wound and dressings

Dr. Muhammad Muzzammil Sangani

Wound-definitions(Manley, Bellman, 2000)

- A loss of continuity of the skin or mucous membrane which may involve soft tissues, muscles, bone and other anatomical structure.

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- Any disruption to layers of the skin and underlying tissues due to multiple causes including trauma, surgery, or a specific disease state.

Wounds - Classification Intentional – results from planned treatment Unintentional wounds- results from unexpected

trauma…accident/ burns/ shooting Open -skin broken, portal of entry Closed – trauma from force, skin intact, soft tissue

damage, internal injury, possible bleeding Acute – goes through normal/timely healing process Chronic – fails to go through normal stages of

healing; no timely progress in healing

Wounds –Classification Superficial Penetrating Perforating

Laceration Puncture Abrasion Contusion

Clean Contaminated Infected Colonized

Pressure UlcersStage IStage IIStage IIIStage IV

Classification of surgical wounds according to the degree of contamination

Clean wounds: Operations in which a viscus is not opened. This category includes non- traumatic, uninfected wounds where is no inflammation encountered and no break in technique has occurred.

Clean-contaminated: A viscus is entered but without spillage of contents. This category included non- traumatic wounds where a minor break in technique has occurred.

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Classification of surgical wounds cont’d (Altmeire 1997, Ayliffe & Lowbury 1992, NAS 1996)

Contaminated: Gross spillage has occurred or a fresh traumatic wound from a relatively clean source. Acute non-purulent inflammation may also be encountered.

Dirty or infected : Old traumatic wounds from a dirty source, with delayed treatment, devitalised tissue, clinical infection, faecal contamination or a foreign body.

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Classification of wounds by depth

I. Partial-thickness: Confined to the skin, the dermis and epidermis.

II. Full-thickness : Involve the dermis, epidermis, subcutaneous tissue, and possibly muscle and bone

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Partial Thickness Full Thickness

Wound Assessment Appearance: granulation tissue, eschar,

slough, edema, tunneling, undermining, sinus tracts, color

Drainage: serous, serosanguineous, sanguineous, purulent and amount

Pain Size & location on body Presence of sutures/staples Presence of drains/tubes Wound edges

Wound assessment cont’d(Hahn,Olsen,Tomaselli, Goldberg ,2004)

1.Location2.Dimensions/Size3.Tissue viability4.Exudate/Drainage5.Periwound condition6.Pain7.Stage or extent of tissue damage , dictates

how often a wound is reassessed8.Swelling

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??Other Factors to Assess??

ODOUR LAB VALUES WHAT CAUSED THE WOUND? NEED FOR TETANUS? WHEN DID WOUND OCCUR? WHAT (IF ANY) TREATMENTS HAVE

BEEN TRIED?

Wound - Healing

Healthy body has the ability to restore itself, it depends on the amount of damage and state of health of the individual.

Referred to as regeneration (renewal) of tissue.

There are (3) phases of regeneration

PHASES OF WOUND HEALING

Healing is a quality of living tissue; it is also referred to

as regeneration (renewal) of tissue.

A. The inflammatory phase (3-6 days)

B. The regenerative (Proliferative) phase (day 4-day21)

C. The maturation (Remodeling) phase (day 21- 1 or

2yrs) (Manley, Bellman, 2000)

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Phase I Wound Healing Inflammatory phase- begins immediately after injury.

Includes Hemostasis (cessation of bleeding) due to vasoconstriction and platelet aggregation

Release of histamine, increasing capillary permeability (plasma leaking) and vasodilation

Also phagocytosis ( process when macrophages engulf microbes and secrete growth factors that promote angiogenesis) stimulates epithelial buds at the end of injured tissue resulting in increased circulation which sustains the healing process

The inflammatory phase (Initiated immediately after injury and last 3-6 days

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Injury /damage Cells

Blood Clot

Uniting the wound edges

Histamine

Vasodilation Permeability

Neutrophils& Monocytes

Oedema& Engorgement 0-3 days

Dry

-Dilated blood vessels-Microcirculation slow down

Phase ICONTINUED Wound Healing Inflammatory Response 4 Cardinal S/S

PainRednessHeatEdema

Phase I Inflammatory Response

SYSTEMIC RESPONSE

Elevated temperature Elevated WBC ( norms 5000-

10000 ) Malaise

Phase II Wound Healing

Proliferation (Fibroplasia) Phase - second phase , fibroblasts synthesize collagens which add strength to the wound. Begins 2-3 days after injury.

