Wound care dressing basics: Difference between revisions

Revision as of 03:34, 1 September 2016

Overview

Selecting appropriate dressings for wound care can improve lives and save limbs. The choice of topical treatment, debridement, the selection of appropriate dressings, and type of closure depends on the type of wound being treated.

General Considerations

The ideal wound dressing:

has the ability to keep the wound bed moist while absorbing excess fluids
protects the wound from further damage
addresses bacterial bioburden
does not injure viable surrounding peri-wound tissue
achieves hemostasis
debrides necrotic tissue
is appropriate for wound size, depth, and location
inexpensive with a long shelf life
doesn't cause the patient pain during changes

Topical Therapy

Type	Benefits	Indications	Contraindications/Precautions
Hydrocolloid	Traps exudate and moisture, washes away during dressing changes and produces a painless mechanical debridement	Epithelialization stage, clean, low exudative wound	Do not use on necrotic wounds, highly exudative, may macerate viable skin.
Hydrogel	rehydrates wounds, feels cooling	Debridement stage, dry wounds, wounds with low exudate.	Do not use on necrotic wounds, highly exudative, may macerate viable skin.
Alginate	Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing	Highly exudative wounds and cavities	Caution with friable tissue
Foams	Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing	Granulation stage, highly exudative wounds and cavities	Do not use on necrotic tissue
Silver-Imgregnated	Antimicrobial action	Use with critically colonized wounds	Can discolor skin, some people are sensitive to it
Silicone	Low adherence, protects neighboring viable skin, conforms to wound	use a contact layer	Dries out easily
Collagen Matrix	Biologic dressing, accelerates rate of complete wound healing	Non-healing Stage 3 and 4 pressure ulcers, when traditional dressings have failed	Expensive
Gauze	Inexpensive	Open dressing	Requires more frequent dressing changes

Closure

Complications

Chronic wounds which are physiologically impaired may require special considerations.

External Links

References

Authors:

@@ Line 16: / Line 16: @@
 ==Topical Therapy==
-==Dressing Types==
+{| class="wikitable"
-# Hydrocolloid
+|-
-# Hydrogel
+! Type !! Benefits !! Indications !! Contraindications/Precautions
-# Alginate
+|-
-# Foam
+| Hydrocolloid || Traps exudate and moisture, washes away during dressing changes and produces a painless mechanical debridement || Epithelialization stage, clean, low exudative wound || Do not use on necrotic wounds, highly exudative, may macerate viable skin.
-# Silver-Imprenated
+|-
-# Silicone
+| Hydrogel || rehydrates wounds, feels cooling || Debridement stage, dry wounds, wounds with low exudate. || Do not use on necrotic wounds, highly exudative, may macerate viable skin.
-# Collagen Matrix
+|-
-# Gauze
+| Alginate || Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing  || Highly exudative wounds and cavities || Caution with friable tissue
+|-
-* Wet-to-Wet Dressings
+| Foams || Absorbs fluids, conforms to wound bed, comes in a rope or ribbon for packing || Granulation stage, highly exudative wounds and cavities || Do not use on necrotic tissue
-Indication: To keep a clean wound clean and prevent the build-up of exudates.
+|-
-Technique: Moisten a piece of gauze with saline and just barely squeeze out the excess fluid so it isn't soaking wet. Unravel the gauze, place it onto the wound, and cover with a dry dressing over the top. The dressing should not be allowed to dry or stick to the wound. Change 2-3 times per day. Moisten with saline if it gets too dry.
+| Silver-Imgregnated || Antimicrobial action || Use with critically colonized wounds || Can discolor skin, some people are sensitive to it
+|-
-* Wet-to-Dry Dressings
+| Silicone || Low adherence, protects neighboring viable skin, conforms to wound || use a contact layer || Dries out easily
-Indication: To clean a dirty or infected wound.
+|-
-Technique: Moisten a piece of gauze with saline and squeeze out the excess fluid so it is damp, not dripping wet. Unravel the gauze, place it onto the wound, and cover with a dry dressing over the top. The dressing is allowed to dry out and when it is removed it pulls off the debris. Ideally, change 3-4 times per day. Change more often on a wound that is in need of more debridement, less often on a cleaner wound. Switch to the wet-to-wet dressing when the wound is clean.
+| Collagen Matrix || Biologic dressing, accelerates rate of complete wound healing || Non-healing Stage 3 and 4 pressure ulcers, when traditional dressings have failed || Expensive
-Note: The wet-to-dry dressing is not a substitute for mechanical/sharp debridement.
+|-
+| Gauze || Inexpensive  || Open dressing || Requires more frequent dressing changes
+|}
 ==Closure==