wound care lectures

WOUND AND PAIN MANAGEMENT3971

Lecture 2. Wound management products

1

RALUCA DUCAR/ 3971NRS/ 2010-2011

LEARNING OBJECTIVES

1.Understand the “TIME” concept in wound management2.Discuss debridement as part of treatment plan.3.Identify signs of infection and discuss interventions related measures.4.Discuss the benefits of maintaining moist wound environment.5. Describe the properties of the eight main categories of wound dressing.

2

6. State indication, precautions and contraindications of the each of the wound dressings7. Discuss new advances in wound management (tissue adhesive, growth factors, biosynthetic dressing ).8. Compare sterile with clean techniques for wound care.9.Identify types of antiseptic agents used for wound care

3

EXPECTED OUTCOMESBy the end of the session you will be able to:

1.Demostrate understanding of wound management principles related to “TIME” frame. (wound debridement, managing infection, keeping moisture wound environment)2. Recognize types of antiseptic agents used for wound care3. Differentiate between the 8 main types of dressings

4

4.Demonstrate willingness to gain more knowledge related to advanced methods used in wound care (web search)5. Apply learned principles of dressing techniques in clinical settings

PREREQUISITES- MYERS (2008) chapters 5 ,6,7 (pp.70-155)- Potter,P.A.,Perry,A.G.,(2009).Fundamentals of

Nursing.(7th ed).Mosby pp.1313-1321- Lecture handout

5

WOUND BED PREPARATION -WBPTo achieve an effective outcome, a wound should

have:1. Well-vascularized wound bed2. Minimal bacterial burden3. Little or no exudate

6

WBP has 4 aspects

1. Debridement2. Exudate management3. Bacterial imbalance resolution4. Undermined epidermal margin

(Schulth et.al.2003)

7

FALANGA (2004) HAS UTILIZED THE WORK OF SCHULTZER ET AL. (2003) TO DEVELOP A FRAMEWORK CALLED TIME TO PROVIDE A COMPREHENSIVE APPROACH TO CHRONIC WOUND CARE.

T Tissue management ( non-viable)

I Inflammation & infection control

M Moisture Balance

E Epithelial Edge advance 8

T-TISSUE MANAGEMENTPREDOMINAT TYPE OF NECROSIS

9

ESCHAR SLOUGH FIBRIN HYPERKERATINOSIS

GANGRENE

Hard

Soft, soggy

Black/brown

Firmly attached

Attached base

Soft, soggy

Soft stringyMucinousYellow/tan

Firmly attached

Attached baseLoosely attached clumps

Soft, soggy

Soft, stringyMucinousyellow/white

Attached baseLoosely attached clumps

Hard

Soft, soggy

White/gray

Firmly attached

Surrounds wound adges

Hard

Black/brown

Firmly attached

Tissue managementAssessment for non viable tissue.Wound debridementdebridement is the principle intervention

10

Is the removal of necrotic tissue, foreign material and debris from the wound bed

(Myers, 2008)

T-TISSUE MANAGEMENT Purposes of debridement• Decrease bacterial concentration within the

wound bed and the risk of infection.• Increase the effectiveness of topical

antimicrobials.• Improve the bactericidal activity of leukocytes.• Shorten the inflammatory phase of wound healing.• Decrease the energy required by the body for

wound healing.• Eliminate the physical barrier to wound healing.• Decrease wound odor.

11

Debridement options• Sharp or surgical• Autolytic • Enzymatic • Mechanical • Biosurgery or larval therapy

12

Sharp or surgical: involves using forceps, scissors, or a scalpel to selectively remove devitalized tissue, from a wound bed. Fastest and most aggressive.

Autolytic: uses the body’s own (endogenous) enzymes, including collagenase to digest necrotic tissue and macrophage to phagocytose debris by applying a moisture retentive dressing and leaving it in place for several days (Hydrocolloids, hydrogels, & alignates).

13

Enzymatic or chemical debridement: is the use of a topical exogenous enzyme (collagenase, elastase, & fibrinolysin) to remove devitalized tissue.

