Venous Insufficiency & Wound Dressings

Venous stasis ulcers result from _______.

Chronic venous insufficiency (CVI)

Explain the pathophysiology behind dysfunctional venous valves --> venous stasis ulcers.

Dysfunctional valves --> blood pooling and increased venous pressure --> capillary leakage, tissue edema, and reduced oxygenation --> inflammatory mediators and fibrin deposition contribute to skin and tissue damage --> breakdown of skin and development of ulcers

Venous ulcers: location

Above or on the malleoli, in the distal 1/3 of the lower leg or "Gaiter" region

**NOTE: if outside this area, may be mixed etiology OR other underlying etiology**

Venous ulcers: surrounding skin

Hyperpigmentation (hemosiderin staining), stasis dermatitis, varicose veins, lipodermatosclerosis (scarring of the skin and fat --> thickened, hard, immobile skin)

Venous ulcers: wound characteristics

Uneven edges, shallow wound bed, HIGHLY exudative (primarily serous)

Venous ulcers: periwound tissue

Maceration, diffuse edges, irritation

List exercise options for patients with venous insufficiency.

- Gastroc stretches

- Ankle pumps, circumduction, ABCs, rocker board

- Heel & toe raises

- Step overs

- Exaggerated heel-toe sequence during walking

- Walking

- Biking

- Aquatics (if no wound)

What is the GOLD STANDARD for the treatment of venous insufficiency?

Compression (chronic situation -- unless surgically intervened)

What should we educate our patients w/ venous insufficiency on?

Compression, consequences of extended standing or sitting or crossing legs, importance of elevation, care and replacement of compression stockings, need for a healthy lifestyle (weight, smoking, diet, sleep, etc.)

PT intervention goals: prevention

DETECT S/S EARLY!! = vascular screening for venous reflux, plan for long-term compression use, surgical consult

PT intervention goals: treatment

Edema mgmt (PRIMARY) = leg elevation, compression therapy; wound care = manage drainage, protect periwound skin

PT intervention goals: education for long-term management

Education on condition, expectation for other wounds if not intervened; long-term compression needs

List compression methods for venous insufficiency.

- Tubigrip: light, easy, reusable

- Long-stretch and short-stretch

- Inelastic: Unna boot

- Multilayer: 2-4 layers, high compression

- Stocking: maintenance, custom vs. OTC

- Garments: farrow wrap, Circ-Aid

List the purpose of dressing.

1. Protect the wound from contamination

2. Maintain a moist healing environment

3. Manage exudate

4. Promote autolytic debridement

5. Support tissue regeneration

List KEY considerations in wound dressing selection.

1. Wound type & depth: is it superficial, partial, or full thickness?

2. Exudate level: dry, moderate, or heavy?

3. Infection status: is antimicrobial action needed?

4. Periwound condition: fragile, macerated, or intact?

5. Patient factors: allergies, mobility, cost, ease of use

_______: type of dressing used for low to moderate exudate, promotes autolysis

Hydrocolloids

_______: type of dressing that can absorb moderate to heavy exudate, cushions

Foams

_______: type of dressing for heavy exudate, promotes hemostasis

Alginates

_______: type of dressing that can rehydrate dry wounds and support autolysis

Hydrogels

_______: type of dressing that can stimulate tissue growth and support wound matrix; suitable for minimally exudative, non-infected wounds

Collagen

_______: type of dressing that provides a barrier for superficial wounds, low exudate

Films

_______: type of dressing that incorporates silver, iodine, or honey for infections

Antimicrobial

_______: flexible dressings made of silicone adhesive that is gentle on

skin and wound areas to absorb wound drainage. May be used in areas w/o wounds to prevent friction.

Foam (silicone foam borders -- Optifoam/Mepilex)

Contraindications: foam

Allergy or sensitivity to silicone

Directions for use: foam

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Gently peel off the Foam Border.

▪ Cleanse the wound and around the wound with sterile saline.

▪ Gently blot dry around the wound and the wound bed using clean or sterile gauze.

▪ Peel backing film(s) off of the FoamBorder

▪ Apply Foam Border over wound bed

_______: thin, transparent adhesive dressing that acts as a barrier to external contaminants while allowing oxygen exchange. It is ideal for superficial wounds with minimal exudate and can also be used to secure IV sites or cover healing wounds.

Film (transparent film -- Tegaderm)

Contraindications: film

Allergy or sensitivity to adhesive materials, moderate to heavy exudate, fragile or compromised skin that may tear upon removal

Change as ordered by your provider!!

