Wound care Flashcards
Woven gauze
100% cotton gauze. Good for debridement, wicks vertically, high loft/bulk.
Nonwoven gauze
Synthetic gauze comprised of polyester for non-adherence and rayon for absorbency.
Lower lint, less adherent, horizontal wicking.
U.S. Guaze
• Tested and proven hypoallergenic – safe for patient use w/ any skin type
• USPVII (US Pharmacopeia’s Standard) – often “exceeds” the national standards set
o Testing includes: Chemical purity, thread count, absorbency, sterility, etc…
• Machine Folded vs. Hand Folded – Limited human hands leads to less risk of contamination
• US Cotton Crops Rotated – no slash/burn technique means no risk of p.domesticum
• Tested for endotoxin/pyrogen levels (dead cellular bugs) – less debris and risk of contamination provides cleaner, safer gauze
• Manufacturing is rotor spinning – less debris and higher levels of absorbency
• Air jet loomed – virtually no friction – less lint and better chance of blowing out debris
Import Gauze
- Usually “meets” USPVII standards.
- Fields are slashed/burned – elevates risk of p.domesticum, a mold found in the burned residue in soil, can only be killed by steam sterilization
- Questionable Agricultural Practices – fertilizing, harvesting, shipping/handling of crops
- Higher levels of endotoxin/pyrogen levels (dead cellular bugs) – debris increase risk of contamination
- Manufactured with Ring Spun Technique – potentially traps debris and offers less absorbency
- Shuttle Loomed – Friction caused by Shuttle = increased lint
U.S. vs Import Gauze: Talk Track
- Cotton is grown as a plant – talk about crop rotation vs. slash/burn, questionable fertilization techniques in china
- Harvested cotton is spun into thread – discuss F/B of rotor vs. ring spinning
- Thread is woven into a fabric – discuss F/B of air jet loomed vs. shuttle loom
- Fabric is folded and cut into dressings – discuss F/B of hand vs. machine folding
- At this point you check for customer buy-in/agreement that US dressings are clinically superior.
- Next you address financial implications that can occur from using sub-par dressings..specifically addressing the “silo” talk track
- And this gives you a lead in to explain our blended strategy approach.
Dermacea
value brand gauze
• Cost savings alternative
• Made in China, using either Winner or Allmed (company that Medline uses) =if they use medline product, Dermacea will be clinically acceptable.
• Consistency – only using two mfgs in China
• Sterility – all Dermacea products are steam sterilized, steam is the only way to kill p.domesticum
• Absorbency – we are not as absorbent as our American line, but just as absorbent as all the other Chinese brands….at least we are up front about that and offer two options.
• Blended Strategy Approach
Blended Strategy
Customer is adamant about saving money in TWC. You can use Curity for those codes being used in direct patient contact, and use Dermacea for the non-clinical codes… Promotes cost saving, but doesn’t sacrifice patient care.
Substrate
Backing on the tape/ adhesive. It’s the material that anchors the adhesive.
Two types of adhesive technology?
- Hotmelt (medline) - starts with a solid “block” of glue, adhesive is applied by direct coating at high temps, then cured by rapid cooling (hot glue gun).
- Solvent (3m, Kendall) - acrylic adhesive applied through polymer disbursement, substrate given a “bath” on one side, adhesive cured by heating at high temps.
Differences in the two adhesive technologies?
- Hotmelt is a cheaper alternative
- solvent requires a more sophisticated manufacturing process
- solvents degrade less over time
- solvents are more resistant to temperature changes
- solvents are more resistant to fluids
- solvents are more conformable
- solvents feature higher breathability
Tape: Paper
Used for fragile skin, lightweight tube or dressing securement.
Tape: Cloth
Securement for dressings & ostomy pouches, securement over areas where skin may stretch.
-Breathable
Tape: Clear
Securement for tubing, bi-directional tear is easy to customize length/width.
Tape: Standard porous tape
High initial adhesion for secure of tubing/devices.
-Works well for finger/toe immobilization.
Tape: Water proof
Dressing protection, outpatient use.
-Easy to write on
Tape: Cohesive Bandages
Compression dressing, securement of anything… tubes, dressings, splints, etc.
Tape: Curasilk
Immobilization of joints/limbs, strong adhesion is essential
Curi-strips
Adhesive stitches, used for wound closure.
Skin Anatomy: What are the 5 layers beginning from outer most layer.
- Epidermis
- Dermis
- Subcutaneous Tissue
- Fascia
- Muscle
Epidermis
thin, outermost layer
Dermis
thick, sensitive layer, contains sweat glands, nerve endings, and is vascular (contains blood & lymph vessels).
Subcutaneous Tissue
Primarily made of adipose (fat) tissue.
Fascia
Connective tissue that forms a coating around each muscle, holding fibers in place
Muscle
Tissue that contracts and relaxes to produce movement, maintain tension, or pump fluids within body.