Mechanical: involves the use of force to remove devitalized tissue, foreign matter, and debris. Nonselective debridement type that includes:

- Wet-to-dry dressings- High Pressure wound irrigation- Whirlpool baths 14

Biosurgical or larval parasitic1. Mechanical movement loosen surface

debris2. larvae secrete enzymes into the wound

that break down necrotic tissue to a semi-liquid form

3. Larvae ingest the dead tissue, leaving only the healthy tissue.

15

GENERAL DEBRIDEMENT INDICATIONS THE RED-YELLOW-BLACK SYSTEM

COLOR WOUND BED DESCRIPTION

TREATMENT GOALS

RED Pale, pink,beefy red granulation tissue

Protect woundMaintain worm , moist environmentProtect periwound

YELLOW Moist yellow sloughVary in adherence

Debride necrotic tissueAbsorb drainageProtect periwound

BLACK Thick ,black,adherent eschar,

Debride necrotic tissue

16

GENERAL CONSIDERATIONS FOR DEBRIDEMENT

Wound characteristics- etiology, size, presence of infection, amount of necrotic tissuePatient’s general health, nutrition and other medical conditions (immunosuppression, thrombocytopenia)

17

INFLAMMATION/ INFECTION

18

I

Specific Treatment Objectives for Infected wounds

• To identify the infective organism.• To control and/or eliminate wound infection.• To remove devitalized tissue from the wound

bed.• To cleanse the wound surface.• To absorb excess exudate production.• To protect the surrounding skin from the

effects of maceration.• To control pain/discomfort.

19

HOW DO WE KNOW THE WOUND IS INFECTED?

ASSESSMENT:

- five cardinal signs of infection:R.C.T.D.F

- Decline in wound status

- Detect presence of silent infectinos- abcess

Presence of biofilms with incresed bacterial resistance

Wound cultures (tissue biopsy and swab cultures)

20

HOW DO WE TREAT AN INFECTED WOUND?

1.Topical antimicrobial therapy- in order to provide an agent that destroys the offending organism

- topical ointments or creams are applied to wound surface, penetrate the wound bed to the site of infection and inhibit bacterial growth

- use of antimicrobial-impregnated wound dressings

- use of silver as broad spectrum antimicrobial

21

Advantage of topical antimicrobial use is :

-lower cost than systemic therapy and ease of application

-it will decrease bacterial load if applied properly

-they are applied direct to wound bed – better to treat wounds with compromised circulation

Disadvantage :- needs frequent application

-sensitivity and allergic reactions

- increased chance for microbes to become resistant

22

2. ANTISEPTIC AGENTS(ACETIC ACID, CHLORHEXIDINE, HYDROGENPEROXIDE, POVIDONE-IODINE)

Previously were considered to reduce the rate of infection and speed wound repair

Research showed that beside being broad-spectrum anti microbial, antiseptic agents are also cytotoxic to fibroblast, kerationcytes and neutrophyls

----------increse the duration of inflammatory response and delay epithelialization and wound contraction 23

Antimicrobial solution that prevents

infection by killing microorganisms

Used to decrease bacterial growth on inanimate objectsReduce bacterial concentrations on intact skin- used as surgical scrubCan be used for short period of time on open wounds

e.g. patients with bite from animals in the farm can have short term use of povidone-iodine because this wounds are multimicrobial

(Myers, 2008;p.104-113)

24

3.SYSTEMIC ANTIMICROBIAL THERAPY

Prescribed for patients with sepsis or deep space infections , alone or in combination with topical antibioticsAdvantage –reduce bacterial load, better patient compliance with treatmentDisadvantage- more frequent and severe adverse reactions, development of resistant stains

25

REVIEW:T- TISSUE MANAGEMENT

DEBRIDMENT Sharp or surgicalAutolytic Enzymatic Mechanical Biosurgery or larval therapy

I- INFECTION/ INFLAMMATION

26

M MOIST WOUND HEALINGTraditional theory says: “wounds should be kept dry and clean so that scab can form over the wound” Sussman,Bates-Jensen(2008)

Practice shows that scab is a barrier to healing- because it interferes with moving of epithelial cells- poor cosmetic results and scarringThe wounds should be managed in a moist environment so epithelial cells will be able to move

Moist wound heals 3-5 times faster than dry wound because moist facilitates the three phases of wound healing process .Myers (2008) 27

M

The amount of moisture is not known exactly--a wound too dry will result in crust formation and will

lack the enzymes and growth factors that facilitate healing

-a wound that is to wet can delay healing because of the extra fluid around the wound which will produce maceration of tissue

28

DRESSINGS -FUNCTIONCreate a moist wound environment

- if wound too wet-dressing will absorb the excess exudate

- if wound too dry- dressing will donate moisture to itProvide thermal insulation maintain temp.37-38degrees C

-this temp. increases oxygen saturation and decreases hemoglobin’s affinity for oxygen.