Direction for use: film

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Gently remove the old dressing

▪ Cleanse the wound and surrounding skin with sterile saline

▪ Gently blot dry using clean or sterile gauze

▪ Peel backing from the film

▪ Apply the dressing smoothly over the wound, avoiding wrinkles

▪ Press edges to ensure full adhesion

Change as ordered by your provider OR if it becomes loose or soiled!!

_______: sterile, non-adherent dressing made of fine mesh gauze impregnated with petrolatum and 3% bismuth tribromophenate. It provides a moist wound environment and has mild antimicrobial properties. Commonly used for superficial wounds, donor sites, surgical incisions, and skin grafts.

Non-adherent contact layer/ impregnated gauze (Xeroform)

Contraindications: impregnated gauze

Allergy or sensitivity to bismuth or petrolatum, deep or heavily exudative wounds w/o secondary dressing

Direction for use:

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Gently remove the old dressing

▪ Cleanse the wound and surrounding skin with sterile saline

▪ Gently blot dry using clean or sterile gauze

▪ Apply a new piece of Xeroform directly over the wound bed

▪ Cover with a secondary dressing if needed (e.g., gauze pad, foam)

Change as ordered by your provider!!

_______: flexible dressing that works together with wound moisture and drainage to help wound healing and to help remove dead tissue through autolytic debridement. Autolytic debridement uses your body's own enzymes and moisture to re-hydrate, soften and finally liquefy dead tissue. It is also used as a protective covering to prevent certain types of skin breakdown, such as friction.

Hydrocolloid - thin

Contraindications: hydrocolloid - thin

Allergy or sensitivity to hydrocolloid, moderately or heavily draining wounds, 3rd degree burns

Direction for use: hydrocolloid - thin

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Begin to remove dressing by slowly and lightly peeling up the edges. If dressing is difficult to remove, adhesive remover wipes may be used to assist in dressing removal.

▪ Cleanse the wound and around the wound with sterile saline, making sure to remove all old dressing materials.

▪ Gently blot dry around the wound and the wound bed using clean or sterile gauze.

▪ Optional: Apply Skin Prep around the wound. This will protect the skin when removing the dressing and provide a sticky surface to adhere to.

▪ If necessary, cut piece to fit over the entire wound bed and extending approx 1 inch, if space allows, onto the skin around the wound.

▪ Remove the backing from the Hydrocolloid Thin.

▪ Apply piece of Hydrocolloid Thin over the wound.

Change as ordered by your provider!!

What is important to consider when analyzing a wound that has had a hydrocolloid dressing on it?

Hydrocolloid thin can develop a slight odor; if this odor is present, it should resolve w/ cleansing the wound

What is the difference b/w hydrocolloid thin and regular?

Regular dressings are thicker and more absorbent, making them suitable for low to moderate exudate (while thin dressings are suitable for dry to light exudate)

_______: highly absorptive material that creates a soft gel when wound drainage is absorbed. May also come with Silver Impregnated (Ag).

Hydrofiber

Direction for use: hydrofiber

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Clean the wound and around the wound with sterile saline, making sure to

remove all old dressing material. If you can't easily remove the dressing from the wound, apply sterile saline to the dressing until it is able to be removed. ▪ Gently blot dry around the wound and the wound bed using clean or sterile

gauze.

▪ If necessary, cut a piece slightly larger than the size of the

wound bed, overlapping approx 1 cm (0.5in), on to the skin, if possible.

▪ Apply piece over the wound bed

▪ Cover with dry dressing recommended by your provider

Change as ordered by your provider!!

_______: cooling, soothing

dressings made primarily of water and polymer. They help maintain a moist wound environment, support autolytic debridement, and provide pain relief. Ideal for dry or minimally exuding wounds. Some may contain

antimicrobial agents like silver.

Hydrogel sheet (also comes in a gel variation)

Direction for use: hydrogel sheet

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Clean the wound and surrounding skin with sterile saline. Remove any old dressing gently. If stuck, moisten with saline until it loosens.

▪ Gently blot dry around the wound using clean or

sterile gauze.

▪ If needed, cut to fit the wound size,

allowing a slight overlap onto healthy skin (about 1 cm

or 0.5 in).

▪ Apply directly over the wound bed.

▪ Cover w/ a secondary dressing as recommended by

your healthcare provider (e.g., foam or gauze).

