Wound Care Dressings
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Characteristics of an ideal dressing
- keep wound moist
- prevent maceration
- protect from contamination
- contain wound fluid
- protect granulation tissue
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Traditional dry dressings
- Wounds exposed to air are more inflamed, painful, itchy and have thicker crusts than moist wounds during the inflammatory stage of healing
- decreased collagen production
- dermis is more fibroplastic, fibrotic and scarred
- Epithelium migrates into wound bed: if must burrow between any eschar (crust or scab) healing is slower
- Wet to dry dressing significantly increase healing time
- greater pain
- greater cost
- increased frequency of dressing changes (bid, tid, qid)
- Nonocclusive: increased risk of contamination and infection
- Wounds exposed to air are more inflamed, painful, itchy and have thicker crusts than moist wounds during the inflammatory stage of healing
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Moist wound healing
- Wound kept moist and protected from external environment
- no eschar develops (crust, scab)
- enhances autolytic debridement: promotes role of macrophages and leukocytes
- bacterial barriers: prevent wound contamination
- wound fluids kept at site: contain growth factors and enzymes that promote autolysis and healing
- Potential for infection
- Potential for increasing pathogen growth
- use carefully with immunocompromised patients
- occluded wounds show a shift from gram-positive to gram-negative organisms
- Signs of infection
- I-induration
- F-fever
- E-erythema
- E-edema
- Wound cultures need to be quantitative. Wound infection: > 105 colony forming units (CFU) of a specific pathogen per gram of tissue
- Potential for increasing pathogen growth
- Accumulation of drainage
- Exudate: wound fluid containing dead cells, necrotic debris, liquefied eschar, growth factors, enzymes, etc.
- Drainage that is yellow in color and possesses an offensive odor is common with occlusive dressings (especially early when autolytic debridement is occurring)
- OSHA regulations state drainage must be contained: Maceration interferes with epithelialization
- General Principles
- Wounds generally get worse before they get better as ischemic tissue sloughs
- Odor often worsens
- Several methods need to be tried. Type of treatment changes during the course of healing.
- Primary goal of wound healing is to aid body's own healing mechanism
- Wounds can generally be treated based on appearance and drainage
- Wound kept moist and protected from external environment
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Dressings used in moist wound healing
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Films: Moisture Vapor Permeable Dressing (MVP)
- Characteristics
- porous enough to allow escape of moisture vapor but too small for bacteria and water to pass through
- does not adhere to moist wound bed
- Uses: minimally exudative wound; excellent protection for fragile and/or newly healed tissue; promotes autolytic debridement for eschar covered wound without drainage.
- increase healing 20-40%
- Care:
- examine frequently for patency. Loose edges can be resealed using a skin prep wipe
- allow at least a 3 cm frame between the edge of the wound and the edge of the dressing
- healthy autolytic debridement often creates a yellow, dark beige or brown drainage under the dressing
- initially autolytic debridement will make the wound larger before healing begins
- remove by lifting edges and wiping with alcohol wipe
- change dressing if drainage two times size of wound. Maceration of surrounding tissue may occur if prolonged contact with drainage occurs.
- Characteristics
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Foams (hydrophilic and hydrophobic)
- Characteristics
- more permeable than film
- absorbs more drainage
- maintains body temperature in wound bed
- Uses: wounds with more drainage; full thickness wounds
- Care
- not adhesive coated so require secondary dressing (net or film may be used)
- secondary dressing may alter permeability
- shiny side down (Lyofoam)
- change dressing when see drainage on edge
- needs to be two inches larger than wound
- can use skin prep and apply foam before prep dries so held in place until can apply secondary dressing
- Characteristics
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Hydrocolloid (hydrophilic colloidal particles)
- Characteristics
- absorbs slowly
- more occlusive: non permeable
- ability to conform and seal
- due to particle swelling, hydrocolloids develop a better seal the longer they are in place
- do not adhere to wound
- more effective bacterial barrier than films
- Uses: minimally draining wound
- Care
- clean and dry skin surrounding wound; hydrocolloid will not stick to moist surfaces
- conform and shape the dressing so contact is made with body contours
- may be framed with tape
- likely to see yellow-beige gelatinous mass covering wound because of dressing decomposition
- may also have offensive odor when the dressing removed
- do not need to completely remove gelatinous mass prior to applying new dressing
- since no gas exchange, assess for presence of anaerobic bacteria
- Characteristics
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Hydrogels
- Characteristics
- contain 80-99% water
- high specific heat so feel cool and soothing
- slowly absorb minimal exudate
- Uses
- treating wounds in patients with sensitive skin or in presence of hair
- adds moisture to wounds
- facilitates autolytic debridement
- burns (Aquasorb and Vigilon)
- packing necrotic wounds with gel satuated gauze
- Care
- check label to verify sterile vs distilled water used
- require secondary dressing to hold hydrogel in place
- monitor for maceration in heavily draining wound
- Characteristics
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Impregnated Dressings (Non adherent)
- May be saturated with vaseline, bismuth tribromophenate (3% Zeroform)
- Must be covered with secondary dressing
- If allowed to dry, may bond to wound
- Antibacterial and bacteriocidal impregnated dressings need to be used cautiously since may be cytotoxic
- Biobrane is a biosynthetic dressing that adheres to the wound surface, but not normal skin. Should not be removed until healing has occurred.
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Absorptive powders and pastes
- Usually starch copolymers or colloidal hydrophilic particles (cellulose, gelatin)
- Use: suer slurpers - used in heavily draining wounds: absorb up to 100x weight in fluid: may increase wound pH above physiological levels
- May require wrapping in gauze before inserting into wound bed
- Pastes easier to remove from wound
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Calcium alginate (produced from seaweed)
- Absorbent
- After absorbing exudate, converts into viscous hydrophilic gel: biodegradable
- Used to pack wounds, especially for tunneling
- Requires secondary dressing
- Halodorous after combining with drainage
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Images used with permission of Dave Arnell