Wound Dressings Module 3

What should guide wound dressing selection?

Characteristics of the wound and periwound, NOT supply availability

What are some ideal properties of a wound dressing?

Preserve hydration and limit fluid loss

Difference between primary vs secondary dressings?

Primary: applied directly to the wound
Secondary: applied over the primary dressing

What are advanced dressings capable of?

Serving as both primary and secondary with absorptive and adhesive qualities

Why is Wet-To-Dry Gauze considered outdated?

- Painful
- Non-Selective
- Leaves fibers
- Promotes desiccation
- Bacterial permeable
- Disrupts normothermia

Gauze Characteristics:
Absorptive, Occlusive, Autolytic

Yes, No, No

What are some appropriate uses of Gauze fiber?

- Maintain drainage opening in tunneling wounds
- Gently support cavity wounds
- Secondary dressing with heavy exudate

Why should Gauze not be aggressively packed?

Impedes oxygen/nutrient flow and inhibits granulation and epithelialization

4X4 Gauze used wet-to-dry provides what type of debridement?

Non-selective mechanical debridement

What is Impregnated Gauze?

Gauze saturated in agents

What are some purposes of impregnated gauze?

Prevent sticking to the wound surface

What are some common gauze impregnation material?

Petroleum emulsion (Ex. Vaseline)

What are some typical uses of impregnated gauze?

Primary dressing for new sutures, preventing adherence to secondary dressing

Impregnated Gauze characteristics:
Absorptive, Occlusive, Autolytic

Minimally, No, No

What are Transparent Films?

Transparent membrane of acrylic adhesive layer to cover a wound and facilitate a moist wound enviornment

What is the best indication for transparent film dressing?

Wounds with mild exudate

What are the benefits of using Transparent Films?

- Moist environment
- Autolytic debridement
- Angiogenesis
- Wound homeostasis

Transparent film characteristics:
Absorptive, Occlusive, Autolytic

Minimal/Very few, Yes, Yes

Transparent film protects the wound from the effects of:

Shear, friction and incontinence

What are some precautions for transparent films?

Risk of skin tears in fragile skin
Not for highly exudative wounds

What are the key features of a foam dressing?

Highly absorbent and creates an occlusive environment for moist wound healing

What is reason for foam dressing uses?

Primary or secondary for moderate-heavy exudate wounds

When should foam dressing NOT be used alone?

Dry wounds (use gel primary first)

Foam dressing characteristics:
Absorptive, Occlusive, Autolytic

Yes, Yes, Yes

What is the benefit of newer foam dressings being impregnated with Methylene Blue, Silver or Gentian Violet?

Antimicrobial control to assist in bioburden without risk of being cytotoxic

What is the composition of a hydrogel?

90% water, amorphous gels or flexible sheets

What are some indications for hydrogels?

Dry wounds
Necrotic Tissue Softening
Autolytic debridement

True or False: Hydrogels require a secondary dressing

True

Hydrogel dressing characteristics:
Absorptive, Occlusive, Autolytic

Minimal, Minimal, Yes

What is the most occlusive of moisture retentive dressings?

Hydrocolloid

What are some different forms of Hydrocolloids?

Paste
Granule
Powder
Sheets

What are some uses of Hydrocolloids?

- Mild-moderate exudate
- Occlusive covering of infected wounds
- Maggot therapy

True or False: Hydrocolloid dressings best used for mild to moderate exudate

True

When using a hydrocolloid dressing, what is the expected reaction with exudate?

Soft, yellow, gelatinous, malodorous mass (NOT infection)

Hydrocolloid characteristics:
Absorptive, Occlusive, Autolytic

Yes, Yes, No

What is the source of calcium alginates?

Algae
Kelp

What is the absorptive capacity of Calcium Alginate?

20-30x their weight

Calcium Alginate characteristics:
Absorptive, Occlusive, Autolytic

Yes, No, No

What is the best use for gel alginates?

Maintain moisture and absorb excess exudate

True or False: Alginates are permeable and do not provide a barrier against bacteria

True

When is using an Alginate an effective choice

Moderate to heavy exudate, when an infected wound cannot be covered with occlusive dressing

How do Hydrofiber (Hydroactive) Dressings work?

Vertical wicking keeps exudate into dressing

Hydroactive dressings have combined characteristics of:

Alginate, foam and gel

What are some advantages of Hydrofibers?

- Non-adherent
- Less pain
- Maintain growth factors

What are some common product examples of Hydroactive dressings?

Aquacel = readily absorbs moisture
Aquacel + Silver = for bacteria

What defines a composite dressing?

Multiple dressing layers combined into one

What are the three layers of composite dressing?

1st - inner non-stick
2nd - middle absorbent
3rd - outer waterproof

True or False: A composite dressing could be primary or secondary

True

What are the sources of skin substitutes?

Neonatal male foreskin
Porcin (pig) dermal collagen

How are skin substitutes produced?

In a laboratory, shipped frozen or cooled and applied to patient’s wound

What is the purpose of skin substitutes?

Temporary coverage
Protection
Stimulate healing

What are some indications for skin substitutions?

Chronic diabetic foot ulcers
Venous leg ulcers
Deep burn wounds

What are the driving forces behind innovative dressings?

Resistant bacterial strain and cost

What are the goals of innovative dressings?

- Ideal environment
- Collagen dressings
- Hyaluronic acid derivatives

Transparent Film Dressing
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1,2
Dry to minimal
+
+
Closed; Partial Thickness
3x/week

Hydrogel Dressing
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1
Dry to minimal
Semi-occlusive
+
Full Thickness
Daily (filler) or 3x/week (sheet)

Hydrocolloid Dressing
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1,2
Minimal to moderate
++
+
Partial; Full Thickness
3x/week

Gauze
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1,2
Minimal to heavy
-
-
Full Thickness
Daily to 3x/week

Foam Dressing
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1,2
Moderate to Heavy
+
+
Full Thickness
3x/week

Alginate Dressing
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1
Moderate to Heavy
-
-
Full Thickness
Daily

Composite
Primary or Secondary:
Exudate:
Occlusive:
Autolytic Debridement:
Depth:
Frequency of Change:

1,2
Moderate to Heavy
+
+
Partial; Full Thickness
3x/week