Dressings Flashcards
TIME prinicple
Tissue viable or deficient: debride wound and restore base.
Infection or inflammation: high microbial: antibiotics
Moisture imbalance
Epidermal margin: stimulate migration
Primary vs Secondary Dressings
Primary: comes into contact with wound
Secondary: placed over primary for increased protection, cushioning, absorption, or occlusion
Dressing Considerations
anatomical site bacterial load drainage amount depth edema aggressive vs conservative
Gauze advantages
Various shapes/sizes. Can be used for packing. Can be impregnated. Nonadherent. Primary or secondary Non-selective debridement
Gauze disadvantages
Pain with removal. Can harm healthy tissue. Can dessicate wound bed. Little absorption. No barrier to bacteria.
Not cost effective due to frequency of changes.
Contact layers
Provide wound bed protection with fluid flow through.
May be able to be reused
Usually non-absorptive
Requires secondary dressing
May be impregnated
Transparent films advantages
examples: tegaderm, op-site
Wound visible. 3-5 days. Autolytic debridement Semi-occlusive Waterproof Protect from friction/shear Can be 1* or 2*
Transparent films disadvantages
Minimal absoprtive. Maceration. Skin irritation. Trauma upon removal. Not to use on infection.
Hydrocolloid advantages
“duoderm”, “second skin”
Occlusive Autolytic debridement Minimal-moderate absorbance Can be used with compression 5-7 days 1* or 2*
Hydrocolloid disadvantages
Odor Hypergranulation Maceration Skin irritation Edges roll/melt Not to use with infection, undermining, or tunneling
Hydrogel advantages
Waterbased gel
Moist wound environment Pain management Autolytic debridement Primary dressing Can be used on viable and nonviable tissue.
Hydrogel disadvantage
Variable viscosity
Maceration
Not for heavily draining wounds
Usually requires 2*
Alginates and Hydrofibers advantage
Moderate-heavy draining wound Viable or non-vaible tissue Can assist with debridement Can use compression Can use on infected Can pack wounds Hemostatic
Alginate disadvantages
Dessication
Alginate scab
Foam advantages
Moderate to heavy drainage Semi-occlusive Adhesive or non-adhesive Longer wear time Wick away moisture Protects/insulates Retard hypergranulation
Foam disadvantages
Maceration
Dessication
May require 2* dressing
Expensive
Collagen Dressing advantages
Moderate to heavy drainage
Multiple forms
Reduces MMP
Collagen disadvantages
Bovine ingredients (allergies)
Composites
Two in one dressing: foam with other
Multiple features in one dressing
Various forms/sizes
Combination
Two in one with antimicrobial
Multiple activities with one dressing
May be confusing for caregiver
Silicone gel sheets
Used in maturation phase
Assists with scar management
May reduce hypertrophic scarring
Increase scar mobility
Reduce discoloration
Antimicrobial dressings
Ointments Silvadene Silver dressings Cadexamer Wound cleanser Dakin's Acetic Acid Betadine
Antibiotic ointments
Bacitracin: water based, good for hands and face
Bactroban: effective against MRSA
Neosporin: allergies to neomycin
Silvadene
Sulfa and silver
May look purulent when ready to remove
Can turn wounds dull/gray 2* silver
Silver dressings
Effective against Pseudomonus, MRSA, staph, strep, eterococcus
Can stain
May require activation c sterile water
Change twice for effectiveness against bacteria
Hydrofera blue
Bacteriostatic against MRSA, VRE, staph, ecoli, more
Methylene blue and crystal violet
Requires rehydration
Light/White when ready to be replaced
Only antimicrobial that can be used in conjunction with enzymatic debriding
Cadexamer
Iodoflex and iodosorb: pseudomous, MRSA, strep, staph
Time release Moderate to heavy drainage Assist with debridement Rust colored playdoh on application Yellow applesauce=ready to remove Indicated for sloughy, draining wounds
Honey
Promotes moist wound environment Highly absorptive Cleanses and debrides Lowers pH Non-toxic, natural, safe
Honey indications
DFU VLU ALU Pressure ulcer Superficial burns Donor sights Traumatic wounds
Growth factors
Utilize platelet derived growth factor to stimulate proliferative phase.
Regranex: recombinant.
Indicated for DFU.
Oasis
Biologic: from porcine small intestine
Collagenous ECM c cytokines
Temporary dressing for partial/full thickness loss.
Hydrated on application
Packing wounds
Fill, dont stuff, dead space
Do not traumatize
Use 1 piece if possible
Changes if macerated
Increase dressing change freuqency
Use skin barrier
Use more absorbent dressing
Hand bandaging
Keep bandaging minimal
Each finger individually.
Tubular if sterility not required
Occlusive for small wounds
When to change treatment
No sig change in 2-4 wks
Wound worsening
New odor or drainage
Bleeding
When to stop treatment
Osteomyelitis Recurrent, unresolved erythema Persistent purulent drainage New ulcers Necrosis of muscle, tendon, bone.