Change as directed by your provider OR when it becomes dry or soiled!!

_______: made from seaweed-derived fibers that form a soft gel when in contact with wound exudate. They are highly absorbent and ideal for moderate to heavily draining wounds. When impregnated with silver (Ag), they provide antimicrobial protection to help reduce bacterial load in the wound.

Alginate

Direction for use: alginate

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Clean the wound and surrounding skin with sterile saline. Remove any old dressing gently.

If stuck, moisten with saline until it loosens. ▪ Gently blot dry around the wound using clean or sterile gauze.

▪ If needed, cut to fit the wound size, allowing a slight overlap onto

healthy skin (about 1 cm or 0.5 in).

▪ Apply directly into or over the wound bed.

▪ Cover with a recommended secondary dressing (e.g., foam or gauze pad) to secure and

manage drainage.

Change as directed by your provider OR when the dressing becomes saturated or soiled!!

_______: sheet dressings contain medical-grade Manuka honey infused into a sterile, absorbent gauze. The honey provides natural antimicrobial action, supports autolytic debridement, and helps maintain a moist wound environment. The sheet format allows for easy application and removal.

Honey sheet (note: there is also a gel version and alginate version that provides absorption)

Contraindications: honey sheet

Allergy or sensitivity to honey or honey-derived products, 3rd degree burns, heavily bleeding wounds

Direction for use: honey sheet

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Cleanse the wound and surrounding skin with sterile saline. Remove any old dressing gently. If stuck, moisten with saline until it loosens. ▪ Gently blot dry around the wound and wound bed using clean or sterile gauze.

▪ If needed, cut to fit the wound bed.

▪ Apply directly over the wound. If the wound has depth, lightly pack the

dressing as directed by your provider.

▪ Cover with a dry secondary dressing as recommended by your healthcare provider.

Change as ordered by your provider!!

_______: Iodine based gel, used to reduce dead tissue and bacteria on the surface of wounds.

Cadexomer Iodine gel (there is also a pad variation)

Contraindications: Cadexomer Iodine - Gel

Iodine allergy or sensitivity, pregnant or breastfeeding, thyroid metabolism issues (if used long-term)

Direction for use: Cadexomer Iodine - Gel

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Clean the wound and skin around wound with sterile saline, making sure to remove all old dressing materials. If you can't easily remove the dressing from the wound, apply sterile saline to the dressing

until it is able to be removed.

▪ Gently blot dry around the wound and wound bed using clean or sterile gauze ▪ Apply enough Iodosorb to cover wound bed using either a cotton tip applicator (Q-Tip) or by squeezing

the gel onto the secondary dressing such as a gauze and applying it over the wound

▪ Cover with dry dressing recommended by your provider

Change as ordered by your provider!!

When wound drainage is absorbed by Cadexomer Iodine - Gel, the Iodosorb changes color from what to what? (note: also, take extra care to ensure all old Iodosorb material is removed before placing new Iodosorb)

Brown --> cream/grey color

_______: what our bodies need to produce new cells; this synthetic version dissolves into the wound bed to act as scaffolding for tissue in wounds to grow. Comes in a silver impregnated version as well.

Collagen

Contraindications: collagen

3rd degree burns, allergy or sensitivity to collagen

Direction for use: collagen

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Cleanse the wound and around the wound with sterile saline, making sure to remove all old dressing materials. If you can't easily remove the dressing from the wound, apply sterile saline to the dressing

until it is able to be removed.

▪ Gently blot dry around the wound and the wound bed using clean or sterile gauze.

▪ Cut a piece to fit the size of the wound bed.

▪ Apply cut piece to the wound bed

▪ Moisten with sterile saline until entire piece of collagen dressing turns translucent/gray.

▪ Cover with dry dressing recommended by your provider

Change dressing as ordered by your provider!!

Is it necessary to remove residual collagen dressing from the wound bed during dressing changes?

NO!! -- collagen will naturally absorb into the body over time

_______: foam dressing that helps stop the growth of bacteria (bacteriostatic). The foam is made up of polyvinyl alcohol sponge, Methylene Blue, and Crystal Violet, which are the bacteriostatic ingredients.

Hydrofera Blue

Contraindications: Hydrofera Blue

Allergy or sensitivity to polyvinyl alcohol, Methylene Blue, or Crystal Violet; 3rd degree burns; heavily bleeding wounds

Direction for use: Hydrofera Blue

NOTE: we're always going to assume that you washed your hands (or used hand sanitizer) before & after and applied clean gloves.

