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    What Dressing For What Wound: Prudence Lennox National Clinical Leader Healthcare Rehabilitation LTD

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    Imafighter4Him
    The document discusses factors to consider when selecting wound dressings, including wound characteristics, stage of healing, client needs, and properties of different dressing types. It emphasizes performing accurate wound assessments and choosing dressings based on the goals of treatment, such as managing exudate, promoting healing, or reducing bacterial burden. A variety of common dressing types are described, noting their appropriate uses, application instructions, and potential contraindications. The overall message is that dressing selection should be tailored to the individual patient and wound to optimize the wound bed and progress toward healing.

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    What Dressing For What Wound: Prudence Lennox National Clinical Leader Healthcare Rehabilitation LTD

    Uploaded by

    Imafighter4Him
    106 views37 pages
    The document discusses factors to consider when selecting wound dressings, including wound characteristics, stage of healing, client needs, and properties of different dressing types. It emphasizes performing accurate wound assessments and choosing dressings based on the goals of treatment, such as managing exudate, promoting healing, or reducing bacterial burden. A variety of common dressing types are described, noting their appropriate uses, application instructions, and potential contraindications. The overall message is that dressing selection should be tailored to the individual patient and wound to optimize the wound bed and progress toward healing.

    Original Description:

    Helpful Wound Care Protocol; What type of dressing for specific types of wounds

    Original Title

    9-Prue_Lennox_23-05-2015

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    The document discusses factors to consider when selecting wound dressings, including wound characteristics, stage of healing, client needs, and properties of different dressing types. It emphasizes performing accurate wound assessments and choosing dressings based on the goals of treatment, such as managing exudate, promoting healing, or reducing bacterial burden. A variety of common dressing types are described, noting their appropriate uses, application instructions, and potential contraindications. The overall message is that dressing selection should be tailored to the individual patient and wound to optimize the wound bed and progress toward healing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    106 views37 pages

    What Dressing For What Wound: Prudence Lennox National Clinical Leader Healthcare Rehabilitation LTD

    Uploaded by

    Imafighter4Him
    The document discusses factors to consider when selecting wound dressings, including wound characteristics, stage of healing, client needs, and properties of different dressing types. It emphasizes performing accurate wound assessments and choosing dressings based on the goals of treatment, such as managing exudate, promoting healing, or reducing bacterial burden. A variety of common dressing types are described, noting their appropriate uses, application instructions, and potential contraindications. The overall message is that dressing selection should be tailored to the individual patient and wound to optimize the wound bed and progress toward healing.

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    What dressing for what wound

    Prudence Lennox
    National Clinical Leader
    Healthcare Rehabilitation Ltd
    Wound assessment

    Accurate wound assessment is a prerequisite to planning


    appropriate care & should adopt an holistic approach

    Assessment is enhanced by an understanding of:


     Physiology of wound healing
     Factors that affect this process
     Optimal conditions required at the wound site
    Assessment tools

    Your Eyes…
    Knowledge
    Your Nose…

    Your Ears…
    Your Mouth…
    Wound care

    It’s not about the hole in the patient…………

    It’s the whole of the patient…of any age!


    Dressing Selection
    Factors influencing selection

     Bacterial Profile  Wound type


     Depth
     Wound Characteristics  Aetiology/cause
     Dry
     Moist  Stage of healing
     Heavily Exuding
     Malodorous  Tissue type
     Excessively Painful  Necrotic
     Difficult to Dress  Sloughy
     Liable to Bleed Easily  Granulating
     Epithelialising
    Client choice

     Known sensitivities
     Fragile or easily damaged skin
     Hygiene needs / bathe or shower
    frequently
     Mobility / dexterity
     Compliance / concordance
    Wound healing
    Your responsibility is to learn
    Product Related Factors…

     Conformability  Antibacterial activity


     Mass or volume  Haemostatic properties
     Fluid handling properties  Ease of use
     Sensitisation  Permeability
     Odour absorbing properties  Microclimate impact
     Ease of application & removal
    How do I choose a dressing…???

    Ask ‘what do I want the dressing to do…?’

     Rehydrate?
     Absorb exudate?
     Deslough?
     Reduce bacterial contamination?
     Promote granulation?
     Promote a moist / dry wound bed
    Optimise the wound bed

    Too dry
    • Add moisture
    Moisture balance
    • Maintain

    Too wet
    • Remove moisture
    • Absorption / Retention /
    Sequestration
    • Debridement
    • Treat infection
    Fill Dead Space

     Dead space must be filled with


    dressing material to ensure
    that wound closure is delayed
    until the space has been
    replaced with granulation
    tissue:

     Cavity
     Undermined tissue
     Tracts

    Make sure you can get it out in


    one piece!
    Remember….

