Wound Interventions: Wound Dressings Flashcards
Dressing selections - in general you should consider
what it is you are trying to accomplish at this point in time with a particular wound
Objectives
Fluid control function
Compressive ability
Maintain a certain level of temp
Debridement capacity
Goals
Provide a healing environment
User friendly
Control infection
Cost effective
Goals - Provide a healing environment
Control moisture
Allow gas exchange to occur
Maintain thermal control
Debride, if needed
Goals - user friendly
Easy to apply and remove
Minimal dressing changes
Remains in place with limited trauma to surrounding area
Goals - control infection
Dec risk for infection
If infection is present, can it be used for the wound safely (occlusive is contraindicated for infected wound)
Two types of dressings
Primary dressing
Secondary dressing
Two types of dressings - primary
Direct contact with the wound bed
This is the one that will be meeting your goals most likely
May or may not require a secondary dressing
Two types of dressings - secondary
Used over the primary dressing
Purposes - hold the dressing on, protection, occlusion, absorption
Occlusive vs. Permeable dressing: Occlusive =
Allow no evaporation
Retain moisture
Ex - latex, rubber, saran wrap
Occlusive vs. Permeable dressing: Permeable =
Allow full evaporation
Dec moisture content
Air is most permeable
Ex - Gauze
Occlusive vs. Permeable dressing - In between the two extremes are
Semiocclusive and Semipermeable dressings
Most permeable non occlusive dressing
Air
Most impermeable occlusive dressing
Latex
Gauze - is what
Most common dressing material used
Two types - woven and non–woven
Variety of forms - squares, pads, rolls, Packing strips, Telfa dressings
Gauze - woven are made of
cotton fibers woven together
Gauze - non woven are made of
synthetic fibers pressed together
Gauze - absorption
Come in varying levels of absorption
Come in layers, known as plies
Gauze - primary or secondary
Either
Gauze - infected wounds
Can be used with infected wounds
Except for waterproof gauze - this tends to be more occlusive
Gauze - what is unique about it
It can be impregnated with medications or other substances
Can be packed into tunnels
Gauze - negative to it
It tends to traumatize tissue
Used for wet-to-dry dressings and when you take it off, it can lead to trauma
Soaking it in saline solution before taking it out can help
When do we use gauze - what wounds
Wound with heavy exudate
Infected wounds
When packing is required
Frequent dressing changes needed
Film dressings - permeability
Permeable to moisture vapor and air (gas)
Impermeable to fluid/ pathogens
Film dressings - Characteristics
Flexible
Unable to absorb exudate
Film dressings - primary or secondary
Either
Film dressings - often used over
minor burns
surgical repair
simple abrasions/lacerations
Film dressings - Negative
Adhesive may cause problems in the wound area
Film dressings - can be used for what
Autolytic debridement
Film dressings - Do not use with what wounds
infected wounds!
Is impermeable to microorganisms
Film dressings - can remain in place how long
up to a week
Foam dressings - permeability
Semi permeable
Foam dressings - descriptions
typically composites
Easy to apply and remove
Provide a warm environment
Foam dressings - hydrophobic or philic?
Can be either
Foam dressings - should not be used in what wounds
Tunneling
Dry/Non draining wounds
Foam dressings - adherent?
Typically nonadherent
Some have adhesive component though to connect to wound margins
Foam dressings - Primary or Secondary?
