wound dressing selection Flashcards
moist wound healing indications:
indicated only for healable wounds
healable wounds require:
correctly identifying and addressing wound etiology
adequate immune function
sufficient perfusion to tissues
mitigation of client-specific risk factors
moist wound healing contraindications:
dry eschar-covered wounds on lower limbs
if dry eschar becomes soft/boggy, refer to an NSWOC/Wound clinician
safest action is to support a dry wound environment until healability can be confirmed
moist wound healing improves wound healing:
rates by 50% when compared to dry wound bed environments
moist level you want = similar to whites of your eye
hydrating/adding moisture using gels, pastes, ointments
maintaining moisture by using dressings that absorb and hold moisture in the wound bed
absorbing excess moisture using absorbent dressings, which pull moisture off the wound bed and “hold it”
autolysis
one method of debridement
uses enzymes in wound exudate to achieve a clean wound bed
softens and breaks down devitalized/necrotic tissue
debridement is only for:
healable wounds
do not debride dry eschar-covered wounds on the lower limbs
most dressings can be used to support autolytic debridement, such as:
wound gels
hypertonic dressings
honey-based antiseptic/antimicrobial dressings
dressings that retain moisture = occlusive, semi-occlusive, moisture retentive (hydrocolloid or paste dressings) or foam dressings
prevent MASD (moisture associated skin damage)
clean and moisturize
keep periwound skin dry and intact by using skin barrier films and protectants
select appropriate wound bed products to wick and absorb wound exudate
prevent MARSI (medical adhesive related skin injuries)
select correct size of dressing
prepare periwound skin
apply and remove dressing
consider non-adhesive options for those at risk - such as gauze wraps or tubular stockings
non-adhesive options (for those at risk for MARSI)
gauze wraps
cast padding
self-adherent wrap
elastic bandaging
tubular stocking or net sleeves
medical tapes
silicone = most gentle option
*not suitable for securing critical medical devices
paper, plastic, and paper/plastic hybrids
fabric
film dressings
used as adhesives to “window pane” dressings
allows breathability while securing the dressing
covering entire dressing with film with create an occlusive dressing
primary dressings = come into direct contact with wound bed
** most require a secondary/cover dressing
non-adherent contact layers
wound fillers
non-adherent contact layers
petrolatum
silicone
paraffin
lipido-colloid
antimicrobial impregnated
- sliver
- povidone iodine
- chlorhexidine
allow exudate to move through them to the secondary/cover dressing
wound fillers
gauze
alginates
gelling fibres
hydrogel
hydrophilic paste
hypertonic dressings
non-adherent contact layers are used when:
friable/fragile or painful wound bed
tissue graft or flap
underlying structures
surgical implants
minimal exudate
petrolatum
jelly made from mineral oil
used as a barrier to protect skin and to lock in moisture
silicone
low rates of sensitivity and skin reactions
tackiness allows for multiple adhesive contact points with skin = does not shift once in place
hydrophobic = does not adhere to moist areas = reducing wound bed trauma
paraffin
derivative of petrolatum
acts as moisturizer to prevent drying out wound bed and periwound skin
shortest wear time (24hrs) of non-adherent contact layers
antimicrobial impregnated
used to prevent or treat wound infection
lipido-colloid
matrix forms a gel in presence of wound exudate to provide a moist interface between wound and dressing
when selecting products and treatments for wounds, you must consider the following factors:
1) client considerations
2) needs of wound bed and periwound skin
3) products that are available to you
Ms. C Barton and her 16 yr old niece Leanne come to your outpatient clinic to have a minor burn on Leanne’s arm looked at. The wound is clean but painful, and the periwound is warm and firm. The dressing is being changed at the clinic twice a week.
Which non-adherent contact layer would be most appropriate?
silver-impregnated
wound is showing inflammatory signs of local wound infection and requires a topical antiseptic/antimicrobial with 3-7day wear time
M.E.ahoney has a skin tear on her forearm after bumping it on the over-bed table. The wound is cleansed, bleeding is controlled, and the skin flap can be fully approximated.
Which would be the most appropriate to apply?
petrolatum
supports a moist wound bed and can be in place for up to 7 days = allows flap to reattach
secondary covers/dressings:
can be used independently or used over a non-adherent contact layer or wound filler
maintain or absorb exudate
- many have moisture vapor transmission characteristics
maintain thermal insulation
protect the wound bed from contamination and trauma
types of secondary covers/dressings
acrylic
hydrocolloid
composite
foam
acrylic dressings
absorb small amounts of exudate = allow it to evaporate through breathable top layer
* do NOT cut these dressings
semi-occlusive
*do NOT use on infected wounds
*do NOT use for medium-large amounts of exudate
have an extended wear time
hydrocolloid products
absorb and retain small amounts of moisture
can be used to protect intact or fragile skin from adhesives
can have a distinctive odour
*diff than odour infection
available in sheet/wafer dressings, powders, or pastes
composite
multiple layers contained in one dressing
many shapes and sizes
come w/ and w/o adhesive borders - impact risk of MARSI
have a top sheet
cannot be cut
foam
function best with thin exudate
absorb scant to high levels of exudate depending on composition of dressing
provide moist wound environment by wicking and holding exudate in dressing
provide adequate thermal insulation to support wound healing
cost effective when used correctly
most have 5-7 day wear time
do NOT use on foot wounds or those with diabetes or any arterial insufficiency = keep wound bed too moist
Ms. D Dix has an abrasion on her back form being pulled up in bed. There is a small amount of exudate and no signs of symptoms of infection. You want to be able to monitor the wound, and would like to avoid frequent dressing changes.
What’s the best choice?
acrylic dressing
can absorb small amounts of exudate, wound would be visualized, dressing is long-wear (7-21 days)
Ms. H.W> Johnson-Brown presents at her Primary Care Clinic with a wound on her lower leg that she has had for several months. She had vascular studies that show chronic venous disease. She cannot tolerate wraps, but does wear over-the-counter compression stocking (most days). Wound is draining moderate amounts of thin serous drainage.
Which would be the best secondary dressing to select?
best choice: foam
could work: composite
not suitable: acrylic or hydrocolloid
charcoal dressings
cover up wound odor but do not treat cause of odor
silver in the dressing will not treat wound infection - it kills bacteria in dressing only
should be in close contact with wound to be effective
can be folded to fit around contracture digits, and tubes
do not cut
zinc
zinc-impregnated gauze
anti-inflammatory and soothing effects when treating dermatitis and eczema
can dry out leading to traumatic removal = only considered non-adherent if it is moist