29

-wound dressing should protect against infection- wound dressing should protect exposed nerve endings, decreasing the pain-provide hemostasis, edema control elimination of dead

-dead space=void left by a wound cavity, undermining or tunneling---it must be avoided to prevent abscess formation and premature wound closureProvide gas exchange between wound and environment

30

TYPES OF WOUND DRESSING

PRIMARY DRESSING-Comes in direct contact with wound

e.g.Band EidSECONDARY DRESSING

-Placed over primary dressing to improve protection

e.g. Self-adhesive bandage placed over primary dressing

31

CLINICAL DECISION MAKINGMOST APPROPRIATE WOUND CARE

-

32

MOISTURE RETENTIVE DRESSINGMaintain an ideal wound healing enviromnentAre specialized synthetic or organic dressings that are more occlusive than gauze

Have a lower moisture vapor transmission rate than gauzeAllows patients to bathe, swim without contaminating the wound 33

Describes the ability of a dressing to transmit moisture ,vapor and gases from wound to atmosphere

Maintain wound temperature better than gauzeProtect the wound from trauma and infectionAre adhesive---there is no need for secondary dressingAre elastic and stay in place for 3-7 daysStimulate granulation tissue formation, collagen synthesis and epithelialization

Main risk for using moisture retentive dressingINFECTION

TRAUMA TO THE WOUND BEDMACERATION OF SURROUNDING SKIN

34

8 TYPES OF DRESSING1.GAUZE DRESSING2.IMPREGNATED GAUZE 3.SEMIPERMEABLE FILMS4.SHEET HYDROGELS5.SEMIPERMEABLE FOAMS6.HYDROCOLLOIDS7.ALGINATES8.COMPOSITE DRESSINGS

35

. GAUZE DRESINGS

WOVEN GAUZE--made of cotton yarn or thread

NONWOVEN GAUZE –-made of synthetic fibers pressed together (have grater

absorbency)

Loose weave gauze- aids in medical debridement but should not be placed over granulating tissueGauze is highly permeable and nonocclusive and can be used as primary or secondary wound dressing 36

1.

MULTILAYER GAUZE DRESSINGS- Outer nonocclusive layer ----allows gas exchange- Middle antisher layer ---------moves with the patient- Nonadherent contact layer—allows absorbtion of exudates,

reduces moisture less risk for maceration

ANTIMICROBIAL-IMPREGNATED GAUZE- The use of such products should be limited ----reduce the

potential of developing resistant microorganisms 37

COMMON USES

Both infected and noninfected woundsLarge wounds or irregularly shaped Packing strips to prevent premature closure or keep away exudates in tunneling or underminig wounds

CAN BE USED ALONE OR IN COMBINATION WITH ANTIBIOTICS, ENZYMES, GROWTH FACTORS, ALGINATES,SEMIPERMEABLE FOAMS OR FILMS

38

PRECAUTINONS /CONTRAINDICATIONS

1.woven gauze require more force to remove----potential wound trauma2.woven gauze may leave residue to which body will respond by forming granulomarolled gauze should be applied snuggly but without tension---to prevent a tourniquet like effectTelfa dressing---nonadherent, little absorption , keeps wound exudates close to wound---maceration of tissue

39

IMPREGNATED GAUZE DRESSING

Mesh gauze non adherent, moderate occlusive,Impregnated with petrolatum, bismuth, zincPetrolatum impregnated gauze might facilitate wound healing by decreasing trauma during dressingCan be used as contact layer on granulating wound beds, combined with secondary gauze dressingUsed to burn wounds because have pain free removal

40

2

PRECAUTIONS/CONTRAINDICATIONS

Bismuth (from xeroform dressings) is cytotoxic to inflammatory cells-----cause increased inflammatory response (not advisable for pt with venous insufficiency ulcer)Iodine-impregnated gauze cytotoxic to human cells only mild antimicrobial

41

SEMI PERMEABLE FILMSThin flexible transparent sheets with adhesive backingPermeable to water vapor, O2, CO2 but impermeable to bacteria and waterHave little absorptive capabilities , but are comfortable because of elasticityShould be applied without tension and wrinkles and can stay in place for 5-7 daysShould NOT be used in cavity wounds or when heavy drainage is noted

42

3.

