Dressings Flashcards
What are ideal topical treatment/dressing characteristics? (5)
- moist environment
- thermal insulation
- removal w/o trauma
- removes drainage/debris
- maintain clean environment
What does “TIME” stand for?
T = tissue non viable or deficient I = infection or inflammation M = moisture imbalance E = epidermal margin
What is the progression of the “T”
defective matrix/cellular debris – debridement – restore wound base and ECM
What is the progression of “I”
high bacterial counts or prolonged inflammation – antimicrobials – low bacterial counts and controlled inflammation
What is the progression of “M”
desiccation or excess fluid – dressings compression – restore cell migration, maceration avoided
What is the progression of “E”
impairment of epidermal migration and ECM – biological agents cell therapy – stimulate keratinocyte migration
what are the functions of the wound dressings?
- primary (direct contact)
2. secondary (over primary - increase protection, cushioning, absorption or occlusion
When choosing a dressing, what are some things you should consider?
anatomical site, drainage, bacterial load, periwound integrity, depth, edema, aggressive vs. conservative
What are the advantages of gauze?
various shapes/sizes, used for packing, impregnated, nonadherent
What can gauze be used for?
primary or secondary, and nonselective debridement (wet to dry)
What are the disadvantages of gauze?
painful with removal, harm healthy tissue, dessicate wound bed, little absorption, no barrier to bacteria, frequent changes
What type of dressing is “contact layer”
gauze
what does “contact layer” do
provides wound bed protection with fluid flow-through
is “contact layer” absorptive?
no, usually non-absorptive and requires secondary dressing
can “contact layer” be impregnated?
yes
what are the advantages of Transparent films?
wound visible, stays for 3-5 days, promotes autolytic debridement (semi-occlusive), waterproof
what can transparent film be used for?
primary or secondary dressing
What are the disadvantages of transparent film?
minimal absorptive capacity, maceration, promote skin irritation, traumatic on removal,
when should transparent film not be used?
infected wounds (its trapping everything in)
What is another term for hydrocolloid?
duoderm
what does a hydrocolloid do?
interacts with wound fluid
what are the advantages to a hydrocolloid
occlusive dressing - autolytic debridement, absorptive capacity, stays for 5-7 days
what amount of absorptive capacity does a hydrocolloid have?
minimal to moderate absorbent capacity
what can a hydrocolloid be used for?
primary or secondary dressing
what are the disadvantages of a hydrocolloid?
wound odor (interact with infection), hypergranulation, macerate periwound, skin irritation, edges may roll,
when should a hydrocolloid not be used?
infected wounds and wounds with undermining or tunneling
what is a hydrogel?
water based gel
what are the advantages for hydrogel?
moist environment, assists with pain management, autolytic debridement,
when kind of tissue can a hydrogel be used on?
viable and nonviable tissue
What is hydrogel used for?
primary dressing
what kind of wounds are hydrogels “soothing” for?
dry wounds - arterial ulcers
what are the disadvantages of hydrogel?
cause maceration, NOT for heavily draining wounds, requires secondary dressing
what are “alginates”
seaweed derived dressing
what are the advantages of alginates?
assist with debridement, used with compression, infected wounds and packing
what type of wounds are alginates normally used on?
moderate to heavy draining wounds
what type of tissue can alginates be used on?
viable or nonviable tissue
alginates help stop _____.
bleeding
what are the disadvantages to alginates?
dessicate the wound (similar to wet to dry), and cause alginate scab
what type of wounds are foams used for? (drainage?)
moderate to heavily draining wounds
what are foams good for?
wounds over bony prominences
what are some advantages for foams?
semi-occlusive, longer wear time, wick away moisture, protects wound, insulator, retard hypergranulation, used with compression
what kind of environment do foams promote?
warm, moist environment
what are disadvantages of foam?
maceration, dessicate wound bed, secondary dressing
what type of wounds is collagen used for? (drainage)
moderate to heavy draining wounds
what are the advantages of collagen?
