Wound Dressings Flashcards
What is the goal for dressing wounds?
- promote a moist healing environment
What does creating a moist healing environment do for a wound?
- facilitates all 3 phases of healing
- preserves endogenous growth factors
- trap endogenous enzymes for autolytic debridement
- promote formation of more cosmetically appealing scar
- reduce patients pain
What happens if a wound is too moist?
- maceration
- additional skin damage
- increased risk of infection
What happens if a wound is too dry?
- desiccation
- decreased enzymes/growth factors
- scab/crust formation
What is the purpose of dressing a wound?
- create/maintain moist wound environment
- absorb exudate
- promote homeostasis
- fill dead space
- provide thermal insulation
- allow for debridement of necrotic tissue
- prevent or treat infections
What else do dressings also have to be?
- user friendly
- affordable
- able to remain in place for long periods of time
- non-traumatic
- thermally insulating
What does the primary dressing do?
- contact w/ wound surface
What does the secondary dressing do?
- adhere primary dressing
- absorb drainage
- provide occlusive environment
- provide protection/cushioning
might need 3 layer to secure dressing
Are medications/topicals dressings?
NO
- includes enzymatic debriders or antimicrobials
minimize dressing change frequency
What are the 9 categories of dressings?
Most Absorptive -> Least absorptive:
- alginates
- semipermeable foams
- hydrocolloids
- hydrogel
- semipermeable films
Most Absorptive -> Least absorptive Gauze:
- Layers of gauze padding
- gauze pad
- nonwoven gauze
- woven gauze
- impregnated gauze dressings
Composite dressings
Interactive dressings
- both absorptive depend on component parts
What are the most occlusive and impermeable layers of dressings?
Most occlusive/impermeable -> least occlusive/permeable
- latex
- hydrocolloids
- hydrogels (sheets)
- semipermeable foam
- semipermeable film
- impregnated gauze
- calcium alginates
- fine-weave gauze
- loose-weave gauze
- air
What are things to remember with wound dressings?
- dressing needs change as wound changes
- there is NO one dressing that works for every wound
- choices of dressings will depend on clinic availability
- know WHY you are using what you are using
What factors should you consider with clinical decision making for dressings?
- amount of drainage
- condition of wound bed
- presence of infection
- skin condition (tolerate adhesives)
- frequency of dressing changes
- availability of wound dressings
- cost
- wound location
- what WAS the patient using
What are alginates?
Calcium alginate:
- salts of alginic acid from brown seaweed
- come in sheets, ribbons, rope, and calcium alginate tipped applicators
- fibers react with wound exudate and form a hydrophilic gel to provide a moist wound environment
- NOT for wounds with exposed tendon, joint capsule, or bone (dries them out)
What are the advantages of alginates?
- highly absorptive (20x its weight)
- easy to use and fill in cavities or irregular wound shapes
- encourages autolytic debridement
- works well under compression
- can be used on infected wounds
- fibers will not cause irritation if left in wound
- can stop bleeding
What are the disadvantages of alginates?
- can dehydrate wound
- requires a secondary dressing (to hold in place)
- may require irrigation to completely remove
What are semi-permeable foams?
- non-stick, absorbent, sponge-like polymer
- pads, sheets, or pillow for cavity
- some have adhesive boarders
- some have waterproof outer layer to prevent strike through drainage
- NOT for infected wounds unless changed daily
What are the advantages of semi-permeable foams?
- 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
- can be left in place for several days
- can be used under compression dressings
What are the disadvantages of semi-permeable foams?
- adhesive type may damage periwound
- can roll at edges
- may need secondary dressing
- may macerate periwound as it absorbs fluid
What are hydrofibers?
- highly absorptive non-woven pads or ribbons of sodium carboxymethylcellulose or rayon/cellulose fibers
- neither an alginate or hydrocolloid but has benefits of both
What are the advantages of hydrofibers?
- absorbs moderate to large amounts of drainage
- works well under compression
- can stay in place for several days
- interaction with wound exudate forms a gel
What are the disadvantages of hydrofibers?
- may fuse to bloody wound base
- can dehydrate wound if there is scant drainage
What are hydrocolloids?
