Wound Dressings Flashcards by Mariana sanjuan

Highly permeable and relatively nonocclusive. Can be primary or secondary dressing

Gauze dressing

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Gauze dressing uses:

Infected and noninfected wounds;
frequent changes; heavily draining;
infected wounds being treated with enzymatic debriding agents; wounds require packing; fragile integument

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Gauze: precautions

Require force to remove; lint;

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Dressing reserved for superficial, minimally or nondraining wounds

Telfa (non-stick) dressings

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Mesh gauze dressings with petrolatum, saline, bismuth or zinc.

impregnated gauze dressing

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Used as a contact layer on granulating wound bed requiring a secondary dressing; is Nonadherent; increase occlusiveness

impregnated gauze dressing

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prevents exposed bone, tendons, etc from dehydrating or adhering to dressing AND Burn wounds

impregnated gauze dressing

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impregnated gauze dressing: precautions

Bismuth dressings (xeroform) cytotoxic to inflammatory cells; bad for venous insufficiency ulcers.

iodine-impregnated gauze cytotoxic and only mildly antimicrobial

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Thin, flexible sheets of transparent (visualization of wound bed)polyurethane with adhesive backing; little absorptive capabilities

Semipermeable film dressings

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Should not be used for wounds with moderate to heavy drainage or on pt’s with fragile skin or infected wounds

Semipermeable film dressings

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Common Uses:

Superficial wounds, lacerations, abrasions, skin tears.
Partial-thickness wounds, sutured wounds, and donor graft sites
Granular wounds and yellow slough-covered wounds with min drainage
areas of friction

Semipermeable film dressings

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80% to 99% water- or glycerin-based wound dressings available in sheets, gels, or impregnated gauzes

Hydrogels

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Absorb minimal amount of fluid.
Donate moisture to dry wounds.
Permeable to gas and water.
May decrease pain.
Almost nonadhesive, requiring secondary dressing

Hydrogels

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Indicated: min/mod draining wounds.
Used on superficial and PT wounds.
Gel used in wounds as a coupling agent for US with a gel sheet.
Sheets provide padding to decrease shear forces in casts and splints. Softens eschar

Hydrogels

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Hydrogels: precautions

Should not be used on heavily draining wounds or bleeding wounds.
Should not be used on infected wounds

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Polyurethane foam with a hydrophilic wound side and hydrophobic outside.
Permeable to gas; not to bacteria
Provide thermal insulation
GOOD for: pressure ulcer

Semipermeable Foams

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Common Uses:

Wounds with min to heavy exudate
Granulating or slough-covered P-T wounds
Donor sites, ostomy sites, minor burns, diabetic ulcers, and venous insufficiency ulcers.

Semipermeable Foams

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Precautions/Contraindication:
Not indicated for:
-dry or eschar-covered wounds
-arterial ulcers –(too dry)
-heel ulcers or areas of high friction
-Not on infected wounds unless changed daily
Skin sealant should be used to protect periwound

Semipermeable Foams

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Contain hydrophilic colloidal particles with a strong film or foam adhesive backing.
Absorb fluid slowly by swelling into gel-like mass.
Residue often remains after removal.
Provide thermal insulation
Impermeable to water, O2, and bacteria.

Hydrocolloids

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An effective barrier against urine, stool, MRSA, hepatitis B, HIV-1, and Pseudomonas

Duoderm (Hydrocolloid)

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Common Uses:

P-T and full-thickness wounds
Granular and necrotic wounds
sacral and coccygeal pressure ulcers
Minor burns and venous insufficiency ulcers
pastes/powders can be used to fill cavities in draining wounds.

Hydrocolloids

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P/Contraindications:
-heavily draining wounds -infected wounds
-caution on immunocompromised patients – can promote anaerobic bacterial growth.
-dry wounds, arterial ulcers, 3rd deg burns, or wounds with min drainage
-wounds with exposed tendons/fascia
Should only be used on: patients with good border skin integrity

Hydrocolloids

Salts are extracted from brown seaweed and converted into Ca/Na salts.
React with serum and wound exudate to form a hydrophilic gel to provide a moist wound environment
Highly permeable and nonocclusive, requires secondary dressing