•COMMONLY USED FOR SUPERFICIAL WOUNDS (TEARS, LACERATIONS, ABRASIONS), INTRAVENOUS CATHETER SITES, AREAS OF FRICTION

to prevent maceration ---apply on areas of intact skin-skin should not be oily or wet-if a channel or wrinkle forms----change dressing-NOT to be used on infected wounds

43

SHEET HYDROGELS80-90% water or glycerin based wound dressingAbsorb minimum amount of fluid by swellingDonate moisture to dry woundsDecrease pain by cooling the wound bedAre permeable to gas and water---less effective bacterial barrier

44

4.


Are not able to absorb heavy drainage Are absorbing very slowly----should not be used on bleeding woundsRequire secondary dressing

: minimal or moderate draining wound-can be used within casts or splints to decrease

pressure- Effective at softening eschar to facilitate autolytic

debridment

45

USE

SEMIPERMEABLE FOAMSMade of polyurethaine, permeable to gas but not to bacteriahave high moisture vapor transmissionProvide thermal insulation Effective in treatment of stage II and III pressure ulcer

46

5.

- WOUNDS WITH MINIMAL AND HEAVY EXUDATES-GRANULATING OR SLOUGH COVERED PARTIAL AND FULL THICKNESS WOUND-SEMIPERMEABLE FOAMS –USED IN DONOR SITES , OSTOMY SITES, MINOR BURNS, DIABETIC ULCER

PRECAUTIONS-Not recommended in dry or eschar-covered wounds-not indicated for arterial ulcers---because of enhancing

dryness- Not indicated for area of high friction—heel ulcers

47

USES

HYDROCOLLOIDSContain hydrophilic colloid particles like gelatin, pectin,Have various absorption abilities Absolves exudates by swelling into a gel-like massProvide thermal insulation to wound bedImpermeable to water, oxygen ,bacteria

48

6.

Uses- indicated for partial and full-thickness wounds-can be used on granular and necrotic wounds-used on minor burns, and pressure ulcers

49

Duo Derm- effective barrier against urine,

stool, MRSA, hepaB,HIV and Pseudomonas

Arginosa

ALGINATESContain salts of alginic acid from sea weeds and covered in calcium/sodium saltsWhen placed on wound, it reacts with the serum and forms a hydrophilic gelAre highly permeable and non occlusive----require secondary dressingStimulate macrophage activityUses: highly draining wounds

-partial and full-thickness wound-granular and eschar-covered wounds

50

7.


Not recommended for use on full thickness burnsNot to be used on wounds with exposed tendon, joint capsule, boneUse with moisture barer to protect periwound skin from maceration

51

COMPOSITE DRESSINGMultilayer dressing that can be used as primary or secondary wound dressings

1. -inner contact-non adherent, prevents trauma to wound bed when dressing changes2.-middle layer-absorbs moisture and keeps it away from wound bed to prevent maceration3.-outer layer-bacterial barrier

52

8.

3 layers

SILVER DRESSING-silver is antiseptic-dressings may be primary or secondary, adhesive or

non-adhesive-release of silver ions----blue-black wound discolorationNo evidence that silver is effective in presence of slough

or escharSilver is cytotoxic to fibroblast

53

CHARCOAL DRESSING

Key function of dressings is to control wound odor by absorbing odor producing gases released by bacteria------improve the quality of life for patients by allowing them to share with normal social activities

54

SUMMARYMANAGING EXUDATES WITH DRESSING

Type of wound Optimal dressing

0=dry Hydrogels, hydrocolloids, interactive wet dressings

1=minimum exudates Hydrogels, hydrocolloids, semipermeable films, calcium alginates

2= moderate exudates Calcium alginate, hydrofibre, hydrocolloid paste/powder, foams

