Advanced wound practice

Acute wound

where acute wounds heal in a normal, orderly, and timely sequence of repair (inlammatory, proliferative, and remodeling)

Chronic wound

fail to progress through the normal, orderly, and timely sequence of repair.

Frequently appears to be "stuck" in the inflammatory phase of healing.

Best wound practice

Local wound care management must occur in the context of a global asessment of the patient and of the environment.

Stage1 pressure ulcer

Stage I Intact skin with non-blanchable redness of a localized area usually over a bony prominence.

May appear differently in darker skin tones (red, blue, or purple hue).

Lasts longer than 20 minutes.

Usually, skin returns to normal within 24 hours after relieving it from pressure.

Stage 2 pressure ulcer

Partial thickness loss of dermis (may extend into but not through dermis). The ulcer is usually superficial and presents as an abrasion, blister, or shallow crater with a red-pink wound bed

Stage5 pressure ulcer

Full thickness tissue loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint, capsule).

Depth of pressure ulcer varies by anatomical location.

includes undermining and tunneling. Deep infections, especially in ulcers of long duration, can often lead to osteomyelitis.

Un stage le pressure ulcer

Full thickness tissue loss in which the base is covered by slough and/or eschar. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth and stage can't be determined.

Rêver staging pressure ulcer

deep ulcers heal, the lost muscle, fat and dermis is NOT replaced. Instead, granulation tissue fills the defect before re-epithelialization. Chart the progress by noting an amprovement in the characteristics (size, depth, amount of necrotic tissue, amount of exudate, etc.)

Deep fissure injury

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacen

Pressure ulcer cause -pressure redistribution

primary causes of pressure ulcers is areas of high pressure (usually over bony prominences).

Pressure redistribution i.e., turning & positioning; reposition at least q2 hours, and use of pillows or foam wedges.

Friction-pressure ulcer cause

force of two surfaces moving across one anothe, creating local heat, and often resulting in an abrasion i.e.,

heels rubbing against the sheet.

Protect & suspend the heels with a pillow or heel protectors.

Shear pressure ulcer cause

mechanical force that moves the bony structures in a direction opposite the overlying skin i.e.,

patient sliding down on a bed.

Maintain HOB at the lowest elevation consistent with medical condition and restrictions → 30" elevation or lower is recommended. When you must raise it, keep periods brief i.e., mealtime.

Mobility cause pressure ulcer

Maximize activity and mobility

Nutrition pressure ulcer

Nutrition: increase protein for healing.

Malnutrition can lead to 」protein levels i.e.,  albumin. Hydration is also important for optimized healing since fluids may be lost not only through exudating wounds but also through emesis, frequent loose stools, large urinary outputs, etc.

Control moots tire pressure ulcer

urinary & fecal incontinence can result in excessive moisture, chemical irritation, and skin breakdown. Absorbent pads or briefs should be changed soon after soiling. Use a mild pH- balanced, non-sensitizing skin cleanser. Apply skin barrier products to protect from skin breakdown i.e., Cavilon, Proshield or lrnple care.

Diabetic foot ulcer

ommonly over bony prominences ocated on the plantar surface of the foot, over the metatarsal heads & beneath the heels

Diagnosis of diabetic ulcer

sually made based on clinical manifestations consisting of a painful, warm, swollen, and decreased to no sensations in the foot, and is supported by X-ray

Foot Assessment

Assess the top and bottom of both feet and in between the toes. Assess for abrasions, blisters, callus formation, or existing ulcer formation

Condition of toenails.

Bony/structural deformities (Charcot foot).

Neurovascular assessment of both lower extremities; sensations, movement, capillary refill, pulse (dorsalis pedis, posterior tibial), color, and temperature of the skin.

Semmes-Weinstein lOg monofilament test - tests for sensation on the plantar surface of the feet.

sites detected is normal whereas 6 or less sites detected would indicate decreased sensations.

Footwear

Cause of diabetic foot ulcer

result of neuropathy, complicated by peripheral vascular disease and infection.

