Vicki's wound care Flashcards
indications for alginates
want to have a lot of moisture because it wicks it up
looks like grandma’s whool sweater
helps prevents peri wound
trauma free removal
what are the disadvantages of aliginates
- Requires a secondary dressing à usually gauze on top
- can’t just put a it on and call it a day
- Dessicates minimally exudating wounds
- otherwise you are going to dry it out.
how long can you leave an alignate product
- , can leave in place up to a week
difference between a kelix and conform roll
- Kerlix-roll, no stretch
- Conform-roll, has some stretch
what are some of the disadvantages if gauze
- Can dry out wounds/evaporative à too dry
- Wicks in all directions
- Fibers shed
- Requires secondary – inc $
- Requires frequent changes – inc $
- Traumatic removal when adhered – gets stuck
- Poor temperature retention
why do we use silver? why it better than hydrogen peroxide and what activates it?
disrupts bacteria
silver ions are continuously delivered
non cytotoxic and does not affact the host
(use to use hydrogen peroxide but that is a big no no now because it kills the good stuff too)
silver containing products are activated by moisture
know what it is becuase it contains “Ag” in it
advantages of foam dressings
can help retain heat
indications for foam
- Exudating wounds (min to mod)
- Primary or secondary
- Sinus tracts, tunnels, cavities
- Infected wounds (w/antimicrobial)
- Granular wounds
disadvantages of foam
- Wicks in all directions
- Requires secondary
- Maceration over intact skin –> causes it to grow thinner and deteriorate
- Less absorptive when compressed
May adhere
need to look at how much fluid and exudate you have
indications
Hydrofera blue
- Gentian violet/methlyene blue foam
- Rehydrate w/NS
- Bacteriostatic (even MRSA and VRE)
- Highly absorptive
Does not affect growth factor and enzymatic dressings
this is an instance where you would need to wet it
inidcations for hydrocolloid
–Exudating wounds (min)
–Primary dressing
–Sinus tracts, tunnels
–Supports autolytic debridement
–Granular or necrotic
–Pressure ulcers–> MC to prevent from developing into stage 2 or 3 SACRAL AREA
–Protection from incontinence
CHARACTERISTICS of hydrocolloid
–Absorbent (thick)
–Occlusive; autolytic environment
–Promote moist environment
–Protect from external contamination
–Infrequent dressing changes
–Various thickness and shapes
disadvantages to hydracolloid
–Periwound maceration
–Growth of anerobes
–Odor of solublized necrotic tissue
–Broth often mistaken for purulence
can also leave on for a week
probably don’t want to use on really open wounds
characteristics of hydrogel
–Dry and exudating wounds (min)
–Primary dressing REQUIRED
–Sinus tracts, tunnels
–Supports autolytic debridement
–Most wound types (including radiation)
–Infected wounds (w/antimicrobial) although most people just carry plain hydrogel.
- can use in exposed tendon
–Soften eschar/necrotic tissue
–Hydrate wound bed
–Non-adherent
–Conformable (gel and sheets)
–Supports autolytic debridement
–Trauma/pain-free removal, sheets cool
periwound disadvantages
–Periwound maceration
–Requires secondary
–Not for heavily draining wounds
–May need frequent changes
non-adherent dressings
–Painful dressing changes
–Protect healthy tissue
–Painful dressing changes
–Protect healthy tissue
disadvantages of non-adherent dressings
–Non-porous type may macerate
–Petrolatum type may macerate
when would you use transparent film (tegaderm)
–Anchor IV sites
–Stage I pressure ulcers
–Reduce friction
–Donor site dressing for STSG (split thickness skin grafts)
nice for folks that want to take a shower
benefits of transparent film
–Visualize tissue beneath dressing
–Very thin, comfortable
–Adhesive usually well tolerated
–Used to secure other dressings
disadvantages of transparent film
–Non-absorbent
–Adhesive may tear fragile skin
composite indications and benefits
–Post-op wound coverage
–Non-to-slightly exudating wounds
–primary
•Convenience combining products
–Save time combining products
composite disadvantages
–Adhesive may tear skin
–May macerate tissue if Telfa present
“pretty transparent film + gauze”
types of debriedmant
•Mechanical- gauze
•Sharp-tissue nippers, scalpal curret
•Enzymatic-
•Ultrasonic- pulse water (very comfortable but this is a specialized clinic thing)
•Biologic (yes, maggots)
optimal pressure for irrigating debriedmant
- Mechanical
- Sharp
- Enzymatic
- Ultrasonic
- Biologic (yes, maggots)
whirpool irrigation is CI in
•Whirlpool is contraindicated in lower extremity wounds*
increase venous congestion and insuffiency
•Santyl collagenase is a
enzymatic debriedmant
when would enzymatic debiredmant be indicated
how would you use it (what would you not use)
–Looks like vaseline. Use nickel thickness, cover w/NS moistened gauze
•Use on necrotic tissue
collagenase
you can’t just throw gause over it and you CAN’T USE WITH SILVER need to cover in NS moisened gauze
need to change EVERY DAY
use a tongue depressor
Topical products
•Iodosorb- iodine based used ot DM foot ulcer
•Iodoform-gauze with iodine
•Acetic acid-vinegar
•Dakins solution- watered down bleach
•Betadine
Iodosorb
baby poop for DM foot ulcers that can be left in for about a week
endoform, oasis, and integra
•Extracellular matrix (skin substitute)
–Don’t use if sensitivity to porcine or bovine products
–Must be undisturbed for several days (7 ideal)
–Needs moist environment–hydrogel
she has used endo derm to close stubborn wounds. it is better because it does not have as short of half life as others
•Human amniotic membrane
–Epifix
you need granulation and slough off to use dermal substitutes
use like the others
•Epibole
–This is tissue which has rolled under at the edges and causes wound to think it’s healed, but it’s not
management of a epibole
harp debridement of the edges, may need a scalpel, or may be able to just use a currette, or silver nitrate sticks
when would you see hypergranulation tissue
- Usually due to too much moisture
- Treatment options-silver nitrate sticks, high density foam, antimicrobial dressings and or/surgical intervention
management of exposed tendon
- Only sharply debride black necrotic tissue tangentially
- MUST keep it MOIST! Use plenty of hydrogel here!
use hydroge;
whta would you use
santyl (enzymatic debriedmant)
what owuld you use on theis highly exudative wound
alginate
•Non-progressing ankle wound- what would you use
foam
endoform
cellutoam
•Diabetic foot ulcer
iodosorb (baby poop)
debried
•Stage 1 pressure ulcer on sacrum
tegederm
hydrocolloid
1st degree and 2nd degree
1st degree-bacitracin or tegaderm or regranix (growht factor)
Hypergranulation tissue mangement
silver nitrate sticks or foam
venous stasis mangement
compression
•Heel eschar
leave it alone and offload
Slough- what is it and how would you manage
- Matrix of cells, fibrin, bacteria, cell debris, leukocytes and exudate
- May be yellow, white, gray, beige tan and or green (pseudomonas?–> DAKINS
- May be crusty, slimy, dry, rubbery, hard or soft
- Fibrin slough-aka a thin layer of slough
Non-viable and needs to be debrided
not eschar not hypergranualtion or granulation (beefy tongue)