What are the 4 stages of wound healing?
- Debridement
- Granulation
- Epithelialization
- Maturation
Debridement
The wound area is cleared of dead tissue and debris before healing commences.
Granulation
The volume is filled in by new dermal like tissue.
Epithelialization
New epidermis migrates across the wound
Maturation
New epidermis and new dermis mature in structure and become functional.
What are the four different types of Ulcers?
- Diabetic- caused by trauma or pressure related to the neuropathy or vascular disease associated with diabetes.
- Venous Statis- Occurs over or near ankle joint, cause by edema and impaired venous blood return.
- Arterial- Caused by ischemia (deficient blood supply to tissue)
- Pressure- Ischemia caused by pressure
Stages of Pressure Ulcers?
Stage I - intact skin, non-blanchable redness
Stage II- partial thickness, shallow open ulcer or serum filled blister
Stage III- full thickness, subcutaneous visible
Stage IV- full thickness, exposed bone, tendon, or muscle.
Unstagable- full thickness, base of ulcer is covered by slough or eschar so you can’t gauge depth.
What are the 5 types of Debridement?
- Autolytic- Body’s self digestion by action of enzymes present in wound fluids
- Biological- Sterile maggots
- Enzymatic- Chemical debridement by use of enzymes.
- Mechanical- Physical force such as wet to dry dressings, wound irrigation, or whirlpool.
- Sharp- Scalpel, laser.
Moist Wound Healing (MWH)
- Conceptualized in 1960
- Epithelial cells need moisture to migrate and spread
- MWH wounds heal quicker, scar less, have less pain.
- MWH is a balance between giving moisture and absorbing excess to prevent maceration.
Kendall Foam: Softness
3x softer than market leading allevyn products.
-Provides maximum patient comfort
Kendall Foam: Absorption/Fluid Capacity
Most absorbent foam in market.
- Leads to longer wear times
- Less expense
- As it absorbs fluid, foam is pulled down into wound bed to fill dead space and help promote healing.
Kendall Foam: Small Cell Size
Outer surface of foam is made up of small cells to reduce the chance of tissue migration into the dressing.
-Causes trauma upon dressing removal
Kendall Foam: Application & Use
Partial thickness wounds, skin tears, abrasions, lacerations, ulcers, draining wounds.
Kendall Foam: Competition
Allevyn, Lyofoam, Ploymem, Mepilex, Optifoam.
Kendall Foam: Talk Track
-Positioned as the “Ultra-soft foam wound dressing with super absorption and superior feel”. Kendall Hydrophilic foam dressings provide ideal moist environment for variety of wounds.This highly absorbent, non-linting dressing is designed to protect and cushion moderate to heavily exudating wounds. Kendall Foam Dressings are semi-occlusive allowing the exchange of gases such as oxygen and water vapor.
Its soft, flexible nature allows the dressing to conform easily to all body contours. Kendall Foam Dressings are non-adherent, making dressing changes easy and comfortable.
Kendall Foam Dressing with Top Sheet features polyurethane top sheet in yellow, pairing super absorbency with effective strike-through prevention. It is also available in Island, Fenestrated and various sizes and can be cut to accommodate hard to dress areas.
TWC Call Points
start with DON, find out if WOCN has a say in this decision, bring materials in for financial/logistical discussions for conversion
AWC Call Points
start with the WOCN, bring in materials for financial/logistical discussions on a conversion
AMD Call Points
start with the ICP, decide how dressings will be used you may need to bring in WOCN or Key Physicians, always bring in materials for financial/logistical conversations on a conversion
• WOCN – main goal is healing/treating wounds
• ICP – looking for products that lower infection rates, prevent infections
Gram Staining
turns bacteria color to help differentiate them into two large groups, gram-positive and gram-negative, generally gram-negative bacteria are more dangerous disease organisms
Log Counts
are used when counting bacteria because of the large number that can be in a specific small area, it’s on a base 10 scale
Log Reduction
10x reductions of bacteria
Infection
log count of 10^5 or higher
Colonization
Log count of 10^3
-Organisms are present, but not at a high enough log count to begin causing disease or infection
Antimicrobials
Generic term for agent that kills or inhibits microorganism replication
Antibiotic
Ingestable bacteria fighting drug. Penicillin, methicillen
Antiseptic
PHMB, Iodine, betadine
Antibacterial
Bacitracin, silver sulfadiazine (thermazine)
Antibiotic Resistance
Ability of microorganism to withstand effects of an antibiotic. (lock & key mechanism)
PHMB
Polyhexamethylene Biguanide
MRSA
Methicillin Resistant Staphylococcus Aureus
VRE
Vancomycin Resistant Enterococci
Fungus
Yeasts, molds, mushrooms
Candida
Form of yeast
Psuedomonas Aeruginosa
Gram Negative
Acinetobacter Baumannii
Gram Negative
Clostridium Difficile
C-diff, gram positive
5 AMD Claims
- Effective against gram + and gram - bacteria
- Prevents bacterial growth and penetration through dressing
- Does not negatively impact epithilization
- Barrier function may help to reduce infections in partial and full thickness wounds
- 510k clearance for sale of AMD as both primary and secondary dressing
AMD Contraindications
- AMD should NOT be used with Dakin’s solution, or bleach solutions
- Use of PHMB and Dakin’s (or bleach solution) deactivates and neutralizes the polymer.