Intervention diabetic ulcer bs control

monitor blood glucose, glycosylated hemoglobin.

Provide diabetic teaching - adherence of regimen to avoid long-term complications

Infection diabetic ulcer

there is a high incidence of infection associated with the diabetic foot. Swab for culture ,cs ,cbc,if the wound is not healing and there is evidence of infection. Provide teaching on feet hygiene & footwear to prevent skin breakdown, ulceration, or risk of infection

Diabetic ulcer loss sensation

most significant predictor of diabetic foot ulceration. Neuropathy prevents the perception of protective pain, resulting in an increased potential for tissue breakdown. Provide teaching on sensory loss.

Pressure diabetic ulcer

pressure-induced ischemia occurs in tissues over bony areas of weight-bearing during ambulation & standing, particularly over long periods of time - most common reason for delayed healing is inadequate offloading. Provide teaching on pressure offloading.

pt teaching hygiene e diabetic ulcer

test he water beliore pulng feet in thewaier, do not soak let wash & dy leet daily; dry gently behweeneachtoe,a thin coatof skinlotion, but not betwen the toes; do not use heating pad ora hot water botle; donot use adhesrve tape, wart treatnments, comn plasters, or strong antiseptics on your let; podatrnst to cut toe nanls.

Wear sock and shoes, comfortable , smooth, get comfortable with it

Mirror to check , identify sensation loss

Pressure onboarding, sandal, removable, insert, elevate feet

Venous ulcer

Ankle and mid calf

shallow and irregular in shape.

Yellow slough or dark red, "ruddy" granulation.

Moderate to large amounts of drainage.

Caused by venous insufficiency.

Ss venous ulcer

Pitting edema of lower extremities.

Skin reddish-brown discoloration.

Skin usually becomes thick, hardened.

Dull ache or heaviness in calf or thigh , especialy after long periods of standing, or pain at the end of the day. Pain is usually relieved with elevation.

Atrophie blanche - characterized by localized, often circular, whitish, and atrophic areas surrounded by dilated capillaries and sometimes hyperpigmentation, often described as porcelain white scars.

Waricose veins - palpable, firm, subcutaneous cord-like vein. Area

Venous ûcer. Size

PiVenous ulcers are caused by chronic venous insufficiency.

Venous insufficiency may be related to abnormal valves, calf-muscle- pump failure, or obstruction i.e., DVT.

Stasis dermatose complications of venous ulcer

common complication related to chronic venous insufficiency. Leakage of fluid and macromolecules into the tissues creates an inflammatory response with erythema, scaling, and intense pruritus. Scratching usually leads to skin breakdown and is often the precipitating cause of venous ulceration

Venous insufficiency intervention

require edema control, with the cornerstone being compression therapy for life and activity modifications to activate the calf-muscle

Compression therapy

compression bandages/wraps are used to reduce both the edema and the inflammatory response. Compression stockings are used to maintain edema control and help prevent stasis dermatitis.

Compression stockings should be individually measured to achieve appropriate compression. Before starting any sort of compression, an Ankle Brachial Pressure lndex test must be done to verify if there is enough circulationo

activity modification venous ulcer

Activity modifications to activate the calf-muscle :

ankle dorsi-flexion and plantar flexion to promote venous blood return; a mix of tolerable walking and elevation of affected limb above the level of the heart to reduce edema.

Other strategies are avoiding long periods of sitting or standing and skin care - moisturization/hydration to prevent skin breakdown.

Note: inot common to treat venous ulcers with anticoagulants; however, patients who have a history of r DVT may be put on them for the purpose of reducing the risk of PEs.

There is no evidence that supports the use of diuretics for the treatment of peripheral edema due to pure venous disease unless it's linked to other causes i.e., CHF, renal failure, or hepatic cirrhosis.

Currently, provincial health insurance plans will pay for saphenous vein ligation and stripping procedures for patients with venou

Arterial ulcer

Most commonly occur over bony prominences on the toes, feet, or lower leg

Punched outf? appearance that is deeper than a venous ulcer.