3=heavy exudates Hydrofibre dressings, foamsheets/cavity, wound/ostomy bags

55

WHEN CHOOSING TYPE OF DRESSING USED WE HAVE TO CONSIDER ALSO THE SURROUNDING SKINSKIN

EDGE ,EPITELIAL ADVANCEMENT

Signs of epithelial (edge) advancement

1. WB filled with granulating tissue.2. Epithelialization at the wound margins.

56

E

THE FOLLOWING QUESTIONS SHOULD BE ANSWERED PRIOR TO THE CLEANSING OF ANY WOUND:

1. What is the purpose of wound cleansing?

2. What method of wound cleansing would be most appropriate?

3. Does the wound require cleaning at each dressing change?

4. What type of wound cleansing product would be most appropriate?

57

1.THE PURPOSE OF WOUND CLEANSING:

• Wound infection.• Excessive exudate.• Presence of foreign bodies, debris,

eschar or slough.• A need to reduce contamination or

devitalised tissue prior to suturing, in wounds healing by delayed primary intention (i.e. tertiary intention). 58

DECIDING TO CLEANSE A WOUNDSHOULD BE BASED ON THE FOLLOWING:

• The size, shape and location of the patient’s wound.

• The condition of the wound and stage of healing.

• The availability and effectiveness of different methods of cleansing.

• The availability and effectiveness of different cleansing agents.

• The patient’s perceptions and needs59

CLEANSING TECHNIQUE

• Clean versus sterile technique• Use of Normal saline and tap water • Hand washing is essential to reduce infection• Wound field concept• Dirty hand & clean hand

60

IRRIGATION VS. SWABBING

Swabbing the wound surface of a wound may mechanically dislodge loose, devitalised tissue but does not actively remove pathogens from the wound.

Irrigation under pressure is an effective method of cleansing wounds that are infected or heavily contaminated. High pressure irrigation using a 30ml syringe and an 18-20G needle lowers the infection rates in contaminated wounds. 61

STERILE VS.CLEAN TECHNIQUESterile technique -is defined as use of sterile equipment, ( gloves,wound dressing, instruments) in order to reduce exposure to microorganisms.

-----------only sterile items may contact the pt’s wound, ------------use of sterile gloves and sterile field------------meticulous set-up and maintenance of sterile

field( review table.6-8,p.117 text book)

62

Clean technique- procedures that reduce overall number of microorganisms

-------------------hand, washing, sterile instruments-------------------use of clean gloves and maintenance of

clean field -------------------use clean hand dirty hand dressing

procedure

(see table 6-10,p.117,text book)

63

CONCLUSION OF RESEARCH- No difference in the rate of wound

healing was found when comparing sterile with clean technique dressing

-clean technique less expensive----clean technique----standard in wound

management-sterile technique---reserved for wounds

that require packing, severe burns, wounds of immunosupressed patients

64

CLEANING AGENTS

AntisepticsAntibioticsHoneySaline 0.9%Tap water

65

ANTISEPTICS• Defined as a non-toxic disinfectant, which can be

applied to skin or living tissues & has the ability to destroy vegetative compounds, such as bacteria, by preventing their growth.

• If antiseptics are simply used to wipe across the wound surface, they will have little effect.

• They need to be in contact with bacteria for about 20 min. before they actually destroy them.

• They can applied in the form of soaks or incorporated into dressings, ointments, or creams.

66

LOTIONS - ANTISEPTICS1. Cetrimide2. Chlorhexidine3. Hydrogen Peroxide4. Iodine5. Potassium Permanganate6. Proflavine7. Silver8. Sodium Hypochlorite

LOTIONS - ANTISEPTICS1. Cetrimide• Useful for its detergent properties, particularly for

the initial cleansing of traumatic wounds or the removal of scabs & crusts in skin disease.

• It is mostly only used in ER for initial cleansing of wounds rather than a routine cleanser

• Two dangers should be noted:- Skin irritation & sensitivity- Very easy to become contaminated by bacteria, especially Pseudomonas aeruginosa.

(Dealey, 2005)

LOTIONS - ANTISEPTICS• It is available as a cream or as a lotion in combination

with chlorhexidine.

