Dressings Flashcards
What factors go into dressing a wound?
- Wound type
- Wound depth
- Wound location
- Wound bed description
- Wound characteristics
- Conformability
- Absorption capabilities
- Mass or volume
- Odor absorbing properties
- Antibacterial properties
- Permeability to tissue fluid and microorganisms
- Ease of use
- Pain related factors
- Cost (unit, application, wear time)
What are the benefits of moist wound environment?
- Faster closure
- Less scarring, better cosmesis
- Lower infection risk
- Less painful, more comfortable
- Less caregiver time
- Lower cost
What potential harm can you do with dressings?
- Dehydration
- Reinjury to granulation tissue
- Hypergranulation
- Maceration
- Periwound injury
- Increased pain
- Infection
- Contact dermatitis
Besides the cardinal signs of infection, what signs specific to wounds indicate infection?
- Skin breakdown (wound getting larger)
- Increasing pain/ tenderness in wound area
- Purulent or increasing exudate
- Discoloration of granular tissue
- Delayed healing
- Abnormal or foul smell
When would you use a topical agent?
- infection - esp if superficial and local, and if poorly perfused
- not responding to other tx
- not for routine use or general prophylaxis
What are the 3 main classes of topical agents?
- Antiseptic
- Antimicrobial
- Antibiotic
Topical agent; Cytotoxic to viable cells and can impede wound healing; Limited role – short term use only; Dakin’s solution (deleted bleach), povidine-iodine (betadine), acetic acid (vinegar), hydrogen peroxide
Antiseptics
Topical agent; Cadexomer iodine - Controlled release iodine, Cytotoxic to bacteria but not healthy cells; Silver - Kills bacteria, Limited resistance, Available in nearly every category of dressings
Antimicrobials
Topical agent; Bacitracin
Neosporin (triple antibiotic); Silvadene (silver sulfadiazine) - Cream, Indicated for burns, Check for sulfa allergy; Systemic drugs are often superior to topical agents because of better penetration
Antibiotics
What are basic dressing principles?
- If it’s wet – Absorb it
- If it’s dry – Hydrate it
- If there’s a hole – Fill it
- If there’s necrotic tissue – 5. Remove it
- If there’s healthy tissue – Protect it
What is the difference between primary and secondary dressings?
Primary Dressing = Covering applied directly to the wound
Secondary Dressing = Used over a primary dressing to secure it
What is the difference between non-occulsive/ permeable dressing and occlusive/ impermeable dressing?
Non-occlusive or permeable dressings = Moisture and gases able to escape from wound easily
Occlusive or impermeable dressings = Moisture and gases unable to escape from wound
What are the dressing categories?
- Alginates*
- Collagens
- Composites*
- Contact Layers
- Foams*
- Gauze
- Honey*
- Hydrocolloids*
- Hydrofibers*
- Hydrogels*
- Transparent Films*
Description - derived from seaweed which is spun into rope or flat dressing
- Action – forms a gel when they come in contact with exudate/moisture, absorbs up to 20x its weight, gently fill in dead space (tunneling)
- When to use – moist red or yellow wounds, moderate to heavy exudate, infected wounds, tunneling wounds
Alginates
- Advantages – moldable, absorbent, non-adherent, easy to use, provides moist wound healing
- Disadvantages – expensive for large wounds, not for use on dry wounds or eschar, requires a secondary dressing
- Frequency – change every 1-3 days, can be left in place up to 5 days
Examples – sorbsan, kaltostat, algicell, curasorb – ropes or sheets
Description – freeze dried sheets of collagen, particles, pastes, or gels usually derived from cowhides
- Action – stimulate new tissue growth and encourages granulation tissue
- When to use – primary dressing for partial/full thickness wounds, tunneling wounds, minimal to heavy exudate, skin grafts, donor sites, infected, granulating, or necrotic wounds
Collagens
- Advantages – absorbent, non-adherent, easy to apply and remove, moldable, may be used in infected wounds
- Disadvantages – requires secondary dressing, cannot be used for 3rd degree burns or eschar
Examples – fibercol, BGC Matrix, CellerateRX, Stimulin, Promogran Matrix
Description – combination of 2 or more distinct products manufactured as a single dressing that provides multiple functions
- Action – autolytic debridement, allow exchange of moisture vapor
- When to use – primary or secondary dressing, partial to full thickness, minimal to heavy exudate, infected, granular, or necrotic wounds
Composites
- Advantages – molds well, easy to apply and remove, adhesive border, may use on infected wounds
- Disadvantages – require border of intact skin to anchor dressing
Examples – covaderm, alldress, telpha island, stratasorb
Description – thin, non-adherent sheets placed directly on wound bed to protect wound tissue from direct contact with other agents or dressings, porous to allow fluid to pass through
- Action – protect wound base from trauma during dressing changes, introduce topical medications or wound fillers into wound
- When to use – primary dressing for partial and full thickness, exudative wounds, donor sites, split thickness skin grafts
Contact layers
- Advantages – protects wound base, can use with topical medications
- Disadvantages – not recommended with shallow, dehydrated, or eschar covered wounds, requires a secondary dressing
Examples – tegapore, dermanet, mepitel, telpha clear, adaptic touch