Can be either
IF primary though, need the kind that adheres to wound margins
Foam dressings - can be used with
Autolytic debridement
They are semipermeable, but they do tend to keep moisture in
Foam dressings - if used on infected wound - how long can you leave it on
Need to change it on a daily basis
Foam dressings - how long can it be left on
up to 4 days
Hydrogel dressings - content
High level of water content so can’t absorb a lot of exudate
Because of high water content, they can become moisture donors to the wound site
Hydrogel dressings can be used for what (5)
1 for its autolytic properties
2 And can be used to fill in dead space
3 Can also be used to prevent drying of anatomical structures
4 As carriers for topcal meds (would require a secondary dressing)
5 Coupling agent for US
Hydrogel dressings - do what
can dec friction and pressure
Hydrogel dressings - do not use with
infected wounds
Hydrogel dressigns - can remain on wound how long
up to 3 days
Hydrocolloid dressings - properties
Generally occlusive, some are semiocclusive to semipermeable
Has adhesive properties
Hydrocolloid dressings - come in what form
Paste or powder
Or Sheets as well
Hydrocolloid dressings - primary or secondary
May require secondary sheets when used as primary?
Hydrocolloid dressings are primarily used for
autolytic debridement capabilities
Hydrocolloid dressings - absorption
Limited absorption
Hydrocolloid dressings - Not recommended for what wounds
With tunnels or undermining
Infected wounds
Hydrcocolloid dressings - removal may cause what
damage to surroudning skin
Hydrocolloid dressings - permeability
Impermeable to urine, stool, bacteria
Hydrocolloid dressings - 2 random facts
1) will leave residue in the wound
2) When they absorb exudate, they spread it out in the sheet
Hydrocolloid dressings - can be left on for how long
up to 4 days
In general, what are signs that dressing needs to be changed
The edges are coming up - this means that the dressing has lost its occlusive properties and is also no longer impermeable to thing
Calcium Alginate dressings (CAD) - made from what?
Calcium salts extracted from seaweed
Many different shapes and sizes
Calcium Alginate dressings (CAD) - properties
Highly absorbent, good in wounds with moderate to heavy exudate
Reacts with exudate to form a hydrophillic gel
Conforms to the shape of the wound - good for tunnels and undermining
Easy to apply and remove
Calcium Alginate dressings (CAD) - Primary or secondary
Requires a secondary dressing
Calcium Alginate dressings (CAD) - is often used with
autolytic debridement
Calcium Alginate dressings (CAD) - dressing changes occur how often
If on infected wound = daily
Otherwise = no longer than 7 days
Calcium Alginate dressings (CAD) - caution with
exposed structures - it is meant to absorb, it is not contributing moisture!
Composite dressings are what
Combination dressings
Multiple layers with each layer having different qualities
Wound cavities - what is it and what do you do
Substantial loss of tissue structure
Packing or filling may be required
Wound cavities - packing is what
Typically the application of a dressing to delay healing
Infection, draining an abscess
Wound cavities - filling is what
the application of a dressing to promote healing from the inside out and to control exudate
Undermining, tunneling, large cavities
Wound cavities - how to pack
Pack loose at the narrow end of the tunnel (the part you can’t see) and tighter at the wider area of it (the exposed part you see)
Antimicrobial Dressings are what
Slow and sustained release of antimicrobial agent
Antimicrobial dressings - most popular is what?
Others?
Popular = Silver Others = iodine, methylene blue, gentian violet, polyhexamethylene biguanide
Antimicrobial dressings - need to address for what
Adverse rxns - ALLERGIES!
Collagen - properties
Hemostatic, mitogenic, chemotaxis effect Highly absorbent Hydrophilic Animal product (sens issue) Need Rx
Collagen - product forms
Variety
Gels, paste, powders, freeze dried sheets
Collagen - should not be used un
dry wounds! Highly absorbent!
Growth factors - are what
products that enhace cell growth and proliferation
Multiple growth factors are being used and researched
Not all are approved for use in all wounds
Growth factors
Applied topically
Rx needed
Types of growth factors used
Platelet derived GF (1st to be approved) FIbroblast GF (clinical trial) Epidermal GF (clinical trial)
Collagen and GF - most common
OASIS
made of pork submucosa, collagen matrix and some growth factors
Requires physician application!!!
Biosynthetic or Biological Dressings
Developed from human or animal sources
Can include autografts, allografts, xenografts
They are composite dressings that serve as skin substitutes