69

(Dealey, 2005)

LOTIONS - ANTISEPTICS2. ChlorhexidineIt is effective against G-ve & G+ve.It could maintain its antimicrobial levels for a

period of time when impregnated into a dressing.However, its efficacy is rapidly diminished in the

presence of organic material such as pus or blood.

70

(Dealey, 2005)

LOTIONS - ANTISEPTICS

It is more suitable for disinfection & hospital hygiene rather than wound care

71

(Dealey, 2005)

LOTIONS - ANTISEPTICS3. Hydrogen Peroxide 3%• Effective against anaerobes• It loses its effect when comes in contact with

organic material such as pus or cotton gauze.• Cytotoxic to fibroblast unless diluted to a

strength of 0.003%. This dilution is not effective against bacteria. But, this dilution still inhibits keratinocyte migration & proliferation.

(Dealey, 2005)

LOTIONS - ANTISEPTICSIt is no longer widely used as there is

no evidence to demonstrate its efficacy & there are number of other more alternatives.

(Dealey, 2005)

LOTIONS - ANTISEPTICS4. Iodine• Broad-spectrum antiseptic• Used in wound care as povidine iodine 10% which

contains 1% iodine.• Used as a skin disinfectant & to clean grossly

infected wounds.• Effective against MRSA.

(Dealey, 2005)

LOTIONS - ANTISEPTICSDebate…?Lineaweaver et al. (1985) found that it is Cytotoxic

to fibroblasts unless diluted to 0.001%, retards epithelialization & ↓ the tensile strength of the wound.

However,

Bennet et al. (2001) found that it significantly ↑fibroblast proliferation slightly ↑ neodermal regeneration & epithelialization.

(Dealey, 2005)

LOTIONS - ANTISEPTICS• In 2003, Selvaggi et al., have reviewed &

appraised the role of iodine & concluded that povidine iodine is an effective antibacterial that is superior to other products & has no problems with resistance.

Iodine should not be used for the patients with thyroid disease or those who are sensitive to the product.

76

(Dealey, 2005)

LOTIONS - ANTISEPTICSPovidine iodine is available in ointment, spray, &

powder form & impregnated into dressings.

77

Betadine

(Dealey, 2005)

LOTIONS - ANTISEPTICS

• Used on heavily exudingwounds.

• Generally, associated with leg ulceration.

• Found in the form of tablets; to be dissolved in 4 L of water.

5. Potassium Permanganate 0.01%

(Dealey, 2005)

LOTIONS - ANTISEPTICS6. Proflavine• Has a mild bacteriostatic effect on G+ve, but no

effect on G-ve.• It is available as a lotion

79

(Dealey, 2005)

LOTIONS - ANTISEPTICS7. Silver• Has a bactericidal effect on a wide range of

bacteria (Dealey, 2005)

Problem• It is extremely caustic, stains the skin black.• Prolonged use causes ↓Na, ↓K, & ↓Ca (Dealey,

2005)

Solution• To overcome these problems → a cream,

silver sulphadiazine, was developed →successful in controlling burn wound infections (Lansdown, 2004)

LOTIONS - ANTISEPTICSAvailable in 3 modalities:• Liquid (Silver Nitrate)• Cream (Silver Sulphadiazine)• Silver-coated dressing

(Dealey, 2005)

LOTIONS - ANTISEPTICS8. Sodium HypochloriteOriginally used in the 1st World

War.Have few beneficial effects & do

much harm.

(Dealey, 2005)

LOTIONS - ANTIBIOTICS• D’Arcy (1972) recommends that any antibiotic that

is used systematically should not be applied to the skin.However, antibiotics that are not appropriate for

systemic use may be developed for use on the skin or in wound care.

• → creams, gels, ointments or impregnated dressings containing gentamicin, tetracycline, fusidic acid, or chlortetracycline. Should not be used as these antibiotics are used systematically (Dealey, 2005).

• Mupirocin could be used for treatment of MRSA

(Dealey, 2005)

LOTIONS - ANTIBIOTICS• A range of antibiotics is available in topical form.• There is considerable risk of sensitization to the

patient as well as the development of resistance organisms.

• Systematic antibiotics are the treatment of choice when treating infected wounds.