Yellow slough or black eschar in wound bed with little granulation tissue.

Minimal amount of drainage to none.

Caused by arterial insufficiency.

Ss arterial insufficiency

Pain: intermittent claudication of the calf; pain is precipitated by exercise or ambulation. Elevation of the limb may aggravate the pain.

Pulselessness: faint or absent pedal, popliteal, or femoral pulses.

Pallor: elevation of the lower extremity results in pallor, but when the extremity returns to a dependent position the foot color is reddish/blue (often called dependent rubor).

Paresthesia: numbness or tingling occurring in the toes or feet.

Paralysis: a very late sign of aterial ischemia & signals the actual death of nerves supplying the extremity.

Poikilothermia: inability to control one's body temperature, most often cool legs, or feet.

Arterial insufficiency

Arterial insufficiency may be related to arterial stenosis or obstruction from thrombosis, emboli, atherosclerosis, vasculitis, or Raynaud's phenomenon.

Arterial ulcer intervention

sis Restore blood supply to compromised limb : when arterial insufficiency results in impairment of normal activities of daily living or incapacitating, revascularizatio to the compromised limb should be considered i.e., balloon angioplasty (with or without stent), peripheral by-pass.

Nonhealing arterial ulcers and gangrene are the most serious complications. Amputation may be needed if blood flow is not restored adequately or if severe infection occurs.

Control other risk factor in arterial ulcer

Restore blood supply to compromised limb : when arterial insufficiency results in impairment of normal activities of daily living or incapacitating, revascularizatio to the compromised limb should be considered i.e., balloon angioplasty (with or without stent), peripheral by-pass.

Nonhealing arterial ulcers and gangrene are the most serious complications. Amputation may be needed if blood flow is not restored adequately or if severe infection occurs.

Assess ability to heal -blood supply

Adequate blood supply must be present as wcl as the corecticn ofother important host factors to support healing If a regional pulse can be palpated, the local arterial flow will usually support healing.

lf a pulse camnot be felt; an Ankle Brachal Pressure lndex (ABPl) Doppler may be used to measure arternal pressure & diagnose arterial disease.

ABPIlis the rahio of the ankle systoic BPover the brachialsystoic BP.Normal ABPI is0.9to 1.4 and indcadesthat the blood supply is adequate for healing. A ratio <0.5 suggests severe arterial compromise and a low probability of healing.

Venous disease can almost aways be diagmosed withouta duplex Doppler and is usually done by clinical observaion and patient history.

Factor affect ability to heal

Drugs i.e, corficosteroids, immunosuppressives, cytotoxic antineoplastics, vasoconstrictors, anticoagulants, NSAlDs

Edema

Album8n below 3

Anemia -」 hemoglobin → low tissue perfusion and oxygenation

Diseases ie., diabetes, cardiac/pernpheral vascular disease, respiratory disease, rheumatoid arthritis, cancer

Additional factor affect healing

Uncontroled pain. lnfecthon, Advanced age, Lifestyle/habits i.e,poor nutrtion smoking, substance abuse, sedentay ifiestyle, Psychologrcal i.e,molivathon, copng mechanisms, and Support system (patient circle of care, access to care,and financial constraints)

M measure

The precise location of the wound can be noted with a diagram or a body map.

The length is the longest diameter and the maximum width at right angles to the diameter.

Maximum depth can be measured with a sterile cotton swab or a sterile plastic depth guide. Probe the wound with caution for bone, sinuses, and undermining.

Stage, if it is a pressure ulc

Educate assessment

Quantity - scant, moderate, or heavy.

Quality - serous, serosanguineous, sanguineous, or purulent.

      Odor may be a sign of infection.

Can use the following descriptors: no odor at close range, faint odor at close range, moderate odor in room,       or strong odor in the room.

Note: certain dressings develop a distinct odor when exudate interacts with them.

Appearance assessment

Wound bed appearance and tissue type

Granulation: red-pink, firm and moist.

