Dressing selection
Agenda (45 minutes) Some questions for you. Which wound dressing? Dressing categories/types Summary
Which wound dressing poster Ref: Which wound dressing? Practice Nursing, September 2015; 65133
Which wound dressing Dressings provide the ideal environment to promote wound healing. Selecting the correct dressing for a patient s wound can be challenging. It is essential to undertake a holistic assessment to provide the patient with the best chance of healing. Ref: Which wound dressing? Practice Nursing, September 2015; 65133
Points to consider What is the aim of the treatment rapid healing? Contain odour? Prevent infection? Cause of the wound acute or chronic? How long has the patient had the wound? Location of the wound some areas require a specialist product, e.g. peristomal areas, sternum, sacrum, heel Ref: Which wound dressing? Practice Nursing, September 2015; 65133 Size and depth of the wound is the dressing available in an appropriate size? Condition of the surrounding skin fragile? Tissue type is the wound sloughy or necrotic? Debridement may be necessary Pain poor pain management can hinder healing Exudate amount and type Infected/likely to be infected? Patient history allergies? Sensitivity to previous dressings? Any co-morbidities or signs that need more attention, e.g. diabetes?
Dressing Types Foams Gelling Fibres Antimicrobials Hydrogels Semi-permeable films Hydrocolloids Ref: Which wound dressing? Practice Nursing, September 2015; 65133
Dressing Types Foams Gelling Fibres Antimicrobials Hydrogels Semi-permeable films Hydrocolloids
Foams Properties Absorbent maintains a moist healing environment Protects periwoundarea from maceration Cushions Stays in place/doesn t strip skin Key points to remember Can be used as primary or secondary dressings. Adhesive or non-adhesive Wound type Leg ulcers, pressure ulcers, skin grafts, minor burns, skin tears. Especially for wounds with moderate to heavy exudate
Foams Manages wound exudate efficiently at the wound bed preventing the negative effects resulting from desication or maceration, Prevents strike-through of fluid and the leakage of this fluid onto the surrounding skin Consider absorbency, Management of Exudate, Wear Time, MVTR, Non adhesive, adhesive, silicone, border/all over adhesive, cost effectiveness
Gelling Fibres Properties Helps to manage exudate. Forms gel on contact with exudate Conforms to wound bed and removes in one piece Can facilitate autolytic debridement Key points to remember Avoid use in dry wounds Wound type Exuding or cavity wounds burn, leg ulcer, traumatic injury, pressure ulcer, surgical dehisced wound
Gelling Fibres Gelling fibres in the dressing swell and gel on contact with exudate absorbing and locking in the fluid. Reinforcing fibres retain within the dressings bond its shape as it transforms from a dry dressing into a soft, cohesive gel sheet. Consider size, shape, shrinkage, absorbency, level of exudate (enough to form gel), removal, secondary dressing, wear time
Antimicrobials Properties Come in various Formulations - Silver, Iodine, Polyhexamethylene biguanidehydrochloride (PHMB), honey Key points to remember Monitor treatment closely Follow local protocols Wound type Infected wounds - Local (critically colonised), spreading, systemic.
Antimicrobials Need to be interactive at the wound bed with broad spectrum of topical antimicrobial activity that is effective in the wound environment (exudate, pus, slough). Consider delivery vehicle (foam, gelling fibre) absorbency, wear time and antimicrobial agent (Silver, Iodone, PHMB) speed of kill and wear time. Consider content of Ag/I/PHMB (MIC v MBC), released in dressing or to wound, wear time, cost effectiveness..
Before selecting an antimicrobial dressing consider: Has the wound been debrided and cleaned? Is the patient allergic to any components of the dressing? Is exudate controlled? Do you have a plan to review treatment? Is the antimicrobial agent chosen likely to work against the suspected microorganisms involved?
Signs and symptoms of infection: Superficial tissue infection Deep tissue infection Non-healing wound Friable granulation tissue Bright red granulation Increased exudate New areas of necrosis in base of wound Pain Increased size Warmth Erythema >1-2cm Odour Exposed bones N.B. If systemic infection present refer to local protocol for antibiotic treatment
Hydrogels Properties Key points to remember Facilitates autolytic debridement Change every 4 days (weartime) Wound type Dried necrotic/sloughy tissue. Burns, leg ulcers, pressure ulcers, radiation skin damage.
Semi-permeable film Properties Key points to remember Permeable to moisture, vapour and gases, but are impermeable to liquids Can be used as a secondary dressing over gels, alginates etc. Wound type Superficial, shallow wounds.
Hydrocolloid Properties Key points to remember Provide a moist environment to facilitate healing May be left in place for up to 7 days Wound type Dry, necrotic/sloughy tissue. Surgical wounds, burns, abrasions, pressure ulcers, venous ulcers
Wound Fillers: Non-adherent product that maintains a moist environment and manages exudate e.g. gelling fibre, alginate Can be used for shallow (foams, pads or pillows) or deep (beads, creams, foams, gels, ointments, pastes or powders) wounds Can be used for partial and full-thickness wounds, infected wounds and deep wounds that require packing
Which Wound Dressing Poster
Smith & Nephew Croxley Park Building 5, Lakeside Hatters Lane, Watford Hertfordshire WD18 8YE T +44 (0) 1923 477100 www.smith-nephew.com/uk Trademark of Smith & Nephew All Trademarks acknowledged April 2017 Smith & Nephew F +44 (0) 1923 477101 08622 Supporting healthcare professionals for over 150 years