Week 9 Dressings Flashcards
Why is the goal moist wound bed for healing?
- facilitates all 3 phases of wound healing
- preserves endogenous growth factors (which send cells to the wound area to try and heal)
- Trap endogenous enzymes for autolytic debridement
- Promote formation of more cosmetically appealing scar
- Reduce patients pain
What happens if a wound is to moist?
- maceration
- Additional skin damage
- Increased risk of infection
What happens if a wound bed is to dry
- Desiccation
- Decreased enzyme/growth factors
-Scab/crust formation
What is the purpose of wound bed dressings?
- Create/maintain moist wound environment
- Absorb exudate
- promote homeostasis
- Fill dead space
- Provide thermal insulation
- Allow for debridement of necrotic tissu e
- Prevent or treat infection
Primary dressing
The dressing that comes in contact with the wound
secondary Dressing
- adhere to primary dressing
- Absorb drainage
- provide occlusive environment
- provide protection/cushionin
T/F primary dressings always need a secondary dressing
False
Most Occlusive to least occlusive
Latex
Hydrocolloids
Hydrogels
semipermeable foam
Semipermeable Film
Impregnated Gauze
Calcium Alginate
Fine woven gauze
Loose woven gauze
Air
Alginates: Advantages
- NOT for wounds with exposed tendon, joint capsule, or bone
Advantages: - Highly absorptive,
-easy to use and fill cavities or irregular wound shapes, - encourages autolytic debridement,
-works well with compression bandages, - can be used on infected wounds,
-can remain on wound for several days - Fibers will NOT cause irritation if left in wound
- Can stop Bleeding
Alginates: Disadvantages
- Can dehydrate the wound
- Requires a secondary dressing
- May require irrigation to completely remove
Alginates General Information
- NOT for wounds with exposed tendon, capsule, bone
- Calcium alginate= salts of alginic acid from brown sea weed
- Fibers react with wound exudate and form a hydrophilic gel to provide a moist wound enviornment
- Fluff don’t stuff
Semi-permeable Foams General
- Nonstick, absorbent, sponge like polymer
- Not for infected wounds unless changed daily
Semi-permeable Foams Advantages
-Keeps wound moist and warm
- Provides cushioning
- Permeable to gas but not bacteria
- Promotes autolytic debridement
- Will absorb moderate amounts of drainage but not dry out a minimally draining wound if left in place for extended period of time
- Can be left in place for several days
- Can be used under compression dressing
Semi-permeable Foam Disadvantages
-Adhesive type may damage periwound
- Can roll at edges
- May need secondary dressing
- May macerate periwound as it absorbs fluid
Hydrofibers General
- Highly absorbent non-woven pads or ribbons of sodium carboxymethyl cellulose or rayon/cellulose fibers
- neither an alginate or a hydrocolloid but has benefits of both
Hydrofibers Advantages
- Absorbs moderate to large amounts of drainage
- Works well under compression dressings
- Can stay in place for several days
- Interaction with wound exudate forms a gel
Hydrofibers Disadvantages
- May fuse to bloody wound base
- Can dehydrate wound if there is scant drainage
Hydrocolloids General
- Adhesive wafers composed of gelatin, pectin and carboxymetholcellulose
- During application, best to warm it to get it to adhere
- Occlusive dressing
- Not for infected wounds
- DuoDerm-barrier against incontinence and MRSA, Hep-B, HIV, and pseudomonas
- NOT for wounds with exposed tendon aand fascia
Hydrocolloids Advantages
- Impermeable to bacteria and incontinence/waterproof
- encourages autolytic debridement
- Absorbs minimal amount of drainage
- provides thermal insulation
Hydrocolloids Disadvantages
- Edges can roll
-Adhesive can damage periwound - Can cause hyper granulation
- pectin causes odor upon removal-mistaken for infection
- Leaves residual in wound bed
Hydrogels General
- Not indicated for infected wounds
- Commonly used on blisters, abrasions, skin tears, burns, donor sites, mastitis
- Will dehydrate if not covered correctly
- Skin sealant may be required for peridowound protection
- Water or glycerin based gel, sheet, or impregnated gauze
Hydrogels Advantages
- Donates moisture to wound
- Painless removal
- can soften eschar
Hydrogel Disadvantages