Newly formed epithelialization: pink-purple.

Fibrous: yellow, firm or sloughy. A firm yellow base represents underlying deep structures such as fascia, subcutaneous fat or the fibrin base for subsequent granulation tissue and does not need to be removed.

Whereas a soft sloughy yellow material provides a medium for bacterial growth, may indicate infection or degraded fibrin that needs to be removed. Slough may also be tan or green.

Necrotic (eschar): black, soft or firm - devitalized tissue.

Suffering assessment

patient’s pain i.e. PQRST - P(provokes & palliation) Q(quality) R(region & radiation) S(severity 0 to 10) T(timing).

Addressing the underlying wound pathophysiology is the first stage in managing chronic wound pain i.e., improving venous return with compression therapy may reduce pain. Remember that a change in pain level can be the first subtle sign of an infection.

Unresolved pain can negatively affect wound healing which, in turn, has a negative impact on quality of life. Assess pain management and effectiveness regularly.

Undermining assessment

Undermining is an area of tissue injury beneath intact skin around the margins of a wound. Document where undermining is present using the clock as a descriptor and 12 o’clock is at the head of the patient. Undermining can develop into sinus tracts (also known as tunnelling, a channel that extends through part of a wound and into adjacent tissue).

Re reevaluate

Undermining is an area of tissue injury beneath intact skin around the margins of a wound. Document where undermining is present using the clock as a descriptor and 12 o’clock is at the head of the patient. Undermining can develop into sinus tracts (also known as tunnelling, a channel that extends through part of a wound and into adjacent tissue).

Edge assessment

Edge  Condition of wound edge -

presence or absence of attached edge with advancing border of epithelium

. Assess condition of surrounding skin (peri wound) i.e., presence of erythema, induration (increased firmness of soft tissue), and/or maceration (white, waxy, soft & wet looking tissue).

If erythema is warm, hot, and tender, infection is likely.

Induration may indicate an abscess, edema, or trauma.

Causes of maceration: poor exudate control i.e., increased wound drainage and the dressing is not absorbing the exudate, or skin barrier cream was not used around the wound.

Acute noicérive pain

inflammatory response to tissue damage associated with a specific tngger ie., an injury.

Often described as aching or throbbing.

Usualy time limited, meaning when the tissue damage heals, the pain typically resolves. But it can also be a chronic condition such as arthritis pain.

Tends to respond well with opioids, NSAIDs

Chronic neuropathic pain

persistent nerve injury.

Examples are shingles, neuralgia, carpal tunnel syndrome, peripheral neuropathy.

Often described as burning, stinging, stabbing, or shooting.

Can be treated with Gabapentin, Lyrica or low-dose tricyclic antidepressants

Psychological factors as well as environmental factors can afect the patient' s pain experie

Pt education

if there have been difficulties following a treatment plan.

Determine beliefs about self-care.

Assess the clinical response to treatment ie., pil counts/rates of refil and physiological markers.

Empower patients with education through appropriate explanations and support.

Reason for charting

accepted standards of care - quality assurance

Legal requirement (Bil1 90) To assess wound progress toward treatment goa

To facilitate communication b/w health care team

Provide local wound care

choose dressing based on assessment

Débridement

Debridement is the removal of non-viable tissue from the wound bed.

It reduces contamination and removes wound debris which impedes wound healing and in turn reduces the risk for wound infection.

It enables visualization of the wound bhed and provides a clean base necessary for healing.

An absolute contraindication to debride wounds with inadequate blood supply or bleeding tissue.

Before embarking on debridement, check institutional poicy.

Surgical sharp débridement

sharp debridement

Fastest and most effective way to remove devitalized, contaminated, or infected tissue and reach vitalized tissue at the base of a wound.

Converts a chronic, non-healing wound into an acute wound.

dnvolves a scalpel, scrssors, or other sharp instruments and is conducted n a strict sternle environment i.e., the OR by a surgeon

Only wounds that have an adequate blood supply and are considered "healable" should be debrided surgically

Conservative sharp debridement

sharp debridement

Involves trimming of superficial non-viable tissue without causing any bleeding or minimal bleeding as opposed to surgical sharp debridement that usually involves more extensive debridement to reach the vascular layer.

