and became lazy. Yeah…paid for that one.

 

[Anniesantiago]

I liked everything David said until he got to the part where he removed the Compeed.
My experience is that I wear a Compeed patch until it falls off on its own.
Otherwise, it peels the skin right off with the patch.
OWWWw!

 

[DavidsRetired]

You missed the point were I said to put antibacterial cream on the blister itself. This prevents the compeed patch from sticking to the skin/blister. I never press the compeed down onto the blister itself, just around the edges.

Personally, I don’t like to cover the blister for extended periods, as it presents a warm environment and breeding ground.

Now, as far as boots vs shoes go….

Edited (pre-emptive strike before I get jumped on by the masses): I know this is where others will jump in and say “BUT, the package says….”. But the package isn’t walking the Camino everyday I’ll stick with the Mayo clinic advice, about keeping a blister clean and change the dressing daily. At night time I like to allow it to air dry, which I think helps.

BUT, this is just my opinion and what works for me.

 

[Anniesantiago]

You missed the point were I said to put antibacterial cream on the blister itself. This prevents the compeed patch from sticking to the skin/blister. I never press the compeed down onto the blister itself, just around the edges.

Personally, I don’t like to cover the blister for extended periods, as it presents a warm environment and breeding ground.

Now, as far as boots vs shoes go….

Edited (pre-emptive strike before I get jumped on by the masses): I know this is where others will jump in and say “BUT, the package says….”. But the package isn’t walking the Camino everyday I’ll stick with the Mayo clinic advice, about keeping a blister clean and change the dressing daily. At night time I like to allow it to air dry, which I think helps.

BUT, this is just my opinion and what works for me.

I see.

Well, Compeed is a hydro-colloidal bandage - it is made to draw the water out of the blister.
It is safer and more sterile than the needle-thread method and is meant to replace it.

 

[DavidsRetired]

Absolutely, as most similar products use a hydrocolloid technology.That’s why I use the compeed (I actual use Everlast) patches, which continue to draw any residual moisture out while applied.

As for the needle/thread method, I don’t use that at all.

Anyway, this is just the method I use, I’m not trying to offend anyone.

I understand that some take the way I write to be offensive and misconstrue my meaning(s). It’s just the way I write. Too many years of writing military reports, and toss in a touch of Aspergers, and well….

Perhaps, it’s time I left this forum, as it seems to be happening more and more in my case and I don’t wish to aggravate anyone further.

Take care and all my best!

 

[Tincatinker]

@DavidsRetired stay with us amigo. We all get a little sparky from time to time. Any conversation that isn't conducted face-to-face can go awry occasionally. There's little nuance in typescript.

You have provided valuable advice on many occasions and your knowledge and enthusiasm are part of what makes this forum great.

And for those occasions when the forum isn't quite as great as it could be - take a day or two off and come back refreshed.

 

[David]

Hey! Don't you dare go! This is a forum and personal views are welcome as far as I am concerned. Don't go jaggedif someone disagrees with you, though we all do that sometimes.
Thing is that you are obviously capable and can do the blister thing properly but there are many out there who ha e no idea how to self medicate and just slap the compeeds on any old how, which is where I find that they then come to me for help when I am doing the first aid.

I value what you have written, just thatt I don't carry them anymore as I tend not to trust many pilgrims to use them properly. Now - don't go! And Aspergers spectrum isn't a flaw you know, it is just another facet of being human. Rather a wonderful one.

 

[wayfarer]

I will add my call to stay with us to both Tinkatinker's and David's.

 

[DavidsRetired]

I appreciate the feedback, thank you very much. It’s just been one of those weeks (PTSD, little sleep), where I am a bit beat up, and perhaps a tad over sensitive; not an excuse though!

Yes, a few days off, may just reset my equilibrium.

Besides, I am unable to find the delete option under my account and was just going to email Ivar. I'll hold off on that.

Again, thank you all very much for your personal comments and support.

Cheers,
Dave

 

[DavidsRetired]

@Anniesantiago I just received your comment on my phone, and wished to quickly reply. No need to apologise, as you said nothing wrong, nor derogatory. There is a deeper undercurrent of complexity involved. I’ve just had an extremely bad and sleepless week, which has compounded my PTSD. It happens occasionally, and its unfortunately, not unfamiliar, so manageable to a degree. Take care, and thank you!

 

[Siobhan02]

So glad you are feeling a bit better David, thank you for your blister advice I think you'll find that many Camino pilgrims have got what, I hope you don't mind me calling it, 'baggage', in fact most people do I know it's off topic, but some of the life stories I heard along The Way helped me put my life in perspective. I don't wish to speak for others but I would love to think that the people who are part of this lovely little Camino community are here for each other in many ways, not just the 'Camino way'. My thoughts are with you and I do hope your 'equilibrium' (I like that term for it) continues to improve.

 

[DavidsRetired]

@Siobhan02 your comments are warmly received and greatly appreciated; thank you! In regards to those we meet on our Camino travels – they do indeed add a personal perspective to our own lives, and hopefully, we add to theirs. Additionally, I agree whole heartily, as the majority within this online community are openly caring and kind souls.

As for my equilibrium, I am well and smiling, as I am most days

The Morning Dawn

I sat to watch the sunset
and drank the depth of sky –
as the long of day,
began the journey by…..
to find the morning dawn.

I sat to watch the sunset
and dream with glistening eyes
of tomorrow's beauty –
her hand… entwined ~
with mine.