TIME CONCEPT AND LOCAL WOUND MANAGEMENT

Transcription

1 TIME CONCEPT AND LOCAL WOUND MANAGEMENT B. BRAUN WOUND CARE

2 INTRODUCTION: TIME is a global care framework used to implement appropriate care plans and promote wound healing Tissue Management Inflammation and Infection Control Moisture Balance Epithelial (edge) Advancement TIME The TIME framework can be used to apply wound bed preparation to practice The correct implementation of TIME depends on patient and wound assessment TIME is not a sequential process, every wound is different; simultaneous attention to one or more of the components may be required

3 HOW TO CHOOSE THE DRESSING 1 2 Assess the patient Holistic approach: Essential for planning the appropriate therapeutic management of the patient and his/her chronic wound. a. Nutritional Status Glycaemia control in patients with DFU Cachexia, obesity b. Treatment of the primary disease Revascularisation in case of arterial disease Compression therapy in venous ulcer Off-loading in DFU and PU c. Social environmental factors Assess the wound Use TIME* framework : A practical tool for qualifing the wound and implementing a plan of care to promote wound healing. Evaluate: Wound location Depth/size Amount and type of exudate Predominant tissue type on the wound surface Periwound skin condition Wound bioburden and risk of infection * Falanga, 2011 Assess the effectiveness of treatment Evaluate: Full debridment Granulation tissue Wound edges progression Absence of infection Pain level Confort 4 Assess the dressing Check the following criteria: Does the dressing: Stay intact and remain in place during wear time? Prevent leakage and maceration? Reduce pain / odour? Is the dressing: Comfortable, flexible? Easy to apply and to remove? Cost effective? 3 B. Braun Wound Care program Level of Exudate Askina Calgitrol 1-3 days Askina Foam 1-2 days Askina Sorb 1-2 days Askina DresSil, Askina SilNet 3-4 days Askina Biofilm Transparent 3-4 days Askina Gel 1-3 days + Askina Derm up to 7 days Necrosis Debridemnet Phase Granulation Phase Epithelialization Phase Wound cleansing : Prontosan Time

4 TISSUE MANAGEMENT Clinical observations Necrotic tissue and biofilms prevent the healing to start and create an environment favouring bacterial multiplication. Necrotic tissue Calus Slough, presence of biofilm Treatment objectives Eliminate devitalised tissues Eliminate biofilms and decrease the bacterial load Decrease the wound s metabolic charge Facilitate healing by accelerating the proliferative and remodelling phases Uncover potential exudate collections or abscesses Allow to evaluate the correct wound size Control abnormal odour Decrease patient s psychological stress Osmotic Hyperosmolar solutions Biologic Maggots Surgical Bistouri at the OR Methods of debridment Sharp Scalpel, progressive at the patient s bed Autolytic Natural, requires moisture Expected outcome Wound bed without necrosis, slough, and/or biofilms Mechanical Hydrojet Enzymatic Exogenous enzymes Chronic wounds generally require repeated debridement; different methods can be combined or used in sequential or alternate ways B. Braun products Clinical Benefits Prontosan Wound Irrigation Solution Prontosan Wound Gel/Gel X Cleansing and moistening solution and gel Reduces the biofilm burden (2) Reduces inflammatory signs (1) Improves patient outcomes, including time to heal (1,2) For the prevention of biofilm formation (2) Askina Gel Hydrogel Wound dressing Hydrates wound bed Helps to remove necrotic, fibrinous and other devitalized tissue Remains in place after application (1) Bellingeri, A. et al. Effect Of A Wound Cleansing Solution On Wound Bed Preparation And Inflammation In Chronic Wounds: A Single-Blind RCT. Journal of Wound Care 25.3 (2016): Web. (2) Kaehn, Eberlein - In vitro test for comparing for comparing the efficacy of wound rinsing solutions, Britisch Journal of Nursing, 2009;11(11):S4-S10 (3) Opasanon S, Magnette A, Meuleniere F, Harding K. Askina Calgitrol Made Easy. Wounds International 2012; 3(1). Available from (4) Trial C, Darbas H, Lavigne J-P, Sotto A, Simoneau G, Tillet Y, et al. Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT. J Wound Care Jan;19(1):20 6. (5) Wounds International. Using Askina Calgitrol Paste for the treatment of diabetic foot infection: case studies. London: Wounds International Available from