    If there is no blood supply keep


    it dry

    Unless you are 100% sure


    there is viable tissue
    beneath or you have been
    advised by a tissue viability
    specialist or responsible
    physician.
    Types

     Hydrogels
     Alginates
     Gelling fibre
     Hydrocolloid
     Foam
     Non adherent wound contact layers
     Island dressings
     Antimicrobial
     Odour controlling
     Other…TNP or NPWT, maggots, cellular matrix & protease
    modulators
    Hydrogel
    Properties:
     come in sheets & gel high water content facilitates debridement by rehydration

    Wound Types:
     sheets are used for shallow wounds & cavity edges
     gels are suitable for cavities

    How to use, when to change:


     change dressing every 1 to 3 days
     apply directly into/onto wound & cover

    Contradictions:
     heavily exuding wounds
     Maceration & excoriation of the peri-wound area
     infected wounds
    Alginates
    Properties:
     absorbent dressings, the main purpose of which is haemostasis
     forms a gel which conforms to shape of the wound
     made from seaweed

    Wound types:
     moderate to heavily exuding wounds of all types

    How to use, when to change:


     remove by irrigating
     change dressing every 2 to 7 days.
     use secondary dressing

    Contradictions:
     dry wounds & necrotic wounds
    Hydrocolloids

    Properties
     occlusive moist environment, waterproof, can adhere to wet sites

    Wound types:
     clean, granulating or necrotic wounds with low to moderate exudate
     primary dressing for epithelising wounds

    How to use, when to change


     change every 3 to 7 days (warm to make more pliable & adhesive)
     requires 1·5 to 2cm margin
     warn patient about characteristic odour to expect when hydrocolloid mixes
    with exudates.
    Contraindications:
     heavily exuding wounds & infected wounds
    What is an occlusive dressing?

    Definition:
    A type of wound dressing that totally covers the wound bed, sealing it off
    from the environment. It is impermeable or semi-impermeable to moisture
    (HCD or Film)
    (The Wound Programme, 1993)

     Promote a moist wound environment


     Stimulate angiogenesis through providing a hypoxic environment
     Reduction in frequency of dressing changes
     Facilitation of fibrinolysis
     Promotion of autolysis
     Promotion of angiogenesis
     Protection
    Foams

    Properties:
     absorbent dressings, primary & secondary

    Wound types:
     light to heavily exuding wounds

    How to use, when to change:


     exudate is absorbed into the foam & becomes visible at the dressing edges,
    once saturated
     use secondary dressing such as tape or appropriate bandage if product
    does not have an adhesive border do not cover with occlusive film, this may
    effect the vapour permeability of the dressing

    Contraindications:
     very dry sloughy or necrotic wounds May cause peri wound maceration in
    highly exuding wounds
    Gelling fibre

    Properties
     composed of hydrocolloid fibres. Sodium carboxymethylcellulose spun into
    a fibre that forms a gel in contact with wound exudate
     allows for the absorption & retention of exudates

    Wound types:
     indicated as primary dressing for management of medium to highly exuding
    wounds, May be useful for infected wounds as “holds” bacteria

    How to use, when to change:


     apply directly to the wound requires at least 1cm margin overlapping
    surrounding skin to ensure adhesion/reduce leakage/seal wound borders
     requires a secondary dressing – some are built in

    Contraindications:
     lightly exuding wounds
    Films

    Properties:
     High moisture vapour transmission
     used as both primary & secondary dressings

    Wound type:
     low exuding wounds, as they do not absorb exudate
     only suitable for relatively shallow wounds, e.g. dermabrasion, burns and
    donor sites retention dressings, e.g. for cannulas.