▪ Cleanse the wound and around the wound with sterile saline, making sure to remove all old dressing materials. If you can't easily remove the dressing from the wound, apply sterile saline to the dressing until it is able to be removed. ▪ Gently blot dry around the wound and the wound bed using clean or sterile gauze.

▪ If necessary, cut piece to fit into/over the entire wound bed.

▪ If ordered, moisten piece with ordered liquid (example: sterile saline, acetic acid, etc). Squeeze out excess liquid once moistened.

▪ If ordered, fenestrate the dressing by cutting slits in the body of the piece of dressing you will use.

▪ Apply to cover wound bed, if wound has depth lightly pack wound

▪ Cover with dry dressing recommended by your provider

Change as ordered by your provider!!

Advantages vs. contraindications: hydrogel

Advantages: cooling effect, promotes autolysis, hydrates wound bed

Contraindications: heavy exudate

Indications: hydrogel

Minimally draining, dry wounds, eschar

Advantages vs. contraindications: antimicrobials

Advantages: controls bacteria, reduces or prevents infection

Contraindications: known sensitivity, silver may cause staining in wound/skin

Indications: antimicrobials

Infected wounds, wounds at risk for infection

Advantages vs. contraindications: impregnated gauze

Advantages: highly comfortable, non-adherent, promotes autolysis, maintains moisture

Contraindications: heavy exudate, indications may vary based on impregnated dressing

Indications: impregnated gauze

Painful wounds, burns, dry wounds, minimal drainage

Advantages vs. contraindications: alginates

Advantages: highly absorbent, easy to use, slows bleeding, layered for more absorption

Contraindications: dry eschar, 3rd degree burns, heavy bleeding

Indications: alginates

Moderate to heavy drainage, infections, slough or granulation

Advantages vs. contraindications: foams

Advantages: non-adhesive options for friable skin

Contraindications: 3rd degree burns, dry or non-draining wounds

Indications: foams

Minimal to heavy exudate, infected wounds

Advantages vs. contraindications: hydrofiber

Advantages: highly absorbent, packing agent

Contraindications: dry wounds, dry eschar

Indications: hydrofiber

Infection, moderate to heavy exudate

Advantages vs. contraindications: hydrocolloids

Advantages: maintains a moist wound bed, adhesive and absorptive, promotes autolysis

Contraindications: burns or dry wounds, heavy exudate, tunneling or sinus tracts, infection

Indications: hydrocolloids

Dry, necrotic wounds; minimal exudate; clean, granulating wounds

Advantages vs. contraindications: transparent film

Advantages: promotes autolysis, reduces surface tension, various sizes and shapes

Contraindications: moderate to heavy exudate

Indications: transparent film

Dry or minimal drainage, partial thickness, secondary dressing

Guiding question: Can you describe the basic anatomy of the venous system? Do veins have significant smooth muscle within their walls, similar to arteries?

Basic anatomy: network of blood vessels that return deoxygenated blood from the body back to the heart. Low-pressure system with valves to prevent backflow.

NO!! Veins do NOT have significant smooth muscle in their walls. Veins are often referred to as "capacitance vessels" because of their thin walls and large lumens allow them to hold large volumes of blood w/ relatively low pressure.

Guiding question: What is venous hypertension?

Abnormally high pressure within the veins, most commonly in the veins of the legs. This occurs when blood flow back to the heart is impaired (vein valves are not working properly, vein walls are damaged, blood is obstructed, muscle pump failure)

Guiding question: What system is used to classify venous wounds?

CEAP Classification

- Clinical = what can be seen or measured on physical exam

- Etiologic = cause

- Anatomic = which veins are affected

- Pathophysiologic = how the veins are malfunctioning

Provides a universal language, guides treatment decisions, allows tracking of disease progression and healing

Guiding question: Describe the typical location and characteristics of venous insufficiency ulcers (wounds).

Location: medial lower leg, esp. just above the medial malleolus (i.e., the "gaiter" area)

Appearance & characteristics: irregular, shallow, moderate to heavy exudate, pain relieved by leg elevation, hemosiderin staining, stasis dermatitis, pulses present, lipodermatosclerosis, atrophie blanche

Guiding question: What is lipodermatosclerosis?

Chronic inflammatory and fibrotic condition of the skin and subQ tissue of the lower legs caused by long-standing venous HTN.

- skin feels like leather

- shape is an "inverted champagne bottle"

- often tender and discolored

Guiding question: What is hemosiderin staining?