- Minimal absorptive qualities (can donate moisture)
- Non-adhesive requiring secondary dressing
- May macerate periwound
Semipermeable Films General
- Not for infected wounds
-Good for minimally draining wounds, abrasions, skin tears or partial thickness wounds - Breaths like skin, allowing vapor exchanges/doesn’t allow bacteria and urine in
- Indications for change= if channel develops
Semipermeable Films Advantages
- Self adhering
- Can see wound
-Waterproof/incontinence proof
-Impermeable to bacteria - May be used as secondary dressing
- Can stay in place for 5-7 days
Semipermeable Films Disadvantages
- No absorptive qualities
- Poor thermal insulation
- May tear off periwound skin
Silicone Dressings
- Consider usage when having skin tears and fragile skin, skin grafts
- Can reduce friction and sheer injuries
Gauze General
- Non-woven is more absorptive
- Woven gauze can leave lint fibers in the wound
- Finer weaves decrease wound bed trauma
- Usually used in wounds that are infected, require frequent dressing changes, require packing, are highly draining
Gauze Advantages
- Readily available
- Inexpensive
- Increased layers= increased absorption
- Provides cushion
- Can be used with topical agents
- Roll gauze secondary dressing keeps adhesive off of skin
Gauze Disadvantages
- Poorly maintains moist enviornment due to lack of occlusiveness
- Traumatize wound bed upon removal
- Require more frequent dressing changes
- Higher infection rate than occlusive dressing
- needs to be held in place
Impregnated Gauze
- Petroleum= used with burns/ exposed tendon, wont allow tendon to dry out
- Bismuth= antimicrobial properties by being cytotoxic to inflammatory cells
- Iodine= cytotoxic/don’t use it for a prolonged time
- Zinc
- Hydrogel= helps donate moisture to a wound and is very soothing
- Requires a secondary layer
- Good on granulating wounds
Composite Dressing
- combination of 2 or more dressing types
- Inner layer non-adherent
- middle layer= absorptive
- outer layer= bacterial barrier
Interactive Dressings
- Create a moist wound enviornment AND interact with the cells on the wound bed to further promote healing
1. Antimicrobials (silver, honey based dressings)
2. Biologics and Biosynthetic (collagen and polyacrylate dressings) - Impregnated gauze can be an interactive dressing
Antimicrobial Dressings: Silver
- Fights off bacteria
- impregnated for infected wounds or those with high bioburden
- For gram + and - bacteria
- Continuous release so it can be left in place for up to 7 days
- May stain skin or cause sensitization
- No sound research to support its use
Antimicrobial Dressings: Cadexomer Iodine
- its for antimicrobial properties
- Very similar to Silver Characteristics
- Continuous 72 hour release
Contraindications/precautions: - Patient with thyroid disease
- Allergy to shellfish
- large cavity wounds
Antimicrobial Dressings: Honey
- Typically used on a chronic wound that needs a jump start if it is stagnant
- Antimicrobial
- Lowers wound pH which is good for chronic wounds
- Augments Autolytic debridement
Antimicrobial Dressings: Collagen Dressing
- For wounds that need a jump start
- Stimulates macrophages, angioblasts, keratinocytes, and platelets
- Provides collagen framework for cells to grow
- Consider for non-healing category III/IV pressure ulcers
- can donate fluid or absorb drainage
- For clean, uninfected wounds that have just stagnated and need a jump start
Charcoal
- used for odor
- NOT used for wounds with an acute infection
Skin sealant
- Prevents skin stripping upon dressing removal
-Enhances dressing adhesion - Protects skin from maceration
- Pad, swab, or spray used to paint a thin layer of protectant agent onto periwound
Moisture Barriers
- Ointments or creams
- Often used to prevent perineal rashes/skin breakdown
- Can be used on macerated skin
Types of ways to keep a dressing in place
- Tape=
Tubigrip=
Abdominal Binder=
Montgomery Straps=
Growth Factors
- Growth promoting substance that enhance cell size, activity, or proliferation
- Extremly costly
Biological and Biosynthestic Dressings
- dressings derived from natural tissues
- maintain skins natural properties and promote autolytic debridement
- Skin grafts : Auto(from yourself)/ Xeno (from an animal)/ Allo (Cadaver)
