Making the Most of your Dressing Products Catherine Hammond CNS/CNE
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1 Making the Most of your Dressing Products 2013 Catherine Hammond CNS/CNE
2 What do you need in your dressings cupboard? 2
3 Skin tear 3
4 4
5 Lack Confidence in Selecting Dressings? 5
6 Appropriate Use of Product Avoid wasting precious resources 6
7 Some of the older more traditional treatments
8 Providing The Right Environment
9 Holistic Wound Management Determine the underlying cause Assess blood supply Consider comorbidities Educate patient Patient comfort Control factors affecting healing Promote independence Provide optimal wound environment Prevent recurrence 9
10 Creating the ideal wound environment 10
11 What is Wound Bed Preparation? Creation of an optimum wound environment = Tissue management = Inflammation/infection control = Moisture balance = Epithelial (edge) advancement Falanga, V. (2004). Wound bed preparation: science applied to practice. EWMA Position Document: Wound Bed Preparation in Practice. London. MEP Ltd. 11
12 Products Made Simple Antimicrobials for high bacterial Donate Moisture TIME Absorb Moisture Protection
13 Products Made Simple Antimicrobials Donate Moisture TIME Absorb Moisture Protection
14 Products Made Simple Antimicrobials Silver dressings Cadexomer iodine Iodine Honey Absorb Moisture Alginates Hydrofibre Foams Absorbent pads TIME Donate Moisture Hydrogels Hydrocolloids Protection Films Foams Silicone Fine woven tulle
15 Patient 1 What will you include in your history? 15
16 Patient 1: Assess the wound 16
17 What is Wound Bed Preparation? Creation of an optimum wound environment = Tissue management = Inflammation/infection control = Moisture balance = Epithelial (edge) advancement Falanga, V. (2004). Wound bed preparation: science applied to practice. EWMA Position Document: Wound Bed Preparation in Practice. London. MEP Ltd. 17
18 Patient 1: Define aim of treatment? Select your products/treatment 18
19 Products Made Simple Antimicrobials Silver dressings Cadexomer iodine Iodine Honey Absorb Moisture Alginates Hydrofibre Foams Absorbent pads TIME Donate Moisture Hydrogels Hydrocolloids Protection Films Foams Silicone Fine woven tulle
20 Biofilm Biofilm bacteria less susceptible to immune defences Resistance to antimicrobial agents Increase in gene transfer between bacteria
21 Iodine based products Cadexomer iodine Reduces bacterial load Slow release Non-toxic to fibroblasts Absorbent Do not use on dry wounds, on pregnant women or pts on lithium Caution when used in renal failure or thyroid disease
22 Silver products Broad spectrum bactericidal Penetrates superficial tissue Do not use on nonviable tissue Appropriate use to reduce resistance
23 Gamma irradiated Moist environment Antibacterial Osmotic action Odour control Low adherence to wound bed May cause stinging Can result in maceration Honey
24 Polyhexamethylene Biguanide Added to some dressings foam and gauze Very effective with pseudomonas (PHMB) 24
25 Sharp Debridement Local protocols Skill and knowledge of health professional Local anaesthetic Pain control Equipment Lighting Contingency for problems Follow-on treatment
26 Patient 1: 19 days later Reassess the wound and describe what is happening at a cellular level What product would you select now and why? 26
27 Alginate Calcium & Sodium salts from brown seaweed Exchange sodium for calcium ions forms gel Cut to fit wound to avoid maceration Firm stays in one piece Soft dissolves Do not use on low exudating wounds
28 Hydrofibre Woven hydrocolloid Hydrophilic Vertical wicking moist wound, remains dry on surrounding tissue Forms gel on contact with exudate Do not use on low or non exudating wounds
29 ? May Still Need Antimicrobial 29
30 30
31 Patient 1 Describe what is happening at a cellular level What dressing would you select? 31
32 Polyurethane or silicone foam Semi permeable O² and water vapour Absorbs exudate Impermeable to fluid and bacteria Provides padding for protection Do not use on heavily exudating wounds Foams
33 Low adherent dressings Finely woven gauze Allows exudate to pass through dressing Reduces adherence Example - Adaptic
34 Management of Wound Margins 34
35 Patient 2: Post Excision Melanoma Day 1 Day 2
36 Day 3 Day 4
37 Day 5 Day 6
38 Day 7 Day 10
39 Day 14 Day 18
40 Six weeks
41 Products Made Simple Antimicrobials Silver dressings Cadexomer iodine Iodine Honey Absorb Moisture Alginates Hydrofibre Foams Absorbent pads TIME Donate Moisture Hydrogels Hydrocolloids Protection Films Foams Silicone Fine woven tulle
42 42
43 Moisture Balance Control underlying cause eg heart failure Control bacterial burden Dressing products to wick exudate away Frequency of dressing change Protect surrounding skin 43
44 44
45 Protective Barrier Wipes/Remove Wipes 45
46 Hydrofibre Woven hydrocolloid Hydrophilic Vertical wicking moist wound, remains dry on surrounding tissue Forms gel on contact with exudate Do not use on low or non exudating wounds