Brownish skin discoloration caused by the leakage and breakdown of RBCs --> releases hemoglobin --> iron from the hemoglobin is stored in tissues as hemosiderin

Guiding question: What is the primary underlying treatment, most important for treating venous insufficiency ulcers?

Compression therapy!! (removes venous pressure, improves venous return, decreases edema, enhances oxygen and nutrient delivery, promotes ulcer healing, and prevents recurrence)

Guiding question: What are the goals of appropriate wound dressings?

1. Protect the wound from contamination

2. Maintain a moist healing environment

3. Manage exudate

4. Promote autolytic debridement

5. Support tissue regeneration

Guiding question: What considerations are there in choosing an appropriate dressing?

1. Wound type & depth

2. Exudate level

3. Infection status

4. Periwound condition

5. Patient factors (allergies, mobility, cost, ease of use)

Guiding question: What is a primary dressing?

Primary: first layer of dressing that comes directly in contact w/ the wound bed

- maintains a moist environment

- protects

- absorbs exudate (if needed)

- delivers medication (if medicated dressing)

- minimizes trauma when removed

Ex: hydrocolloids, alginates, hydrofibers dressings, foams, non-adherent contact layers, antimicrobial dressings

Guiding question: What is a secondary dressing?

Secondary: additional dressing applied over the primary dressing to provide supportive functions

- secures the primary dressing in place

- provides addition absorption

- protects

- adds compression or insulation

Ex: gauze pads or rolls, elastic or cohesive bandages, foam pads or ABD pads, compression wraps

Guiding question: What is a composite dressing?

Composite: combines multiple layers or functions -- including both primary and secondary dressing roles -- into one single product

- usually has 3 layers

- ex: Tegaderm Plus Pad, Allevyn Adhesive, Covaderm, Opsite Post-Op dressing

Guiding question: When should we change the dressing? How do we know when it's best to change?

Depends on the type of wound, type of dressing, and amount of exudate. General rule is dressings should be changed often enough to keep the wound clean and the surrounding skin intact -- but not so often that you disturb healing. "Change as needed, not by habit."

When in doubt, change dressing as ordered by your provider!!

Guiding question: List the dressing classifications.

Hydrocolloids, foams, alginates, hydrogels, collagen dressings, films, antimicrobial dressings

Guiding question: What does it mean for a dressing to be occlusive?

Occlusive: impermeable to air and water

- completely seals the wound from the external environment

- retains moisture and heat

- typically used for shallow, clean wounds or minor abrasions

Ex: hydrocolloid dressings, some transparent films

Guiding question: What does it mean for a dressing to be semi-occlusive?

Semi-occlusive: allows gas exchange (O2, CO2) BUT blocks water and bacteria

- maintains a moist environment w/ some airflow

- moderate exudate wounds, venous ulcers

Ex: foam dressings, hydrogel sheets, transparent films

Guiding question: What does it mean for a dressing to be nonocclusive?

Nonocclusive: permeable to air, water, AND bacteria

- does not retain moisture

- allows wound to dry out

- infected or heavily draining wounds (often combined with another dressing)

Ex: gauze, tulle dressings

Guiding question: How is gauze best used and what cautions are there with gauze used?

Uses: as a secondary dressing to secure it and absorb excess drainage, for short-term wound packing, for heavily exudative or infected wounds

Cautions: adherence to wound bed (dry gauze sticks), desiccation, fibers left behind, frequent changes needed, non-selective debridement (NO LONGER RECOMMENDED IN MODERN WOUND CARE), poor barrier protection (nonocclusive)

Guiding question: What are the indications and risks with use of impregnated gauze?

Indications: primary dressing; partial-thickness wounds, skin grafts and donor sites, surgical incision, minor burns or radiation injuries, chronic and/or painful wounds

- keeps wound moist, prevents adherence

- best for superficial, clean, or granulating wounds

Risks: limited absorption, potential for maceration, occlusion of air flow, sensitivity reactions, frequent changes needed, not ideal for debridement

Guiding question: What are the indications and risks with using a film dressing?

