873- wound management

contact layer

thin porous, non adherent sheets placed directly on wound bed to protect base from trauma during dressing change

contraindications for contact layers

shallow, dehydrated, or eschar wounds

thick exudate

collagen

derived from animals that encourage granulation tissue formation by providing a framework for collagen deposition

indications for collagen

non-healing granulated wounds, grafts and donor sites, tunneling/undermining 

contraindications for collagen

3rd degree burns, black necortic tissue, sensitivity to animal byproducts

gauze

considered substandard as a standalone dressing

indications for gauze

should primarily be used for packing and cleansing or to secure a primary dressing

contraindications for gauze

persons at an increased risk for infection and/or is unable to change dressing independently

alginate

• originating from calcium and sodium fibers found in seaweed, it’s highly absorptive

• turns into moist gel during contact with exudate to facilitate autolytic debridement

• requires a secondary dressing

indications for alginate

mod/heavy exudate and active bleeding

contraindications for alginate

3rd degree burns, dry wounds, tunnel/sinus tracts

foam

composed of sponge like polymers capable of wicking and containing fluids

can be primary or secondary dressing depending on adhesive

indications for foam

hypergranulation tissue, use under compression, moderately exudating wounds

contraindications for foam

dry eschar, 3rd degree burn, packing

hydrocolloid

wafer dressing containing gel forming agents in an adhesive compound laminated onto a flexible, water resistant outer layer

highly occlusive to provide autolytic debridement and protection

can be used as standalone dressing

indicatiosn for hydrocolloid

scant to minimal drainage, dry wounds, protect intact skin or newly healed wounds

contraindications for hydrocolloid 

infection, 3rd degree burn, heavy exudate, exposed tissue/bone, fragile periwound, tunnels/undermining.tracts

film

thin, transparent polyurethane coated with an adhesive to be moisture and vapor permeable one way

creates waterproof environment for autolytic debridemenr

can be primary or secondary dressing

indications for film

non draining wound, intact blister, protection over catheters/ports, secondary dressing

contraindications for film

mod/heavy exudate, 3rd degree burns, fragile skin, infection

specialty absorptive

multi layered dressing that consists of highly absorptive fiber layers that absorb exudate and provide environment for moist wound healing and autolytic debridement

will require secondary dressing

indications for specialty absorptive

heavy exudating wounds and tunnel/sinus tracts

contraindications for specialty absorptive 

dry wounds and 3rd degree burns

compression therapy

exerts external pressure to narrow veins thus improving blood flow and reduces pooling of fluids in gravity dependent areas

ABI rules and comoression therapy

• contraindicated for ABI <0.5

• light compression (up to 23 mmHg) can be used for ABI 0.5-0.8

• can be used for ABI >0.8

short stretch bandages

• act as a rigid frame to reinforce the calf muscle pump

• high working pressure, low resting pressure

• good for active individuals

long stretch bandages

• apply external compression that adjusts as edema increases

• low working pressure, high resting pressure

• good for sedentary individuals

unna boot

• multilayered, semi rigid layered compression system commonly used to manage venous insufficiency

• short stretch compression

• bottom layer is zinc impregnated gauze

• top layer is self adherent elastic wrap

proffer

multi layer compression bandage system specifically designed for venous insufficiency ulcers

type of long stretch compression 

4 layers:

• padding, light conforming bandage, light compressin bandage, self adherent elastic wrap

pulsatile lavage

hydrotherapy method used to clean wounds

normal saline is irrigated into the wound and sucked out via handheld device

indications for pulsatile lavage

infections and necrotic tissue

contraindications for pulsatile lavage

clean and granulation/epithelializing wounds

HVPC e-stim

• replicates the body’s bioelectric system to kick start wound healing

• intensity: 100-500 volts, 60 mins, 6-7 days/week

• (-) polarity: increase blood flow, decrease edema, kick start a stagnant wound

• (+) polarity: bactericidal, increased granulation formation

indications for HVPC

non healing wounds present at least 30 days

contraindications for HVPC

osteolyelitis, cardiac pacemaker, malignancy 

cold quartz UV phototherapy

UV range of 200-280 nm is shown to have antimicrobial benefits

not covered by insurvance

indications for cold quartz UV phototherapy

infected wounds

contraindications for cold quartz UV phototherapy

intact skin, cancer, lupus, pregnancy, photosensitibity 

hyperbaric O2

breathing 100% O2 at a pressure greater than sea level for 60-90 mins with goal of increasing dissolved O2 delivered to body tissues to improve healing

indications for hyperbaric O2

arterial insufficiency, gas gangrene, osteomyelitis, burns, compromised wounds

whirlpool

goal of vasodilation, increased blood flow, soften necrotic tissue, mechanical debridement, cleansing, pain management

can negatively affect periwound

non selective debridement can occur

contraindications for whirlpool

clean wounds, granulating wounds, epithelializing wounds, new grafts/tissue flaps, venous ulcers, diabetic ulcers

mist ultrasound

use of high frequency sound waves transmitted through misting of normal saline with goal of

• decreasing pain, increasing O2 transport, decreaing edema, and accelerated proliferation

contraindications for negative pressure wound therapy

malignancy, exposed blood vessels or organs, fistulas, >10% slough, and anticoagulated pts

indications for negative pressure wound therapy

large surface area and highly exudating wound

one indication of underlying adhesions

blanching of a scar with tension