- adhesive wafers composed of gelatin, pectin and carbomxymethol-cellulose
- during application, best to warm it to get it to adhere
- occlusive dressing
- NOT for infected wounds
- NOT for wounds with exposed tendon or fascia (will stick to it)
DuoDerm: barrier against incontinence AND MRSA, Hep-B, HIV, and pseudomonas
What are the advantages of hydrocolloids?
- impermeable to bacteria and incontinence/waterproof
- encourages autolytic debridement
- provides thermal insulation
- can be placed where tape attaches to for repeat dressing changes
What are the disadvantages of hydrocolloids?
- edges can roll
- adhesive can damage periwound
- can cause hypergranulation
- pectin causes odor upon removal (mistaken for infection)
- leaves residual in wound bed
What are hydrogels and what are they commonly used for?
- water or glycerin based gel, sheet, or impregnated gauze
- skin sealant may be required for periwound protection
- will dehydrate if not covered correctly
- NOT indicated for infect wounds
- commonly used on blisters, abrasions, skin tears, burns, donor sites, mastitis
What are the advantages of hydrogels?
- donates moisture
- painless removal
- can soften eschar
What are the disadvantages of hydrogels?
- minimal absorptive qualities
- non-adhesive requiring secondary dressing
- may macerate periwound
What are semipermeable films?
- transparent polyurethane membrane
- breathes like skin, allowing vapor exchange
- good for minimally draining wounds, abrasions, skin tears, or partial thickness wounds
- if channel develops in wound change film
- NOT for infected wounds
What are the advantages of semipermeable films?
- 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
What are the disadvantages of semipermeable films?
- no absorptive qualities
- poor thermal insulation
- may tear off periwound skin
What are silicone dressings?
- newer technology
- thin and thick foam
- replacing transparent films and hydrocolloids
- consider usage when have skin tears and fragile skin
- can reduce friction and sheer injuries (especially on sacrum)
What is gauze?
- Woven or non-woven
- primary or secondary dressing
- comes in packing strips for tunneling and undermining
- commonly used for wounds that are infected, require frequent dressing changes, require packing, are highly draining
- non-adherent gauze also available for superficial, non-draining wounds (bandaid)
What are the advantages of gauze?
- readily available
- inexpensive for short term use
- increased layers increase absorption
- provides cushioning
- can be used with topical agents
- roll gauze secondary dressing keeps adhesives off of skin
What are the disadvantages of gauze?
- poorly maintains moist environment due to lack of occlusiveness
- traumatize wound bed upon removal
- require more frequent dressing changes
- higher infection rate than occlusive dressings
- needs to be held in place
What is the difference between woven and non-woven gauze?
Woven:
- made of cotton
- can leave lint fibers in wound bed which can cause irritation (a granuloma)
- less absorptive
Non-woven:
- made of synthetic
- more absorptive
What can gauze be impregnated with?
- petroleum: no odor involved
- bismuth: cytotoxic to inflammatory cells; NOT for VI ulcers -> causes adverse reaction
- iodine: cytotoxic
- Zinc: uno-boots for VI ulcers
- Hydrogel
What is impregnated gauze?
- gauze impregnated with something (usually a antimicrobial)
- requires secondary layer
- makes gauze non-adherent
- increases occlusiveness of gauze dressing
- good on granulating wounds
What are composite dressings?
A combination of 2 or more dressing types
EX:
- inner layer: non-adherent
- middle layer: absorptive (hydrogel, semipermeable foam, hydrocolloid, or alginate)
- outer layer: bacterial barrier (semipermeable film)
What are interactive dressings?
Create a moist wound environment AND interact with the cells on the wound bed to further promote wound healing
2 types of interactive dressings:
- antimicrobials (silver, honey based dressings)
- biologics & biosynthetics (collagen and polyacrylate dressings)
impregnated gauze could be an interactive dressing
What are a couple antimicrobial dressings/gels?
- silver
- cadexomer iodine
- honey
- Anasept, Blast X, etc.
How is silver used in wound care and what is it indicated for?
- impregnated into different kinds of dressings and gels
- indicated for infected wounds or those with high bioburden
- used for gram + and - bacteria (MRSA and VRE)
- continuous release so can be left in place for up to 7 days
MUST REMOVE FOR MRI OR RADIATION THERAPY
How is cadexomer iodine use and what are some contraindications?
Very similar to silver with continuous 72 hr release
Contraindications:
- patients with thyroid disease
- allergy to shellfish
- large cavity wounds
How is honey use?