Indications: barrier for superficial wounds, low exudate

- allows visualization of the wound bed and wound exudate

- waterproof and bacterial barrier w/ oxygen and vapor exchange

- reduces friction and shear

- facilitates autolytic debridement

- conforms to body contours

- serves as a secondary dressing

- is cost-effective

Risks: NOT for infected wounds or wounds w/ excess moisture buildup; NOT suitable for deep, cavity, or tunneling wounds

- may tear fragile skin upon removal

- does not absorb exudate

- may not adhere well to dry, flaky skin

- may macerate skin if fluid collects underneath

**Best for superficial, minimally exudative wounds and for protection vs. absorption**

Guiding question: When should a film dressing not be used?

1. Moderate to heavily exudating wounds (fluid is trapped beneath the surface --> maceration and wound enlargement)

2. Infected wounds (seal traps bacteria and exudate)

3. Deep, cavity, or tunneling wounds

4. Fragile or compromised periwound skin

5. Wounds w/ thick eschar or heavy slough (film blocks oxygen and moisture)

Guiding question: What are the indications and risks with using a hydrogel? When should a hydrogel not be used?

Indications: hydrates dry wounds, support autolysis

- rinse or clean easily

- conforms

- soothe "hot" wounds and reduce pain

- delivery system

Risks: macerate the periwound skin if wound become too wet, do not absorb drainage, dry out if not covered adequately, require a secondary dressing, usually require daily dressing changes

Contraindications: wounds w/ visible exudate

Guiding question: Which dressing class is most appropriate for use over an exposed structure, such as bone or tendon?

Exposed bone or tendon must stay moist and protected. The goal is to prevent desiccation, avoid trauma, and encourage granulation tissue. So, we need a moisture-donating, non-adherent dressing.

Best choice = hydrogel (hydrates exposed structures, promotes autolytic debridement, non-adherent and soothing)

Guiding question: What are the indications and risks with foam dressings?

Indications: absorb moderate to heavy exudate, cushion

- create and maintain a moist environment

- easy to apply

- effective under compression

- absorb light to heavy exudate

- conform well

- do not adhere to a moist wound surface

- available w/ antimicrobials

- protective

Risks:

- require a secondary dressing if non-bordered

- not effective for dry eschar

- may macerate periwound skin if saturated

- costly

Guiding question: What are the indications and risks with hydrocolloids? When should a hydrocolloid not be used?

Indications: low to moderate exudate, promote autolysis

- maintain moist wound

- keep bacteria, moisture, and contamination out of wound

- absorb min to mod exudate

- facilitate autolytic debridement

- thermal insulation

- effective under compression

- self-adhering

- conform well

Risks:

- prevent visualization of wound bed (not recommended for DTPI)

- difficult to remove from fragile skin

- may leak

- require a different primary dressing to fill spaces

Should NOT be used: covering exposed structures (tendon, bone), infections, heavy exudate

Guiding question: What are the differences and similarities between calcium alginates and hydrofiber dressings?

Similarities: highly absorbent (used for moderate to heavily exudating wounds), form a soft, cohesive gel that maintains a moist wound environment and traps bacteria and exudate

**Both are used for venous ulcers, pressure injuries, diabetic ulcers, surgical or traumatic wounds, infected wounds (antimicrobial)**

Differences: base material (alginates = seaweed, hydrofiber = cellulose), fluid retention (hydrofiber retains fluid better), cohesiveness (hydrofiber is more cohesive), hemostatic capabilities (alginates have, hydrofibers do not), wicking (alginates = horizontal, hydrofibers = vertical), cost (alginates are cheaper)

Guiding question: What are the three types of antimicrobials? When are they indicated for use and how long should they be used for?

Types: Silver, Iodine, Honey

Uses: infected wounds, wounds with high bioburden, wounds w/ early infection signs (increased exudate, odor, friable) granulation tissue, or delayed healing), post-debridement wounds or graft sites

How long: standard initial course is 2 weeks. continue beyond 2 weeks only if infection signs persist or bacterial load remains high. discontinue when wound shows progression (less exudate, healthy granulation, no odor, no redness).

Guiding question: When should silver not be used? When should cadexomer iodine not be used?

When NOT to use: clean, healing wounds; dry or minimally exudative wounds; long-term use

Silver: allergy or sensitivity, pediatric population (risk of toxicity), patients w/ electrical implants (can interfere w/ electrical conduction -- rare but noted in precautions), during MRI imaging (may distort MRI images or heat up), in combination w/ oil-based or petroleum products (deactivate the silver), where enzymatic debridement is used (silver inactivates these agents)

Iodine: allergy or sensitivity to iodine, dyes, or shellfish; pregnant or breastfeeding (may affect the baby's thyroid); thyroid metabolism issues; renal impairment