47 Alginates Calcium & Sodium salts from brown seaweed Exchange sodium for calcium ions forms gel Cut to fit wound to avoid maceration Firm stays in one piece Soft dissolves Do not use on low exudating wounds
48 Capillary wicking dressing:vacutex Primary dressing May require non-adherent contact layer Cut to size of wound Caution with pressure ulcers Do not use on dry wounds 48
49 Using Secondary Dressings 49
50 Products Made Simple Antimicrobials Silver dressings Cadexomer iodine Iodine Honey Absorb Moisture Alginates Hydrofibre Foams Absorbent pads TIME Donate Moisture Hydrogels Hydrocolloids Protection Films Foams Silicone Fine woven tulle
51 Dry necrotic tissue
52 Insoluble polymers approx 70-90% H²O Donates moisture to wound Can absorb small amount exudate Permeable to moisture vapour and O² Hydrate dry eschar Do not use on highly exudating wounds Hydrogels
53 Hydrocolloids Flat, occlusive dressing Forms gel over wound Impermeable to water vapour and O² Used to rehydrate dry necrotic wounds Provides moist environment Caution with infected wounds
54 Gamma irradiated Moist environment Antibacterial Osmotic action Odour control Low adherence to wound bed May cause stinging Can result in maceration Honey
55 Film Semi-permeable polyurethane Impermeable to fluids or bacteria Permeable to O² and water vapour Flexible Allows visual checks Monitor for maceration and foliculitis
56 Contraindications to Debridement Ischaemia immune response healing response If dry eschar leave intact and refer for urgent vascular review
57 Iodine based products Povodone iodine solution Useful to reduce bacteria and keep wounds dry eg. Mummified necrotic wounds Reduces bacterial load Release not sustained Toxic to fibroblasts
58 58
59 Biological Debridement Larvae from Lucilia sericata Protect surrounding tissue using hydrocolloid Apply larvae 5-8 per cm² Cover with wound veil secured at edges Cover with absorbent pad Change outer pad PRN Larvae can be left in situ 48 to 72 hours
60 Case Study Mrs J 63 year old women Recently became widow 5 year history Necrobiosis Lipoidica affecting right pretibial region Recurrent cellulitis
61 Case Study Mrs J Necrobiosis labodica Bronchitis Hysterectomy Hypertension Cellulitis Past smoker
62
63
64
65
66 Wound Cleansing Points to consider: Sterile vs non sterile Water or saline Other solutions Additives to water Temperature Technique Morison, M., Ovington, L. & Wilkie, K. (2004). Chronic Wound Care. Philadelphia. Mosby. 66
67 Care of the surrounding skin
68 Management of Eczema Remove irritant/allergen Wash in water Moisturize Cotton tubular gauze bandage Zinc paste bandages Topical steroids Dermatologist Patch testing Cameron, J. (1998). Contact sensitivity in eczema in leg ulcer patients. In N. Cullum & N. Roe. Leg ulcers nursing management: A rresearch-based guide. Bailliere Tindall. London
69 Bandaging Techniques 69
70 LaPlace s Law Related to Compression Bandaging Limb circumference Width of bandages Number of layers Tension of bandages Thomas, S. (2003). The use of the Laplace equation in the calculation of sub-bandage pressure. EWAJ. 3(1)
71 Topical Negative Wound Therapy
72 72
73 Expected outcomes Wounds should reduce by 25% in 4 weeks Venous leg ulcers should heal with compression within 12 weeks Wounds that do not meet this criteria should be referred to the Specialist Wound Management Service Margolis, D., Allen-Taylor, L. Hoffstad, O. et al. The accuracy of venous leg ulcer prognostic models in wound care systems. Wound Rep Regen. 12,
74 What do you need in your dressing Main products for everyday use? Products will in small amounts? Need to order in as required? When do you refer on to other services? cupboard? 74
75 How do you make your case? 75
76 Evidence based guidelines
77 77
78 78
79 References Daunton, C., Kothari, S., Smith, L. & Steel, D. (2012) a history of materials and practices for wound management. Wound Practice & Research. 20(4), Hurlow, J. & Bowler, P. (2009). Clinical experience with wound biofilm and management: A case series. Ostomy Wound Management. April Percival, S. & Bowler, P. (2004). Biofilms and their potential role in wound healing. Wounds, 16 (7), Phillips, P., Wolcott, R., Fletcher, J. & Schultz, G. (2010). Biofilms made easy. Wounds, 1(3),1-6 Ramundo, J. & Gray, M. (2008). Enzymatic wound debridement. WOCN, 35(3), Sibald, G., Goodman, L., Woo, K. et al. (2011). Special considerations in wound bed preparation. Wound Healing South Africa.4(2), Smith, f. Dryburgh, N. Donaldson, J. & Mitchell, M. (2011). Debridement for surgical wounds (review). The Cochrane Collaboration. Issue 5. Sweeney, I., Miraftab, M. & Collyer, G. (2012). A critical review of modern and emerging dressings used to treat exuding wounds. International Wound Journal, 996),
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