(Dealey, 2005)

LOTIONS - HONEYHoney has been used in wound care since ancient

times.Mole (1999) discussed the role of honey & its

properties:Antibacterial actionDeodirising actionDebriding actionAnti-inflammatory actionStimulation of wound healingPain relief (Dunford & Hanano, 2004)

LOTIONS – TAP WATER• Is being used more frequently on wound

areas already colonized such as wounds following rectal surgery of foot ulcer.

• Using tap water to clean wounds did not differ from using sterile normal saline in respect of wound infection and healing rates.

86

(Fernandez, Griffiths, & Ussia, 2002)

LOTIONS – SALINE 0.9%• The only completely safe

cleansing agent & is the treatment of choice for use of most wounds.

• It is used in conjunction with many of the modern products.

• It is presented in sachets, small plastic containers, & aerosols.

(Dealey, 2005)

REVISION OF DRESSING TYPES1. Inert non-stick dressings

GauzeParaffin tulle dressings (Jelonet®, Bactigras®)Non-paraffin, non-tulle, woven products, (e.g. Adaptic®, Inadine®)Non-stick dressings (e.g. Melolin®, Cutilin®)Combine

Primary dressing:• Protective low absorption dressing

(Carville, 2005; Dealey, 2005)

DRESSING TYPES REVIEWApplication:• Clean wound base• Place shiny side of dressing to wound. • May require soaking if exudate strikethrough

has occurred.

Contraindications/Possible Side effects: • Harsh debridement of the wound bed if

exudate dries• Limited use as a primary dressing• Dries out the wound bed


DRESSING TYPES REVIEW2. Film dressing

Opsite Flexigrid®Opsite Post-Op®Tegaderm®Polyskin®

Primary and secondary dressing:• Low exudating wounds, protective dressing.


Application:• Clean wound base• Prepare peri-wound area with a protective barrier wipe. • Apply adhesive side to wound and remove outer layer. • Adhesive strongest in first 24 hours; can remain for 7 days. • Observe for maceration, remove if this occurs.

Contraindications/ Possible Side effects: • Do not apply to infected wounds or if allergic to tapes. • NB: Green sided Opsite is for wounds, orange sided Opsite is

for vascular access devices.

91


DRESSING TYPES REVIEW

3. Foam dressingsAllevyn®Allevyn Adhesive®Allevyn Cavity®Cavi-Care®

Primary and secondary dressing:• Light/mod/highly exudating wounds, protective dressing,

cavity wounds.

92


Application:• Clean wound base• Read packaged for insertion side (patterned or shiny side up) • Sheet foam left insitu up to 7 days (24 hours if infected)• Cavity foams left insitu up to 14 days (daily washing of foam if

infected)

Contraindications/ Possible Side effects: • Avoid covering with occlusive dressings. • Avoid wounds dressed with antibacterial solutions.

93


DRESSING TYPES REVIEW4. Hydrogel dressings

Solugel®Intra site® GelSolosite® GelClear-Site®Duoderm® GelAquaflo®

Primary dressing:• Slough or necrotic wounds requiring chemical

debridement. • Light/moderate exudating wounds, hydrate dry wounds.

94


5. Hydrocolloid dressingsDuoderm Extra Thin®Duoderm CGF®Duoderm® PasteComfeel Plus Transparent®Comfeel Plus® Contour DressingComfeel Plus® Pressure Relieving DressingComfeel® PasteComfeel® Powder

Primary and secondary dressing:• Slough wounds requiring autolytic debridement,

low/moderate exudating wounds.95


Application:• Clean wound base, wipe peri-wound with barrier wipe.• Warm product in hands to activate adhesive.• Place adhesive side to wound. • Leave at least 2 cm border around wound. • Can be left insitu up to 7 days, dependant on exudate

level. • Dressing becomes opaque when due for change.

Contraindications/ Possible Side effects: • Do not apply to infected wounds or if client is allergic. • Remove if patient complains of discomfort.

96


WOUND DRESSINGS REVIEW6. Alginate dressings

Kaltostat®Algoderm®Sorbsan®Curasorb®Kaltocarb®

Primary dressing:• Heavily exudating, bleeding, slough or

infected wounds.97


Application:• Clean wound base• Lightly pack or line the wound, product swells with

exudate. • Avoid pre-moistening the product. • Discontinue use if the dressing remains dry. • Can be left insitu up to 4 days, dependant on exudate

level.• Requires a secondary dressing.

