Dressings

Question 1

What factors go into dressing a wound?

Answer 1

1. Wound type
2. Wound depth
3. Wound location
4. Wound bed description
5. Wound characteristics
6. Conformability
7. Absorption capabilities
8. Mass or volume
9. Odor absorbing properties
10. Antibacterial properties
11. Permeability to tissue fluid and microorganisms
12. Ease of use
13. Pain related factors
14. Cost (unit, application, wear time)

Question 2

What are the benefits of moist wound environment?

Answer 2

1. Faster closure
2. Less scarring, better cosmesis
3. Lower infection risk
4. Less painful, more comfortable
5. Less caregiver time
6. Lower cost

Question 3

What potential harm can you do with dressings?

Answer 3

1. Dehydration
2. Reinjury to granulation tissue
3. Hypergranulation
4. Maceration
5. Periwound injury
6. Increased pain
7. Infection
8. Contact dermatitis

Question 4

Besides the cardinal signs of infection, what signs specific to wounds indicate infection?

Answer 4

1. Skin breakdown (wound getting larger)
2. Increasing pain/ tenderness in wound area
3. Purulent or increasing exudate
4. Discoloration of granular tissue
5. Delayed healing
6. Abnormal or foul smell

Question 5

When would you use a topical agent?

Answer 5

1. infection - esp if superficial and local, and if poorly perfused
2. not responding to other tx

• not for routine use or general prophylaxis

Question 6

What are the 3 main classes of topical agents?

Answer 6

1. Antiseptic
2. Antimicrobial
3. Antibiotic

Question 7

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

Answer 7

Antiseptics

Question 8

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

Answer 8

Antimicrobials

Question 9

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

Answer 9

Antibiotics

Question 10

What are basic dressing principles?

Answer 10

1. If it’s wet – Absorb it
2. If it’s dry – Hydrate it
3. If there’s a hole – Fill it
4. If there’s necrotic tissue – 5. Remove it
5. If there’s healthy tissue – Protect it

Question 11

What is the difference between primary and secondary dressings?

Answer 11

Primary Dressing = Covering applied directly to the wound

Secondary Dressing = Used over a primary dressing to secure it

Question 12

What is the difference between non-occulsive/ permeable dressing and occlusive/ impermeable dressing?

Answer 12

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

Question 13

What are the dressing categories?

Answer 13

1. Alginates*
2. Collagens
3. Composites*
4. Contact Layers
5. Foams*
6. Gauze
7. Honey*
8. Hydrocolloids*
9. Hydrofibers*
10. Hydrogels*
11. Transparent Films*

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

Gauze

• Landmark study showed dry gauze dressings have little value for optimal wound management
• There are better more appropriate choices in wound care now

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What are the supportive products available for dressing wounds?

Answer 25

1. Prescription products - Santyl – only enzymatic debrider in US
2. Skin substitutes - Artificial alternatives to skin grafts
3. Skin sealants - Liquid/cream barriers to prevent maceration of periwound
4. Wound cleansers - Saline
5. Secondary dressings -Medical tape, Roll gauze – kerlix, Cohesive bandage – coban, Tubular dressing - spandage

Question 26

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

Answer 26

Unna’s Boot