Can be done at patients' bedside or in a clinic by a skiled clinician with wound care specialist training.

Mechanical debridement

dry gauze is moistened with normal saline, placed on the wound, and allowed to dry.

When the gauze is removed, the debris trapped in the gauze is mechanicaly separated from the wound bed. Can cause bleeding and pain with gauze removal and can danmage healthy granulating tissue.

Pressurized wound irigation is another example of mechanical debridement.

Autolytic debridement

Works only when there is adequate blood supply to the wound. Involves the body's own healhng processes (i.e., neutrophils, macrophages, and enzymes) to rid wounds of devitalized tissue.

Dressings that promote autolytic debridement also rehydrates, softens, and liquefies necrotic tissue i.e., calcium alginate, hydrogel, hydrocolloid dressings.

Contraindicated with infected wounds or non-healable wounds

Enzymatic debridement

debridement

-involves topical application of proteolytic enzymes to breakdown devitalized tissue i.e., Santyl Collagenase. Used when surgi cal techniques cannot be utilized

. Can get + exudate and iritation to surrounding skin.

Biological debridement

use of Maggots to ingest soft necrotic tissue, cellular debris, serous drainage & pathogenic bacteria. Fast acting, psychologically uncomfortable. Not indicated for ischemic wounds and when deep and surounding infection has not been treated systemicaly.

Debridement choice

depends on the wound heal ability.

Healable wounds =moisture balance dressing to promote granulation i.e., autolytic debridement.

Surgical sharp debridement may need to be considered.

Non-healable wounds or Maintenance wounds = moisture reduction and bacterial reduction i.e, an antiseptic solution with low cytotoxicity. Conservative debridement of slough may be considered; however, caution with non-healable wounds

Infection manage bacterial balance antimicrobial

Antibiotics are agents that kill selectively and require metabolic activity for action. Antibiotics can be bacteriostatic or bactericidal.

Antiseptics are non-selective agents that do not require metabolic action for eficacy. Antiseptics are always bactericidal and usually act on the surface.

Antimicrobial is an umbrella tem often used to group antibiotics and antiseptics. Antimicrobial dressings exert a broad spectrum of non-selective antibacterial action.

Clean wound

the wound Cleanse wounds with normal saline, sterile water, or tap water.

Silver products - use sterile water to clean wounds since NS inactivates the silver.

Antiseptics are cytotoxic and should not be used on clean granulating wounds.

Three main ways of cleaning the wound: NS or sterile water moist gauze to soak or compress. Note: a clean granulating wound bed should NOT be wiped harshly/scrubbed with gauze.

Gently pour saline o sterile water over clean wound.

Dirty wounds: irrigate the wound.

Antiseptic

Antiseptic solutions

Antiseptic solutions break down eschar rapidly i.e., Chlorhexidine, Povidone-iodine.

Antiseptics may be used to cleanse non-healable wounds containing debris that are highly colonized or infected. The prime objective is to reduce the bacterial burden.

6 Once the infection has been controlled, toxic solutions should be discontinued, and a moist interactive dressing should be applied to promote healing.

Sodium hypochlorite

-

sodium hypochlorite is essentially bleach. Dakin's solution is a dilute solution of sodium hypochlorite. Dakin's is a strong antiseptic.

Hydrogen peroxide

Hydrogen Peroxide is a de-sloughing agent while effervescing (bubbling). lt may form air emboli if packed into deep sinuses/cavities.

Both Dakin's and Hydrogen Peroxide are cytotoxic to healthy cells and granulating tissues.

Order for antiseptic tissue toxicity

The lowest tissue toxicity of antiseptics occurs with Chlorohexidine and Providone-iodine.

Therefore, they would be the agents of first choice for most non-healing wounds to dry the wound surface and decrease surface bacteria.