Contraindications/ Possible Side effects: • Do not use on dry wounds as it dehydrates the wound

bed. 98


WOUND DRESSING REVIEW

7. Hydrofiber dressingsAquacel

Primary dressing:• Heavily exudating or infected wounds.

99


Application:• Clean wound base.• Line the wound base with product.• Cover with a secondary dressing.• Can be left insitu up to 7 days, dependant on

exudate level.

Contraindications/ Possible Side effects: • Heavily infected wounds require Hydrofiber

impregnated with Silver. • Do not use in people allergic to hydrocolloids.

100


WOUND DRESSING REVIEW8. Non-crystalline Silver dressings

Acticoat®Aquacel Ag®Actisorb plus® (charcoal)

Primary dressing:• Infected wounds (150 pathogens including MRSA

and VRE), burns, donor and recipient sites.

101


Application:• Clean wound base.• Moisten product with sterile water, daily if not enough

exudate.• Cut to wound size and shape, apply blue side down.• Cover with a secondary dressing.• Can be left insitu up to 7 days, dependant on exudate

level.

Contraindications/ Possible Side effects: • Do not use on people going for a Magnetic Resonance

Imaging.• Do not use in people allergic to silver. 102


WOUND DRESSING REVIEW9. Zinc dressings

Steripaste®Viscopaste®Flexidress®Gelocast®

Primary dressing:• Slough wounds, epithelializing wounds and

to protect limbs at risk of skin tears or degloving. 103


Application:• Cut length as required, usually 3-4 times the size

of the wound .• Fold to make a patch and place over wound. • Requires a secondary dressing.• Can be left insitu up to 7 days.

Contraindications/Possible Side effects: • Allergy to zinc

104


WOUND MANAGEMENT PRODUCTS10. Other dressings

Cadexomer IodineVacuum assisted closure (VAC)

105


REFERENCESSchultz, G.S., Sibbald, R.G., Falanga, V., Ayello, E.A.,

Dowsett, C., Harding, K., Romanelli, M., Stacey, M.C., Teot, L., Vanscheidt, W. (2003) Wound bed preparation: a systematic approach to wound management. Wound Repair and Regeneration, 11(2), S1-S28.

Watret, L. (2005). Teaching wound management: a collaborative model for future education. Retrieved 6 September 2009, from World Wound Wide: http://www.worldwidewounds.com/2005/november/Watret/Teaching-Wound-Mgt-Collaborative-Model.html

106

REFERENCESFalanga, V. (2000). Classification for wound bed preparation

and stimulation of chronic wounds. Wound Repair and Regeneration, 8(5), 347-352.

Falanga, V. (2004). Wound bed preparation: science applied to practice, in European Wound Management Association (EWMA) Position Document, Wound Bed Preparation in Practice, London: MEP Ltd.

Lansdown, A.B.G. (2004). A review of the use of silver in wound care: facts and fallacies. British Journal of Nursing,13(6), S6-S19.

Lineaweaver, W., Howard, R., Soucy, D., McMorris, S., Freeman, J., Crain, C., Robertson, J., & Rumley, T. (1985). Topical antimicrobial toxicity. Archives of Surgery, 120, 267-270.

107

REFERENECEMyers,A.B, (2008).Wound management. Principles and practice.(2nd

ed.)Pearson Education Australia PTY.( pp.71-155)

Bennett, L.L., Rosenblum, R.S., Perlov, C., Davidson, J.M., Barton, R.M., & Nannet, L.B. (2001). An in vivo comparison of topical agents in wound repair. Plastic and reconstructure surgery, 108(3), 674-685.

Carville, K, (2005). Wound Care Manual (5th ed.). Osborne Park, Australia: Silver Chain.

D’Arcy, P.F. (1972). Drugs on the skin: a clinical and pharmaceutical problem. Pharmaceutical Journal, 209, 491-492.

Dealey, C. (2005). The Care of Wounds: A Guide for Nurse (3rd ed.). Oxford, UK: Blackwell Publishing.

Fernandez, R., Griffiths, R., Ussia, C. (2002). Water for wound cleansing. Cochrane Database Systematic Review, 4.

108

wound care lectures

Documents