AMD Product line
- 6 TWC
- 2 AWC
- Kerlix AMD Rolls
- Kerlix AMD Super Sponges
- Telfa AMD Dressings
- Excilon AMD Drain Sponges
- Curity AMD Packing Strips
- Curity AMD Gauze Sponges
- Kendall AMD Foam
- Kendall AMD Foam Disc
AMD Foam Sheet
- Foam is impregnated (not coated) contains .5%PHMB
- Mode of action=foam absorbs wound fluid, PHMB binds to foam material and kills bacteria.
- Open cell microstructure has highly absorptive contact surface with dense core for fluid retention.
- Effective for 3-7 days
AMD Foam Disc: 3 differences compared to competitors
- non-oriented, either side can be applied to wound.
- hypoallergenic, not cytotoxic, and non-irritable.
- Cost effective…$4/5 each on most contracts.
AMD vs. Silver
- Both have same FDA claim
- Silver is priced at premium
- AMD has no change in protocol.
- Silver may elude and overwhelm the wound causing it to stain the wound bed
- Silver is not effective in killing the multi-drug resistant bacteria (Acinetobacter Baumannii)
- Silver dressings are commonly thought of as treatments, not prophylactics b/c they are expensive
AMD Proticol
o No additional training for any nurses to apply it correctly, so there’s no learning curve
o It’s a great product for home health use, as it’s easy for patient’s to apply themselves
o Can be used moist or dry and does not need to be activated
o AMD can be used with virtually any dressings except Dakins.
Silver Proticol
o Moistened and kept moist in order for the silver to release/elude.
o You cannot use saline to moisten a silver dressing….sterile water only. Salt in the saline neutralizes the silver.
o Silver dressings have complicated instructions…usually are oriented (one side goes up or down), if you don’t use the correct side, the dressing is useless. The waste of these dressings is very costly.
o Silver cannot be used with Santyl.
AWC Foams:
-moisture balance for wound healing, cushioned to protect against pressure.
o Kendall Foam – plain, topsheet, drain sponge, gentle adhesion (silicone)
o Copa Island – border
o Softest, most absorbent on the market
AWC Transparents
-Typically used to secure IV sites, PICC lines, etc.
o Kendall Transparent Dressing (polyskin)
o Window transparent dressing (WTD)
o Clinical performance of tegaderm with a potential cost savings
AWC Hydrogels
-donate moisture back to the wound
o Kendall- amorphous gel, impregnated gauze, and disc
o Unique glycerin formula means thicker gel, less chance for it to run out of wound….Aquaflo has unique disc shape for elbows & heels, etc…
AWC Hydrocolloid
-promotes autolytic debridement
o Kendall – sheet, border, and sacral
o 30% alginate gives dressing integrity to keep it from melting into wound
AWC Calcium Alginate
-Conforms easily and absorbs high amounts of fluid.
o Kendall- rope, sheet, and ZN (zinc)
o Made from the stem of seaweed, not leaf so it is stronger than competition, less chance of having it break apart or needed to be irrigated out of wound
AMD Top 10
- No Change in Protocol
- Prevents bacterial colonization within dressing
- Prevents bacterial penetration through dressing
- Broad Spectrum Kill
- Proactive vs. Reactive Approach
- No Known Resistance
- Not Cytotoxic
- Hypoallergenic
- Controls Odor
- Cost Effective
Covidien TWC manufacturing sites in US
Wateree South Carolina
Augusta, Georgia
Oriskany Falls, New York
Pyronema Domesticum
Mold found in Chinese gauze products b/c China burns crops and re-grows vs rotating crops
Woven Gauze products
- Curity Gauze
- Dermacea Woven Sponge
- Kerlix Super Sponge
- Dermacea Super Sponge
- Kerlix 4X4
- Kerlix/Curity Wet Dressings
- Curity Sodium Chloride Dressing
- Curity Packing Strips
Non Woven Gauze Dressings
- Excilon
- Dermacea Drain Sponges and I.V. Sponges
- Sorb-it Drain and I.V. Sponges
- Excilon non-woven all purpose sponge
- curity non woven all purpose sponges
- dermacea non woven all purpose sponges
- curity cover sponges
- curity wet-pruf abdominal pads (ABD)
- Dermacea abdominal pad
CHG
Chlorohexidine Gluconate