Alginates

Alginates: Available in 3 forms

Sheets (to absorb drainage)
Ropes ( to fill tunnels, cavities, or undermining)
Alginate-tipped applicators (to probe wounds, perform swab cultures, and to measure wound depth)

``` Common Uses: -Absorbs 20x their weight in exudate. -Mod to highly draining wounds. -P-T and full-T draining wounds. -infected wounds (Dressings must be changed daily; Skin sealant should be used ```

Alginates

P/Contraindications: - 3rd deg burns (F-T). - wounds with exposed tendon, joint capsule, or bone - neonates (causes electrolyte imbalances). - dry or min draining wounds

Alginates

Multilayer dressings that can be used as primary or secondary dressings

Composite Dressings

Composite Dressings: 3 layers?

-Inner contact layer: nonadherent, prevents trauma. -Middle layer: absorbs moisture to prevent maceration yet maintains moist wound bed (May consist of hydrogel, semipermeable foam, hydrocolloid, or alginate). -Outer layer: serves as bacterial barrier (Commonly a semipermeable film)

- Antiseptic agent incorporated into all classes of dressings. - Release of ions in the wound bed result in a blue-black. - limited research to support it is effective against multiple organisms within a wound or against biofilms. - Saline cannot be used because it deactivates it.

Silver Dressings

Free ____release should be ___ mg/l to have the best results. (effective!)

silver; >20

- caution in use with epithelializing or granulating wounds (cytotoxicity). - No evidence that it helps prophylactically in healing uninfected wounds - cost more than standard moisture-retentive dressings - Don’t use on neonates due to toxicity

Silver Dressings

- Key function: control odor by absorbing odor-producing gases released by bacteria. - Dressings do not enhance wound healing rates more than any other type of moisture-retentive dressing

Charcoal dressings

``` Benefits: Antimicrobial (acidic) Reduces pain Stimulates proliferative phase Reduces edema ```

Honey

- May facilitate wound healing - Bovine has been incorporated into sheets, ropes, wound dressings, and topical agents such as gels or particles - It adheres to wound bed but not to periwound. - may be used on both infected and uninfected wounds including superficial burns and donor sites. - left in place until the wound is resurfaced underneath

Collagen Dressings

Generally alcohol-based wipes are used on intact periwound skin. Makes skin tacky for a better edge seal and protects skin from adhesive.

Skin sealants

Ointments or creams contain petrolatum, dimethicone, and/or zinc oxide. Prevent rashes and skin breakdown in areas of incontinence

Moisture Barriers

- Specially formulated compounds that allow primary wound closure without use of staples or sutures. - Should not be used for heavy contaminated wounds, puncture wounds, or wounds more than 12 hours old

Tissue adhesives (skin glues)

wound dressing that contains a cellular matrix of collagen and growth factors that have been effective in wound healing

Oasis

Growth-promoting substances that enhance cell size, proliferation, or activity

Growth Factors: cytokines, interleukins, colony-stimulating factors

Extremely costly and limited to chronic wounds that are recalcitrant to traditional interventions

Growth Factors: cytokines, interleukins, colony-stimulating factors

If _____ is indicated, a moisture-retentive dressing should be selected and should remain in place for several days

autolytic debridement

If _____is indicated, gauze is appropriate with dressing changes 1–3 times per/day

enzymatic debridement

If ____is desired, a wet-to-dry or other similar technique should be selected.

mechanical debridement

Granular and Nondraining

Wound healing as expected. Moisture may need to be added with hydrogel or a more occlusive dressing should be used

Granular and Draining

Granulation tissue and periwound should be protected. A more absorptive dressing should be applied. If heavily draining, infection may be present.

Necrotic and nondraining

Requires debridement and softening of eschar. Moisture may need to be added. Enzymatic debridement. Surrounding tissue should be protected with a skin sealant

Necrotic and Draining

Requires debridement, absorption, and protection of surrounding tissue. Wound should be observed for S&S of infection.

Granular, nondraining: Dressing Options

Gauze (if not infected) Impregnated gauze (if not infected) Transparent film Hydrogel

Granular, draining: Dressing Options

Gauze Alginate Semipermeable foam Hydrocolloid (if not infected)

Necrotic, nondraining: Dressing Options

``` Gauze (if not infected) Impregnated gauze Transparent film Hydrogel Hydrocolloid ```

Necrotic, draining: Dressing Options

Gauze Alginate Semipermeable foam Hydrocolloid (if not infected)

Necrotic, nondraining: Debridement Options

Surgical Sharp Enzymatic Autolytic (if not infected)

Necrotic, draining: Debridement Options

Surgical Sharp Enzymatic Autolytic (if not infected)

Semipermeable films, adherent semipermeable foams, hydrocolloids, and composite dressings are ___ ____ Dressings commonly used on ___to ___-sized ____wounds with good surrounding skin integrity Adherent occlusive dressings are ideal for __, __, __, and __wounds

Adherent Occlusive. small to medium; uninfected ideal for hands, arms, legs, and trunk wounds