10] Dressings Flashcards
Functions of dressings (5)
Act as a barrier to bacteria
Provide cushioning and protection from shear and compression forces
Decrease pain
Provide for enzymatic or autolytic debridement
Maintain moisture balance
If there is necrotic tissue you want to choose a dressing that promotes?
Autolytic debridement
Examples of autolytic debridement dressings (9)
Hydrogel Hydrocolloid Alginate Foam Silver Silicone Hydrofera blue Unna boot Medihoney
What does NICE stand for
Necrotic tissue
Infection/inflammation
Characteristics
Exudate
A type of dressing you can use in infected wounds
Antimicrobial (silver) dressing
What characteristics should you consider? (3)
Incontinence
Location
Amount of time dressing can be left in place
E- exudate
Match amount of absorbable to drainage
Primary dressings
In contact with the wound
Secondary dressings
Secure primary dressing in place or absorbs excess moisture
When packing wounds.. (3)
Fill it
Dont stuff it
Try to use just 1
Traps wound debris, absorbs exudate from wound
Gauze
Is gauze primary or secondary
Secondary
Advantages of gauze (2)
Good cost
Can be used on infected or non-infected
packing adheres to wound bed; frequent dressing changes; increased infection rate compared to occlusive dressings; no barrier to bacteria
Disadvantages of gauzes
What is transparent film?
Thin membrane permeable to vapor and oxygen but not to bacteria and water
Is transparent film primary or secondary
Secondary
Consider as secondary dressing for ulcers treated with wound fillers that will likely
remain in ulcer for an extended time period
Transparent film
Used for partial or shallow full-thickness wounds; granular or necrotic; minimal
exudate
Hydrocolloid
Consist of gel-forming polymers that absorb exudate
Hydrocolloid
Protect body areas at risk for friction injury orinjury from tape
Transparent film
Adhesive backing adheres to skin surrounding the wound
Hydrocolloid
Do not use as cover over enzymatic agents, gels or ointments
Transparent film
Remove carefully from fragile skin
Transparent film
Advantages of Hydrocolloid (3)
Moist environment- autolytic debridement
Protection
Moderate absorption
May roll in areas of friction; damage to skin of periwound; cannot be used on infected or deep wounds; should not be used on skin tears!
Disadvantages of Hydrocolloid
Two sides of foam
Wound side is hydrophilic and outer surface is hydrophobic
What two types of foams are available
Adhesive and no adhesive
Foam can be left on for
3-4 days
5 advantages of foam
Moist environment Cushions Autolytic debride-mod to heavy absorb Thermal insulation Protects from periwound maceration
Disadvantages of foam (3)
May roll in friction areas
Damage to periwound
Not transparent
What are alginates
Highly permeable, non-occlusive
Alginates are used on what kinds of wound
Partial and full thickness
Contraindications for alginates (4)
Vasculitis
3rd degree burns
Dry wounds
Escher
Advantages: absorb heavy drainage; use on infected or non-infected wounds; can promote autolytic debridement; Can pack Can do hemostasis
Advantages of alginates
2 disadvantages of alginates
Needs secondary dressing
Frequent changes
What is hydro fiber made from and what does it interact with
Made from Na carboxymethylcellulose and interacts with exudate and forms a gel
Advantages of hydro fiber (3)
Highly absorptive, can be placed over or in wounds, hemostasis
Disadvantage of hydrofiber
Needs secondary dressing
What is hydrogel
Sheet or amorphous form
Hydrogel assists
Autolytic debride
Hydrogel is contraindicated for
3rd degree burns
Indications: minor burns, skin tears, venous ulcers, surgical incisions, diabetic foot ulcers, pressure ulcers
Hydrogel
Disadvantage of hydrogel (2)
Can’t be used with mod/heavy drainage
Dressing Might dehydrate
Non-adherent dressings help to
Retain moisture
Non-adherent dressings can be placed ?
Directly over the wound/hydrogel/skin graft
Examples of non-adherent dressings (3)
Oil emulsion
Petroleum based
Vaseline gauze
Immediate and sustained release of ionic silver
Silver dressing
Silver dressings is an effective barrier to?
Penetrating bacteria
Silver dressings is used for?
Infected or highly colonized wounds
Advantage of silver dressing
Stops pathogen growth
3 disadvantages of Silver dressings
Can’t use with enzymatic debriders, topical meds or oil
Secondary needed
Dont use with cellulitis
Bacteriostatic dressing
Methylene Blue and Gentian Violet
Effective against MRSA and VRE
Hydrofera blue
Hydrofera blue must be?
Changed every 3 days or when dressing turns white
Absorbency of hydrofera blue
High
Wound types for hydrofera blue
All types EXCEPT 3rd degree burns
Reduces bacterial load in wound environment, i.e. MRSA
Cadexomer iodine dressing
Removes loose slough and debris
Cadexomer iodine dressings
Manages excess exudate in highly exudate wounds
Cadexomer iodine dressings
Avoid iodine in
Large cavity ulcers that need daily changes
Can you pack iodine in wounds?
Yes
Consider as would contact layer to promote atraumatic dressing changes
Silicone
When would you use silicone?
To prevent tissue injury when ulcer/periwound is fragile
Enzymatic debride aka
Santyl
EzD santyl is what?
Chemical agent that breaks down devitalized tissue
Santyl is used for
Wounds with necrotic tissue- infected or non
What do you need a prescription for?
EzD- santyl
Silver nitrate
Advantage of santyl
Surgery alternative
3 disadvantages of santyl
Daily dressing change
Inactivated by wound cleanser
Needs secondary
% of silver nitrate
75% silver nitrate
25% K nitrate
Silver nitrate is used on
Hypergranulation tissue
How do you do silver nitrate
Apply tip to moist wound and drag around until grey
Antimicrobial; keeps wound bed moist, allowing for autolysis of eschar
Silvadene
Changes for silvadene
Daily to BID
Silvadene indicated for
Burns, road rash
Does silvadene need a Rx?
YES
What to remember with silvadene?
allergies!!
4 types of tape from most to least harsh
Silk
Plastic
Paper
Foam
Silk aka
Durapore
Plastic aka
Transpore
Paper aka
Micropore
Foam aka
Micro foam
Lowers pH to decrease inflammation, inhibit
bacteria growth, and increase oxygen diffusion
Honey
Honey impregnated dressings can be used on
All types of wounds
1st and 2nd degree burns
Typical wear time of honey
3 days
Indications for honey (4)
Necrotic tissue
Foreign bodies
Wound infection/biofilm
Autolytic debride
Most occlusive to least occlusive
Hydrocolloid Hydrogel Foam Film Impregnated gauze Alginate Normal gauze
Moisture retention from most to least
Alginate Foam Hydrocolloid Hydrogel Film
High adherence to low to skin
Silk
Plastic
Paper
Foam
Dressings you CANT use with infected wounds (3)
Transparent film (not as primary)
Hydrocolloid ( no pus!)
Silicone