Wound Dressings Flashcards
How do dressings maintain homeostasis?
- Degree of hydration (wound bed and person)
- Sufficient blood perfusion
- Availability of growth factors
- Appropriate oxygen partial pressure
- Acceptable levels of microflora (cells and growth in wound)
- Maintain voltage gradients
Factors to consider with dressings
- Moisture (Soak up or provide)
- Gaseous exchange (O2)
- Thermal insulation
- Impermeability to micro-organisms
One degree increase in skin temperatue by one degree increases wound healing by ____%
33
What is strike through? Why is it bad?
- Strike through is when drainage gets out of the dressing
- Create a bacteria cross bridge (Change immediately!)
What is an occlusive dressing? What are the advantages to using one?
- Means to occlude wound (block something off)
Advantage:
* Faster healing
* Autolytic debridement
* Decreased pain at wound site
* Control exudate drainage
* Cost effective (person that changes dressing)
Water Vapor Permiability - Occusive to Non-Occlusive
Can you cover an infected wound? What dressing should you use on it?
- No, you cannot cover an infected wound
- Must be semi-occlusive or non-occlusive
Gauze Dressing
- Primary or Secondary
- Open weave or Fine Mesh
– Open weave will get stuck in granulation tissue (unless special dressings)
– Fine mesh will not get grow into; can be used for tunnels - Plain, pre-moistened or impregnated
Primary vs Seconday Dressing
Primary: Next to the wound bed
Secondary: What goes over the top of it
Calcium Alginate/Hydrofiber Dressings - Advantages
- Absorb up to 20X weight in exudate
- Form a gel over wound
- Supports enzymatic debridement
- Fill in dead space
- Easy to apply and remove
Primary Dressing
Must stay in wound bed or it will macerate the skin.
Calcium Alginate/Hydrofiber Dressings - Disadvantages
- Not recommended for light exudate or dry eschar
- Requires 2nd dressing as a cover dressing
- Can dehydrate wound
Calcium Alginate needs to be changed every ____ hours
24-72 hours
Silver Impregnated Dressings
AQUACEL® Ag is the first antimicrobial dressing that:
* Provides immediate and sustained antimicrobial activity to kill many types of bacteria and fungi.
* Offers the unique gelling properties of Hydrofiber® technology enabling dressing to gel on contact with the wound fluid creating a large fluid-absorption capacity
* Locks bacteria within the gelled AQUACEL® Ag fibres7 away from the wound bed.
* AQUACEL® Ag is indicated for use on acute and chronic wounds including burns, surgical wounds, diabetic foot ulcers, pressure ulcers and leg ulcers.
What is Impregnated Gauze - MeSalt
NaCl solution in fine mesh gauze
Impregnated Gauze - MeSalt
Advantages
- Permeable to oxygen
- Can be used with infected wounds
- Excellent absorption (30x weight)
- Suppresses growth of E coli, staph, pseudomonas
- Easy to apply and remove
- Does not allow granulation to grow into dressing
Impregnated Gauze - MeSalt
Disadvantages
- Must be pre-moistened with dry eschar or lightly exudating wounds
- Requires a 2nd dressing as a cover dressing
Impregnated Gauze - MeSalt must be changed every ____ days
1-3
Impregnated Gauze - Aquaphor
Advantages
Vaseline impregnated gauze
- Permeable to oxygen
- Can be used with infected wounds
- Easy to apply and remove
- Does not stick to wounds
- Can be used for burns or graft sites
Impregnated Gauze - Aquaphor
Disadvantages
- Does NOT absorb drainage
- Requires a secondary cover dressing
Impregnated Gauze - Aquaphor needs to be changes every ____ days
2-3
Semi-permeable Film (SPF)
Advantages
- Impermeable to bacteria
- Maintains moist environment
- Promotes autolytic debridement
- Allows visualization of wound
- Less trauma with changes unless done too soon
- No secondary dressing needed
Tegaderm
Semi-permeable Film (SPF)
Disadvantage
- Do not use for large exudates
- Requires intact dry borders for adhesives
- Difficult to handle
- May not stay in place in high friction areas
Semi-permeable Film (SPF) needs to be changes every ____ hours
24-72
Semi-permeable Foam
Advantages
- Faster healing
- Moist wound environment
- Good exudate absorption
- Fair moisture vapor transmission
- Fair oxygen permeability
- Maintains body temperature in wound
Semi-permeable Foam
Disadvantages
- Non-adhesive
- Clinician must supply tape or covering
- Easily displaced by mechanical forces
- More expensive than SPFs, but still cost effective vs. gauze
How often does Semi-permeable Foam need to be changed?
1-3 days
Hydrocolloid Thin
Advantages
Semipermeable
- Impermeable to bacteria
- Maintains moisture
- Autolytic debridement
- Self-adhesive, molds well
- Provides limited to moderate absorption
- May be left in place for long time
- Minimal trauma when removed
- Waterproof
- Lowest oxygen gradient that may promote granulation tissue
Hydrocolloid Thin
Disadvantages
Semipermeable
- Do not use if heavy exudate or eschar
- Not transparent
Hydrocolloid Thins need to be changed every ____ days
3-7 days
Hydrogels (HDG)
Advantages
- Soothing, reduce pain
- Rehydrate wound bed
- Autolysis
- Minimal/moderate absorption
- Easily removed (without borders)
- Leaves no residue in the wound bed
- Transparent
Hydrogels (HDG)
Disadvantage
- Cannot be used in infected wounds
- Do not use if heavy exudate
- May required secondary dressing (non-boarded)
- Some may dry out
Hydrogels need to be changes every ____ hours
8 to 72
What dressings can be used with an infected wound
Gaze to Hydrocolloid Thin
Hydrocolloid Thick (HDCi)
Advantages
Impermeable
- Impermeable to bacteria
- Maintains moisture
- Autolytic debridement
- Self-adhesive, molds well
- Provides moderate absorption
- May be left in place for long time
- Minimal trauma when removed
- Waterproof
Hydrocolloid Thick (HDCi)
Disadvantages
- May not be used on infected wounds
- May not be used on arterial insufficient wounds (ABI <.8)
- Not transparent
- May tear fragile surrounding skin when removed
- Leaves adhesive residue on surrounding skin
Hydrocolloid Thick (HDCi) needs to be changed every ____ days
3-7
Growth Factor Stimulation
Regranex Gel
* Recombinant human platelet-derived growth factor (rh-PDGF)
* Actively stimulates angiogenesis and granulation tissue formation
Types of Grafts:
Autograpft
Allograft
Homograft
Heterograft
- Autograpft: tissue from same patient
- Allograft: tissue from another person
- Homograft: tissue from same species
- Heterograft: tissue from different species; SIS is good forepithelialization for diabetic and AI patients.
The “VAC”
- Vacuum Assisted Closure
- Continuous assisted drainage from wound bed prevents maceration
- Physically assists neovascularization and wound contraction through positive pressure
- Can prepare wound bed for skin grafts
VAC precautions
- Active bleeding (anticoagulation)
- Difficult hemostasis in the wound bed
- Patients on anticoagulants
VAC Contrindications
- Large amounts of necrotic tissue in the wound bed
- Cancer in the wound margins
- Untreated osteomyelitis
- Fistulas to organs or body cavities
Collagenase and ____ can never be used together
Silver Dressings