Just watch for patients with sensitivity to iodine or patients with thyroid disease because of the potential for absorbed iodine to interfere with thyroid gland function.

Contaminated

Non replicating bacteria

Colonization

Colonization: replicating bacteria but not causing injury to the host Critical colonization (increased bacterial burden) ; occurs when bacteria delay or stop healing of the wound

. First signs may be delayed wound healing as evidenced by no change in wound size or increasing exudate.

dnfection: the presence of replicating micro-organisms in a wound associated with host injury.

Superficial infection (critical colonization) z 3 NERDS criteria

Non-healing

Exudate increased

Red friable granulation

Debris (yellow or black) in wound

Smell or unpleasant odor

Deep infection 3 stone

Size is bigger

Temperature is elevated

Os probes to or exposed bone

New areas of breakdown

Exudate, erythema, edema

Smell

Culture wound

Culturing a wound that is healing at an expected rate and does not display any signs and symptoms of infection is not necessary.

7 Because all wounds are contaminated and colonized,

a culture simply confirms the presence of micro-organisms without providing any infomation as to whether they are having a detrinmental effect on the host.

Culte swab indication

However, bacterial swabs can be used to guide antimicrobial therapy or antibiotic therapy and to identify the presence of resistant organisms such as MRSA or VRE.

Remenber to culture if a wound is not healing and if there is evidence of infection

Treat infection

First, focus on optimizing host resistance by addressing the underlying cause that is impeding healing.

Superficial infection/critical colonization (a 3 NERDS criteria) = topical antimicrobials i.e, antimicrobial dressings or antiseptics i.e., Chlorhexidine, Povidone-iodine

Deep infection (2 3 STONES criteria) = systemic antimicrobials i.e., antibiotics

Dressing sélection

The patient - degree of pain, sensitivity to medicated dressings, self-care ability for wouncd care, cost.

The wound - location of wound, wound type, appearance, exudate, odor, undermining, condition of wound edge and surrounding skin.

Bacterial profile lf an infection is present, it may be necessary to use a dressing that has proven antibacternal properties as an adjunct to systemic therapy.

The product - match the dressing to the needs of the wound and the

Wound bed moist

Dressings should retain enough moisture to stimulate good healing yet not cause maceration or irritation to the surrounding tissues.

When a wound surface is too wet or too dry, the repair process is delayed. The goal is to keep a wound bed moist, not wet

Advantage of moist wound healing

Prevents cellular dehydration.

Enhanced autolytic debridement.

Triggers the phases of repair.

Reduces pain.

Choose dog tip

Choose a dressing that keeps the surounding skin dry while keeping the ulcer bed moist.

Choose a dressing that controls exudate but does not desiccate (dry out) the ulcer bed.

Occlusive dressings can provide a barier to the migration of micro-organisms into the wound.

Moist wound healing and occlusive dressings are not recommended for wounds with nadequate blood flow to heal. Non-healable wounds need moisture reduction to reduce bacterial load.

Eliminate dead space by loosely packing the wound.

8 Tight packing of a wound wil result in pressure to the walls of the wound, slowing down the healing process.

Never use cytotoxic solutions to pack a wound. lnstea

Film

Semi-permeable adhesive transparent films.

lmpermeable to water molecules and bacteria.

Moisture vapor transmission rate varies from film to Creates an occlusive barrier against infection but can encourage growth of anerobic bacteria and fungus.

Good for small, superficial wounds such as skin tears or for protection of high-risk skin.

Not to be used on draining or infected wounds.

Wet to dry gauze

Cotton or synthetic material.

Low absorptive capacity.

Wet to dry gauze saline dressings are not considered continuously moist.

Used as a form of mechanical debridement

Can cause bleeding and pain with gauze removal and can damage granulating tissue., not recommended in a clean granulating wound.

Lint fibers left in wound increases risk of infection. When used to pack, gauze should be lightly moistened with hydrogel to provide moisture to wound bed.