Description – composed of polymers that contain small open cells capable of holding fluids and pulling them away from wound bed, waterproof outer layer, highly variable category (thin and thick versions)
- Action – provide moist wound environment, permeable to water vapor, absorbent depending on thickness, helpful for hypergranulation tissue
- When to use – moderate to heavy exudate, red granular wounds, softened necrotic tissue, shallow draining wounds, may be used under compression, infected wounds
Foams
- Advantages – provide moist wound healing, provides cushioning, can be used with infected wounds, effective with hypergranulation if used with compression
- Disadvantages – expensive if daily dressing change, not for full thickness burns or tunneling wounds, may require secondary dressing, may dessicate wound bed
Examples – allevyn, curafoam, flexzan, LYOfoam, polymem
Description – woven and non-woven fibers of cotton, rayon, polyester
- Action – used for cleansing, packing, and covering wounds, used as a secondary dressing
- Most widely used wound care dressing
Gauze
- Landmark study showed dry gauze dressings have little value for optimal wound management
- There are better more appropriate choices in wound care now
Description – various dressings made with medical grade medium; Gel, paste, alginate, or hydrocolloid mediums
- Actions – promotes moist wound by pulling fluid to wound bed, assists in autolytic debridement, lowers pH in the wound slowing bacteria growth, increases local perfusion
- When to use – diabetic, venous, arterial, pressure, 1st and 2nd degree burns, donor sites, traumatic and surgical wounds
Honey
- Advantages – non-toxic, natural, safe, easy to use, some can be used in pediatrics
- Disadvantages – may sting briefly, sensitivity to honey/bees, monitor patients with diabetes due to sugar content
Examples – MediHoney, Manuka products
Description – wafer dressing containing gel-forming agents in an adhesive compound laminated onto a flexible water resistant outer layer
- Action – occlusive dressing (nothing in nothing out), provides moist healing environment, autolytic debridement
- When to use – protect intact skin or newly healed wounds, non-infected wounds with scant to moderate drainage, necrotic or granular wounds, dry wound, partial or full thickness
Hydrocolloids
- Advantages – adhesive and moldable, impermeable to bacteria, easy to use, long wear time, somewhat waterproof
- Disadvantages - not for heavy exudate or infected wounds, curling at edges, odor with removal, may injure fragile skin with removal
Examples – duoderm, replicare, tegasorb, restore, comfeel
Description – soft, sterile, non-woven pad or ribbon, cellulose-based dressing combo between hydrocolloid and alginate
- Action – absorbs large amounts, fluid is turned into a soft gel
- When to use – all moderately to highly exudating chronic or acute wounds, infected wounds
- Can remain in place for up to 7 days
- Gels with absorption
Hydrofiber
- Advantages – absorbs and retains exudate and bacteria, fluid remains confined to a small area preventing maceration, can remove without tissue trauma, aids in autolytic debridement
- Disadvantages – can be costly for large wounds, requires secondary dressing
Examples – Aquacel, Aquacel AG, Versiva XC
Description – 90% water in gel base found in sheet, gel form, or impregnated gauze
- Action – donates moisture to wound, moist healing environment, promotes granulation and autolytic debridement, pain control
- When to use – dry wounds, softening eschar, cooling painful wounds, partial and full thickness wounds, abrasions, minor burns, granulating or infected wounds
Hydrogels
- Advantages – cooling and soothing, promotes autolytic debridement, can be used on infected wounds, fills in dead space
- Disadvantages – may require secondary dressing, may cause maceration, can be difficult to secure, not for heavily draining wounds
Examples – curasol, solosite, nugel, duoderm hydroactive gel, vigilon, transigel
Description – transparent sheets of polyurethane coated with an adhesive
- Function – act as a blister roof and provide moist environment, promote autolytic debridement and protect wound bed from mechanical trauma and bacterial invasion
- When to use – surface wounds with minimal drainage or full thickness wounds covered with eschar, non-infected wounds, granular wounds, wounds with scant to no drainage, secondary dressing
Transparent films
- Advantages – able to visualize wound base, comfortable, excellent bacterial barrier, water resistant, provides moist wound environment and promotes autolytic debridement, mostly waterproof
- Disadvantages – not to be used with moderate to heavy exudate, infection, or fragile skin
Examples – tegaderm, opsite, biocclusive
Removal – pull parallel to skin
What are the supportive products available for dressing wounds?
- Prescription products - Santyl – only enzymatic debrider in US
- Skin substitutes - Artificial alternatives to skin grafts
- Skin sealants - Liquid/cream barriers to prevent maceration of periwound
- Wound cleansers - Saline
- Secondary dressings -Medical tape, Roll gauze – kerlix, Cohesive bandage – coban, Tubular dressing - spandage
Gauze impregnated with a thick, creamy mixture of calamine and zinc oxide that hardens once applied; Used for the treatment of venous insufficiency ulcers; Helps to protect the wound and provide compression; Patient must be up on feet for it to work
Unna’s Boot