5 INFLAMMATION AND INFECTION Infected Perineal Wound Infected PU Sacrum Infected venous ulcer Infected DFU Clinical observations High bacterial load, biofilms, persistent inflammation: > 10 6 bacteria per gram of tissue Inflammatory Cytokines Activated Proteases G + (Aerobes) Relationship between bacterial progression, biofilm formation and host resistance Adhesion Contamination (host control) Treatment Eliminate the focus of infection Use of systemic antibiotics Use of anti-inflammatory drugs Local use of topical antimicrobials Local use of protease modulators Expected outcome G + G - (Aerobes) G + G - Aerobes Anaerobes Yeasts Exopolymeric Substances Progression & Accumulation CLIMAX COMMUNITY (Synergy, Quorum Sensing) Colonisation (established microbial population, host control, microbial balance) Critical Colonisation (established microbial population, wound not progressing, microbial imbalance, no sign of infection) Host Resistance Topical Antiseptic Agents Micro-organism (load x virulence) Bacterial equilibrium Control of the inflammatory response Viable wound bed Detachment & Dissemination Infection (microbial control) Systemic Antibiotics & Topical Antiseptic Agents Percival & Bowler, 2004 B. Braun products Clinical Benefits Prontosan Wound Irrigation Solution Prontosan Wound Gel/Gel X Cleansing and moistening solution and gel Reduces the biofilm burden (2) Reduces inflammatory signs (1) Improves patient outcomes, including time to heal (1,2) For the prevention of biofilm formation (2) Askina Calgitrol Paste / Ag / THIN Silver alginate wound paste and dressings Immediate availability of silver ions (3) Sustained controlled release to the wound bed during use of the dressing (3) Tolerable and antimicrobially efficient (4) Easy to use & conformable (5) Askina Carbosorb Charcoal dressing Absorbs wound bacteria and malodourous substances For all types of malodorous wounds To be used as a secondary dressing

6 MOISTURE BALANCE DFU Necrosis Hyperkeratose maceration Sacrum Venous ulcer Dries the wound Delays epithelial migration Clinical observations Lack of humidity Clinical observations Excess of humidity Periwound skin maceration Breakdown of necrotic tissue Bacterial load increase Treatment Use of dressings providing and/or keeping humidity Treatment Use dressings that absorb and retain the exudate Compression if needed Negative Pressure Wound Therapy Moisture Balance Normal Epithelial migration Expected outcome Dryness avoided Normal Periwound skin Viable wound bed B. Braun products Clinical Benefits Askina Foam Hydrophilic foam for superficial wounds Excellent fluid handling characteristics Enhances a moist wound environment No adherence to the wound: designed to allow atraumatic, painless dressing changes Visual control of exudate absorption Askina Dressil Heel / Sacrum Hydrophilic foam for heel wounds Anatomic shape adapted to heel and sacrum areas Atraumatic dressing removal Repositionable: allowing wound inspection Showerproof Askina DresSil Border Foam dressing with silicone adhesive for fragile skin Gentle and secure adherence Minimized trauma during dressing changes Good adaptability on difficult-to-dress areas and skin contours Askina Sorb Highly absorbing alginate dressing Conformable and easy to apply Forms a soft gel which can be removed in one piece Vertical absorption process, no lateral strike through Designed for avoiding wound maceration Atraumatic dressing removal

7 EPITHELIAL (EDGE) ADVANCEMENT Swollen wound edges: no progression of epithelialisation Maceration damage at the wound edges Calous tissue impeeds the progression of wound edges Dry wound edges with incomplete epithelialisation Clinical observations Treatment Expected outcome Altered epithelialisation due to problems in the extracellular matrix (granulation), keratinocytes or ischaemia Reassess the cause and consider corrective measures: selective debridement skin grafting advanced healing therapies Appropriate cellular response Migrating keratinocytes Balanced activity of proteases, growth factors and microorganisms Newly formed tissue Healthy granulation tissue B. Braun products Clinical Benefits Protection of the wound bed against mechanical disruption Askina SilNet Soft silicone contact layer Non-adherent: protects fragile granulation tissue Atraumatic dressing changes Soft and conformable Allows exudate passing through the dressing Residual exudate management Askina Biofilm Transparent Transparent hydrocolloid dressing Thin design that fits any body contours Transparent, allows visual control of the wound Easy to apply Protection of the wound edges against maceration Askina Barrier Film Spray Breathable skin barrier Rapid drying, transparent, breathable skin barrier Used for the protection of intact or damaged skin from urine, faeces, tape trauma and friction Completely sting free Protection of epithelialized wound Askina Derm PU film dressing Maintains a moist environment Impermeable to liquids and bacteria Transparent: allows visual wound inspection Protection of area at risk (PU) Askina Heel Anatomically shaped hydrocellular heel dressing Ready to use concept, no fixation device needed Innovative anatomical design covering the malleolus Pressure relieving foam, helps prevent stage I ulcers Good protection against friction and shear stresses

8 Manufactured by: B. Braun Hospicare Lt. Collooney Co. Sligo IRELAND B. Braun Medical AG Infection Control Seesatz Sempach SWITZERLAND This document, its contents, including institutional data, information, trademarks and logos mentioned herein are the exclusive property of B. Braun. Any representation and/or reproduction, total or partial, of this document and its contents without the express prior consent of B. Braun, is strictly prohibited and constitutes an infringement of the intellectual property rights of B. Braun. Non-binding documents and photographs. For healthcare professional use only. ZG