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What do I do with the maggots when they arrive?
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When the maggots arrive, read the label to make sure that they are for you and not the others in your facility.
Remove the packing slip/invoice from the outer box, before it gets lost,
and send it to the person responsible for accounts payable.
Open the box carefully, so as not to damage the dressings inside.
Remove the dressings and Styrofoam box, which contains the maggots.
Open the Styrofoam box to check the maggots and let air into the box.
Inspect the vial(s) of larvae, making sure that that are alive (moving around) and without slime.
If they appear healthy and active,
replace the Styrofoam lid and store at room temperature until use, ideally within 24 hours.
Don’t forget to notify the doctors and nurses that the maggots have arrived.
Gentle heat (80-90 F) will speed their development and make them slightly larger, sooner.
Gentle cooling (45-55 F) will slow their development and prevent them from growing much larger.
If the maggots can not be seen or if they are very slow moving, place the vial in a warm incubator to speed their development, and check again in one and two hours.
If they still appear dead or immobile, or if they appear infected (slimy or foul smelling), notify Monarch Labs immediately.
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How do I keep the maggots on the wound?
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Since the maggots’ natural tendency is to wander off before and after they have finished feeding,
they must be kept in place by dressings that allow air to enter, allow liquified necrotic tissue to drain out,
and still keep the maggots securely over the wound.
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How do you get all of the maggots out?
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Once the dressing is removed, all of the maggots will crawl out of the wound and away from the host.
If they are hiding within a crevice, simply cover the wound with saline-moistened gauze,
and replace it three time/day; the remaining maggots will leave the wound and burry themselves in the gauze
within 24 hours.
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How do I dispose of the maggot dressings?
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Maggots are germ-free when applied, but become contaminated when they come into contact
with the patient’s wound flora.
MDT dressings should be handled like all other infectious dressing waste:
placed in an appropriate bag and autoclaved or incinerated by the waste management department.
Place the maggot dressings in a plastic bag and seal the bag completely.
Then place the sealed bag into a second plastic bag and seal completely.
Place the bag with the other infectious dressing waste, which should be disposed of within 24 hours.
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How do I dispose of unused maggots?
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Unused maggots are germ-free. They may be discarded in regular trash bins.
Seal their vial so that they can not escape.
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How many treatment cycles are necessary?
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The number of treatment cycles depends on the size of the wound and the ultimate goal of treatment
(debridement, wound be preparation for graft, or wound closure). The average course is 3-5 cycles.
Examine the wound after treatment (and 24 hours later, if possible),
to determine if another treatment is necessary.
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Does maggot therapy hurt?
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For those few patients who feel wound pain, they will likely also feel pain or discomfort with maggot therapy
as the maggots become large enough to feel (about 30 hours into the treatment cycle. Use analgesics liberally,
and remove the dressings if/when analgesics fail to control pain.
The pain will abate immediately after the dressing is removed.
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How might reimbursement work?
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Code separately for the procedure and for the maggots.
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For the procedure code, consider using a CPT code for selective debridement without anesthesia
(97597 if the wound is < 20 sq cm; 97598 if the wound is > 20 sq cm)
or a CPT code for misc. skin procedures (17999).
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When billing for the maggots themselves, consider using either the ABC code for maggots (EAACT)
or the HCPCS code for misc. devices (A9270).
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Appeal may be necessary. The BTER Foundation will assist with appeals.
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Additional information can be found in the recent
press release by the BTER Foundation.
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Where can I find more information?
NOTE:
Medical Maggots™ are indicated for use in the care and treatment of chronic wounds ("wound care") of humans or other animals
for the following indications:
For debriding non-healing necrotic
skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers,
neuropathic foot ulcers and non-healing traumatic or post surgical wounds.
Medical Maggots™ are used to clean ("debride") and manage wounds in a procedure known as "maggot therapy."
Sometimes wound debridement using maggots is also called "maggot debridement therapy," "MDT," "larva therapy," "larval therapy,"
"larva debridement therapy," or "biodebridement."
In the United States, Medical Maggots™ are regulated by the Food and
Drug Administration as a prescription only medical device used in the care and treatment of wounds. Read all packaging information carefully.
Copyright ©
2006 by Monarch Labs. All Rights Reserved.