- used with chronic wounds
- antimicrobial
- lowers wound pH which is good for chronic wounds
- highly osmotic, drawing exudate, bacteria and slough toward dressing
- augments autolytic debridement
What are collagen dressings?
- derived from animal collagen
- stimulates macrophages, angioblasts, keratinocytes and platelets
- can donate or absorb drainage
- provides collagen framework for cells to grow
- for CLEAN, MOIST, UNINFECTED WOUNDS
consider for non-healing category III/IV pressure ulcers
What is charcoal used?
- used for those with odor
- NOT for infection
- used for malodorous wounds and psychological aspects (get rid of the smell)
What do debriding agents do?
NOT A DRESSING
- breakdown necrotic tissue without disturbing healthy tissue
- slow debridement when sharp debridement not allowed
- used for enzymatic debridement
EX: collagenase, panafil, accuzyme
What are skin sealants?
- pad, swab or spray used to paint a thin layer of protectant agent onto preiwound
- prevents skin stripping upon dressing removal
- enhances dressing adhesion
- protects skin from maceration
used with VI ulcers
What are moisture barriers?
- ointments or creams
- often used to prevent perineal rashes/skin breakdown
- can often be used on macerated skin
often used with incontinence in nursing homes
What are some ways to keep dressings in place?
- tape
- tubigrip
- abdominal binder
- Montgomery straps
What are growth factors?
- growth-promoting substances that enhance cell size, activity, or proliferation
- extremely costly
What are biological and biosynthetic dressings?
- dressings derived from natural tissues
- maintain skins natural properties and promote autolytic debridement
- Skin grafts: auto (self), xeno (animal), allo (cadaver)
What are skin substitutes?
- engineered tissue that does not trigger rejection
- rapid closure of wounds
- used with significant burns all over body
What are some dressing generalities?
- contaminate dressing materials as little as possible
- open dressing packages by pulling ends apart
- wash hands frequently
- change gloves regularly
- note the date of last dressing application prior to removal
- date, time, and initial dressing on tape BEFORE on patient
What are some clinical decisions for draining and non-draining wounds?
Draining -> absorb moisture -> protect surrounding tissue
Non-draining -> provide moisture & prevent evaporation -> skin sealant for periwound protection
What are some dressing options for granular & non-draining wounds?
- gauze (with topical agent such as hydrogel)
What are some dressing options for granular & draining wounds?
- gauze
- alginate
- semipermeable foam
- hydrocolloid (probably not)
What are some dressing options for necrotic & non-draining wounds?
Gauze with topical agent such as:
- hydrogel
- impregnated gauze
- transparent film
- hydrocolloid
What are some dressing options for necrotic & draining wounds?
- gauze
- alginate
- semipermeable foam
- hydrocolloid if NOT infected
What are some considerations for infected wounds when it comes to dressing?
- avoid occlusive dressings = infection festers under dressing
- re-bandage daily
- options for dressings: gauze (could be impregnated to fight infection), alginate, semipermeable foam
What are some size considerations when it comes to dressings?
- small: gauze or moisture-retentive dressings
- really large: gauze dressings
- deep: lightly fill to prevent abscess formation (fluff don’t stuff)
- tunnel: rope gauze into tunnel and frequent changes
What are some considerations when it comes to frequency of dressing changes?
As needed for strike-through drainage
Infected: daily or more than once a day
Based on dressing type:
- transparent film/hydrocolloid: > 5 days depending on wound
- alginate: 3-7 days, when strike through drainage, depends on wound
Based on antimicrobials:
- collagenase santyl: daily
- medihoney: 3 days
change wound according to dressing that needs to change most frequently
What are some “yay’s” of wound dressing?
- dry eschar: leave alone, remove pressure source
- absorptive dressings covered with dry gauze/ABD pad
- change according to protocol or strike through drainage
- hydrocolloids not used as secondary dressings and not replaced too often (too sticky - same w/ transparent films)
- ALWAYS moisten gauze with packing a wound, even a draining wound
- treat infection and change dressings regularly
- dont cool or heat infections
What are some “nay’s” of wound dressing?
- Mutiple absorbent dressings on top of each other
- moist dressing covered by absorbent dressing
- occlusive dressing over a crater = fills with fluid and traps moisture