reduce MMPs which may attract components for healing
what is collagen designed to do?
absorbed into the wound and “jump start” a stalled out wound
what is the disadvantage of collagen?
sensitivities for bovine material
What are advantages of composites? (foam that has adhesive around it)
multiple function in one dressing, easy to use, various forms and sizes
what are advantages of combinations? (dressing plus antimicrobial)
provides multiple functions
what is an example of a “combination?”
silver (antimicrobial) and alginate or foam
when are silicone gel sheets used?
maturation phase
what are advantages of silicone gel sheets?
scar management, increase scar mobility/elasticity to reduce contractures
when should you use antimicrobial dressings?
wound that is infected (systemic) or critically colonized (local)
what type of debridement is antimicrobial dressings?
enzymatic debridement
what are some examples of antibiotic ointments?
TAO (triple antibiotic ointment), bacitracin, bactroban, polysporin, and neosporin
what is bacitracin?
water based - used for hands and face
what is bactroban effective against?
MRSA
what are the primary ingredients in silvadene?
sulfa an silver
why can silvadene look purulent when ready to remove?
reacts with drainage (serous drainage has absorbed into white cream)
what kind of dressing cancels out silver?
collagenase (enzymatic debridement)
what are silver dressings effective against?
psudomonus, MRSA, staph, strep, enterococcus
What is hydrofera blue effective against?
MRSA, VRE, staph, seratia, e-coli, etc.
what does hydrofera blue require daily?
rehydration - and moisture for removal
hydrofera blue is the only antimicrobial dressing that?
can be used in conjunction with enzymatic debriding ointment
what is cadexamer iodine?
time released iodine so not cytotoxic but antimicrobial
what kind of wounds is cadexamer iodine used for? (drainage)
moderate to heavy draining wounds (iodine is a drying agent)
can cadexamer iodine assist with debridement?
yes
what is the use of cadexamer iodine indicated?
> 50% slough, draining wounds
what does honey promote?
moist wound environment, highly absorptive
Due to its high osmolarity, honey _______ and ________ the wound
cleanses and debrides
what does honey do the wound pH?
lowers it for optimal environment
what are the indications for honey?
DFU, VLU, arterial leg ulcers, pressure ulcers, burns, mixed, donor sits, traumatic/surgical wounds
regranex is an example of?
topical growth factors
what is regranex indicated for?
LE diabetic neuropathic ulcers
what is Oasis an example of?
biological or biosynthetics
what is oasis derived from?
small intestinal submucosa (SIS)
what kind of wounds is oasis indicated for?
partial or full thickness loss, pressure, vascular, diabetic, thermal, or surgical origins
what can you pack wounds with?
calcium alginate, collage alginate, cadexamer iodine, gauze, foam, packing strips
what are skin sealants used for?
additional protection for periwound
what is an example of barrier ointments?
vaseline
what are some periwound considersations?
maceration vs. dryness, irritation, incontinence, trauma, dermatitis, skin prep, moisturizer, antibiotic ointment, moisture barriers, protective dressings and steroid ointments
what are tricks for the finger?
each digit wrapped individually, keep bandaging to minimum, “tubular dressings”
what are tricks for the hand?
occlusive dressing for small wounds, figure 8 for large wounds to minimize bandage for use of extremity
what are tricks for arms/legs?
occlusive dressing for uninfected wounds, nonadherent dressings
what are tricks for the trunk?
short-stretch wraps applied with caution to allow respiratory capacity, “burn vest”
what are the tricks for the abdomen?
Montgomery straps
what are the tricks for ankle/foot
bandaged like hand wound (Figure 8), more absorptive dressings, thick gauze on plantar surface,
when should you change treatment course?
no change in 2-4 weeks, wound getting worse, necrosis debrided with viable tissue present, new odor, new redness/pain, bleeding present, too dry/moist
when should you terminate treatment?
osteomyelitis, recurrent erythema, persistent drainage, necrosis with muscle/tendon/bone involvement, unexplained pain, new ulcers