    How to use, when to change:


     frequency of change depends on nature of wound
     skin surrounding wound must be clean and dry
    Contraindications:
     excessive exudate may accumulate under dressing
     may cause adhesive trauma on removal
    Wound contact layers

    Properties:
     primary dressing on dry or lightly exuding wounds
     secondary dressing required
     most are low adherent

    Wound types:
     Especially suited to epithelising wounds

    How to use, when to change:


     Apply directly to wound bed

    Contraindications:
     Moderate to highly exudating wounds
    Island dressings

    Properties:
    primary dressing on dry or lightly exuding wounds
    Barrier and non barrier available

    Wound types:
    Postop, low exudate

    How to use, when to change:


    PRN – depends on wound and protocols postop

    Contraindications:
    Moderate to highly exudating wounds
    Cadexomer iodine

    Properties:
    cadexomer iodine paste, red-brown in colour
    starch microbeads, iodine trapped in 3D lattice

    Wound types:
    exuding wounds. infected, sloughy wounds

    How to use, when to change:


    apply directly to skin allowing a small margin of overlap onto surrounding skin
    changing is indicated by loss of colour in the product

    Contraindications & considerations:


    there are maximum doses/application per week
    each single course of treatment should not last for more than 3 months.
    Contraindicated in people with thyroid problems, lithium, pregnancy
    Honey

    Properties:
    low concentrations of hydrogen peroxide
    high sugar content draws lymph fluid from beneath the wounds surface.
    debrides slough, rehydrates necrosis

    Wound types:
    infected or critically colonised indolent/non-healing wounds

    How to use, when to change:


    apply directly to wound should be changed when saturated with exudate
    dressings can be cut

    Contraindications & considerations:


    Monitor glucose levels of patients with diabetes, pain
    Silver

    Properties:
    Antibacterial properties through silver ions
    interference with bacterial electron transport
    binding to DNA of bacteria and their spores, so impairing cell replication
    cell membrane interaction – structural and receptor function damage

    Wound Types:
    Infected or critically colonised indolent/non-healing wounds

    How to use, when to change:


    All very different – pay attention

    Contraindications & considerations:


    may give skin a general grey discolouration (argyria) – largely a cosmetic
    problem. Only occurs with long-term use
    PHMB – Polyhexamethylene Biguanide

    Properties:
    Antibacterial properties through silver ions
    Binds to cell membrane causing holes to form, the cells leak, collapse and die
    Often impregnated into foam or gauze or as a liquid or gel

    Wound Types:
    Infected or critically colonised indolent/non-healing wounds

    How to use, when to change:


    All very different – pay attention

    Contraindications & considerations:


    Different for each product
    Odour reducing charcoals

    Properties:
    utilise charcoal to absorb odour particles
    usually require to stay dry

    Wound types:
    Malodourous

    How to use, when to change:


    All very different – pay attention

    Contraindications & considerations:


    Put high up your dressing layers & consider client changing it themselves
    Necrotic

    Description:
    Devitalised ischaemic tissue
    Black / brown eschar /slough

    Aim of Treatment:
    Debride & remove
    (*NB Ischaemic wound)

    Rationale:
    Host for infection
    Impairs healing
    Sloughy

    Description:
    Mixture of fibrin, protein, serous exudate,
    Leucocytes & bacteria yellow/grey
    Glutinous covering
    Aim of Treatment:
    Remove slough & provide clean base for
    granulation
    Rationale:
    Host for infection
    Impairs healing
    Granulating

    Description:
    Composed of capillary loops, collagen,
    proteins & polysaccharides.
    Red, granular appearance

    Aim of Treatment:
    Protect & promote granulation

    Rationale:
    Base for epithelialisation
    Fills wound bed
    Epithelising

    Description:
    Epithelial cells migrate across the wound
    bed to complete the repair process
    Pink Colour
    Aim of Treatment:
    Protect & promote epithelial tissue
    Rationale:
    Complete Repair Process & promote
    maturation
    Infected

    Description:
    Mixture of fibrin, protein, serous
    exudate, Leucocytes & bacteria
    Coloured exudate
    Pain
    Inflammation

    Aim of Treatment:
    Isolate & identify pathogen commence
    appropriate antimicrobial treatment
    systemically & topically

    Rationale:
    Impairs healing
    Causes inflammation & wound
    breakdown
    Exudate management
    avoid the “splat factor”
    Take home messages

    There are many dressings & treatment Keep it simple its about moisture balance
    choices available to clinicians use the scale

    Work within your formulary/availability as If you don’t have one adopt one or develop
    1st line treatment-they are cost effective & one
    evidence based
    As the clinician you must be clear what Assessment is key
    desired outcomes are required for each
    client before commencing dressing selection

    Treatment choice should be based on the Know the products, talk to the companies
    clear understanding of the benefits & otherwise its clinical risk
    limitations of each product

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