wound management Flashcards
1
Q
Wound management dressings
A
- Primary dressing: in direct contact with wound
- Secondary dressing: if required, to secure primary dressing, absorb exudate, etc.
- Traditionally dressings are classified by their generic description, which depends on their main ingredient rather than performance
2
Q
Alginate
A
- Produced from sodium and calcium salts of alginic acid, a natural polymer derived from seaweed
- Main purpose is absorption of exudate – very high absorbency per gram of material
- Flat sheets or packing for cavity wounds
- It has been suggested that alginates have pharmacological properties (?) due to healing rates achieved in one study
3
Q
Alginate Indications
A
- Sloughy or clean wounds producing moderate to heavy exudate
- Ribbon/rope for packing cavities
- Sheet for shallow wounds
4
Q
Alginate Contra-indications
A
- Dry wounds
- Diabetic foot ulcers if underlying infection
5
Q
Cadexomer-iodine
A
- Spherical starch microbeads that form a 3D lattice, iodine trapped in lattice at a concentration of 0.9%
- Starch has high absorption capacity – as it absorbs the pore size of the lattice increases (swells)
- Releases iodine for up to 3 days, which has an antimicrobial effect against Gram-positive and Gram-negative bacteria, fungi and yeasts, protozoa, and viruses
- Ointment or powder (Iodosorb®)
- Paste sandwiched in protective gauze backing (Iodoflex®)
6
Q
Cadexomer-iodine Indications
A
- Adsorption of high levels of exudate
- Infected wounds and prevention of infection
7
Q
Cadexomer-iodine Contra-indications
A
- Dry wounds
- Hx of thyroid dysfunction
- Severely impaired renal function
- Potential interaction with lithium
- Secreted into milk – avoid in breastfeeding
8
Q
Povidone-iodine
A
Knitted viscose fabric containing 10% povidone-iodine (equivalent to 1% iodine) in a PEG base
9
Q
Povidone-iodine Indications
A
Prophylaxis and treatment of wounds where likely bacterial, fungal, or protozoal infection
10
Q
Povidone-iodine Contra-indications
A
- Sensitivity to iodine
- Breastfeeding or pregnancy (risk of elevated serum iodide)
11
Q
Honey
A
- Honey has been used in wound healing for centuries
- Only honey that has been sterilised should be used on wounds
- Contains an enzyme that produces hydrogen peroxide
- Acts as a deodorizer
- Maintains a moist environment and it is claimed to stimulate tissue growth
12
Q
Honey Indications
A
- Malodorous wounds
- Dry or sloughy wounds
- Necrotic wounds
13
Q
Honey Contra-indications
A
- Allergy to bee venom
- Caution in diabetes – potential for absorption of glucose and fructose from the woun
14
Q
Hydrocolloid
A
- Micro-granular suspension of gelatin, pectin, and sodium carboxymethylcellulose in an adhesive matrix
- Granules are hydrophilic and capable of absorbing exudate – forms a gel
- Matrix is hydrophobic and prevents wound from desiccation
- Waterproof – patient can bath or shower with dressing in place
15
Q
Hydrocolloid Indications
A
- Dry to moderately exuding wounds
- Sloughy or necrotic wounds – prevents loss of water vapour and hydrates dead tissue encouraging autolysis
16
Q
Hydrocolloid Contra-Indications
A
- Contains gelatin
- Debate regarding use in diabetic foot ulcers
17
Q
Hydrocolloid-fibrous
A
- Many be used in similar situations to alginates, but greater capacity for retaining exudate
- Converts from a dry dressing to a soft coherent gel sheet
18
Q
Hydrocolloid-fibrous Indications
A
- Moderate to heavy exudate
- Infected wounds, but must be changed daily
19
Q
Hydrocolloid-fibrous contra-Indications
A
Dry wounds
20
Q
Semi-permeable film
A
- Thin, comfortable, hypoallergenic sheets of polyurethane coated with a layer of acrylic adhesive
- Permeable to water vapour and gases, but not to liquid water or microorganisms
21
Q
Semi-permeable film indications
A
- Can be applied as secondary dressing, to cover shallow wounds, or to protect the skin (e.g. protection against pressure ulcers)
- Securing venous catheters, surgical drains
- Suitable for showering as waterproof
22
Q
Semi-permeable film contra-indications
A
Fragile skin (trauma on removal)
23
Q
Silver
A
- Silver readily ionises in contact with body fluids to become reactive
- Antibacterial mechanisms of silver are poorly understood – can bind to and damage bacterial cells at different sites
- Used in caution in epithelialising wounds – silver potentialy toxic to the monolayer of epithelial cells resurfacing the wou
24
Q
Silver indications
A
Used to decrease bacterial count when critical colonisation suspected
25
Q
Silver contra-indications
A
- Pregnancy, breastfeeding
- Sensitivity to sulphonamides
26
Q
Topical negative pressure (TNP)
A
- Uses negative pressure applied directly to the wound bed to promote healing
- A vacuum unit capable of providing controlled levels of sub-atmospheric pressure is required
- Foam dressings or gauze are used with this system
- Works by continuous wound cleansing and stimulation of granulation tissue:
-Fluid removal – bacteria, inflammatory mediators, cellular waste
-Increased blood flow
-Reduced oedema
27
Q
Larval therapy
A
- Common greenbottle maggots
- When applied to wound they produce proteolytic enzymes that degrade necrotic tissue
- 2-3 mm when applied, grow to 8 – 10 mm
- Also remove odour by ingesting bacteria in the wound
- Larval Debridement Therapy (LDT) is classified under the European Medicines Directive 2001/83/EC as a medicine
28
Q
3D-printed sensor dressings
A
- Can sense when bacteria are growing and change colour
- Based on the CO2 produced by respiring bacteria
- Xylenol blue dye changes from blue to green to yellow in the presence of CO2
- Can help to diagnose the onset of infection so antibiotic therapy can be started