Non adhérent dressing

Porous sheets of dressings with low adherence to tissue

Non-medicated tulles, silicone, and petrolatum- based woven dressings.Allows drainage to seep through pores to a secondary dressing.

Provides protection to fragile granulating tissue

Facilitates application of topicals

Used on minor wounds or skin tears

Mepitel, Telfa

Bactigras Shur-conform oil emulsion

Hydrogel

Polymers with high water content.

Available in gels, solid sheets, or impregnated gauze.

Best with dry wounds or with low exudate.

Helps hydrate the wound and provides a moist environment. Requires a cover dressing i.e., Telfa.

Can lead to maceration - protect the periwound.

Solid sheets should not be used on infected wounds.

intrasite gel

hydrocolloid

May contain gelatin, sodium carboxymethylycellulose and/or pectin.

Sheet dressings are occlusive with polyurethane outer layer.

Creates an occlusive barrier against contamination.

hydrocolooid indication

Wounds with small to moderate exudate.

Use with caution on fragile skin. Will swell slightly when in contact with wound exudate. Observe peri-wound skin for maceration. Characteristic odor may accompany dressing change and should not be confused with infection. Not to be used on infected wounds. Thin duoderm - fon superficial wounds within minimal exudate on Stage I pressure ulcer.

Duoderm

Calcium alginate

Sheet  or fibrous ropes of calcium sodium alginate (seaweed derivative).

Some have fluid wicking.

Has hemostatic capabilities but varies.

Bioabsorbable.

Useful in highly draining wounds.

Highly absorbent dressings. As it absorbs the exudate, it converts to a gel - irrigate to remove.

Most have a low tensile strength - avoid packing into narrow deep sinuses.

ln general, can be used on infected wounds but requires to be changed daily

Melgisorb Mesorb Kaltostat CovaWound

Foam

Non-adhesive or adhesive polyurethane foam.

Some have fluid wicking, prevents maceration Some include silver.Moderate to heavily draining wounds.

Non-adhesive borders require taping or secure with a gauze wrap. Can cause maceration if not changed regularly. Occlusive foams should not be used on infected wounds; however, foams with silver mav be used on infected wounds

M’épilez alevyn

Hypertonic

Gauze sheet, ribbon or ge impregnated with sodium concentrate.

May be painful on sensitive tissue.

Moderately draining wounds including infected wounds. Goes in dry and absorbs exudate

Always apply Mesalt dry - wetting it decreases effectiveness.

Gauze/ribbon should not be used on dry wounds

Hypergel for dry wounds

Hydrophilic fibre

Sheet or packing strip of sodium carboxymethylycellulose.

Some include silver.Wounds with moderate exudate.

Converts to a solid gel when activated by moisture. Soaks out exudate moisture in the wound and still maintains moisture in the wound.

Secondary dressing required i.e., foam. Low tensile strength - avoid packing into narrow deep sinuses. Aquacel with silver may be used on infected wounds. lf no silver, it may be used on infected wounds but requires to be changed daily.

Charcoal

Contains odor absorbent charcoal within product.

Used mainly for malodorous infected or fungating wounds. Requires a secondary dressing to hold in place - ensure that dressing edges are sealedSome include laver of silver to reduce bacterial count

Carbof’ex actisprb

Antimicrobial

Silver or cadexomer iodine vehicle delivery: sheets, gels, alginates, foams, on paste.

Broad spectrum against bacteria. Treats only wound surface bacteria, not deeper infections.

Not to be used on patients with known hypersensitivities to product components.

Sterile water must be used with products containing silver.

Acticoat Silvercel lodosorb lnadine Medihoney Hydrofera blue, PHMB

Devices

Negative pressure wound therapy (NPWT) applies negative pressure drawing wound edges together.

Dressings consist of a special dressing, a vacuum tube, and a vacuum pump

Vac indication

Removes exudate, fluid, infectious materials, promotes granulation formation and draws wound edges together.

For chronic, non-healing wounds, esp. those that are deep and complicated.

Skill required for this therapy.