Thin layer of epithelial cells forms, blood flow is reinstituted. Tissue forms - known as granulation tissue. Translucent red color/fragile/bleeds easily.

The Regenerative (Proliferative) phase

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Blood vessels near the edge of the wound become porous

- Resultant tissue filling is referredTo as granulation tissue- process of wound contraction begins

Traps other blood cells & damaged blood vesselsBegin to regenerate within the wound margins

Allowing excess moisture to escape

Macrophage activity

Formation& multiplication of fibroblasts

migrate along fibrin threads

- Laying down of a ground substance- Beginning the synthesis of collagen fibers (granulation tissue )

Stimulates

WhichThis fibrous network

Resulting

Begins 2-3 days of injuryLasting up to 2-3 weeks

Phase III Wound Healing Maturation (Remodeling) Phase- final phase begins about 3 weeks after the injury and can extend up to 6 months up to one or two years after the injury.

Collagen originally in haphazard order remodels and reorganizes into a more orderly structure.

Scar (cicatrix) forms - avascular tissue , doesn’t sweat, grow hair, or tan.

Keloid- abnormal amount of collagen laid down, hypertrophic scar. ( common in dark skin).

Types of Wound Healing Primary Intention: clean, straight line, edges

well approximated with sutures, rapid healing

Secondary Intention: larger wounds with tissue loss, edges not approximated, heals from the inside out, granulation tissue fills in the wound, longer healing time, larger scars

Tertiary Intention: delay 3-5 days before injury is sutured, greater access for pathogens to invade, greater inflammation, more granulation, larger scars .

Healing GI tract- scar tissue can cause ADHESIONS which

may lead to pain and alteration in bowel elimination

Bone healing-1st stage is soft tissue healing. Blood clots occur between the ends of the bones. Granulation tissue then forms called procallus. 2nd stage-osteoblast enter the area and form cartilaginous tissue called callus.(similar to bone except it does not have calcium salt. Tends to be softer). 3rd stage-tissue remodels and calcium salt is laid down resulting in stronger bone.

Healing Nerve tissue healing: Central nerves do not heal Peripheral nerves have shown to regenerate. Schwann cells form a sheath around the nerve fiber

which is the key to regeneration. The avg regeneration is 2mm/day.

If the connective tissue growth occurs over the path of the nerve fibers, the growth will be stopped. Hence there needs to be careful alignment of the nerve fibers at the close of a surgery to ensure healing.

Factors influencing healing of a wound Site of the wound Structures involved Mechanism of wounding

IncisionCrushCrush avulsion

Contamination (foreign bodies/bacteria) Loss of tissue Other local factors

Vascular insufficiency (arterial or venous)Previous radiationPressure

Factors influencing healing of a wound con’t Systemic factors

Malnutrition or vitamin and mineral deficienciesDisease (e.g. diabetes mellitus)Medications (e.g. steroids)Immune deficiencies [e.g. chemotherapy, acquired

immunodeficiency syndrome (AIDS)]Smoking(ref: Bailey and Love)

Risk Factors Which Increase Patient Susceptibility to infection (Manley.K, Bellman. L,2000)

A- Intrinsic risk factors:1. Extremes age: Defined as “ Children aged 1 year

and under, and people aged 65 years and over’.2. Underling Conditions/Disorders

A. DiabetesB. Respiratory disordersC. Blood disorders

3. Smoking4. Nutrition and build

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Risk Factors Which Increase Patient Susceptibility to infection cont’d (Manley.K, Bellman. L,2000)

B- Extrinsic risk factors:1. Drug therapy as a risk factor: e.g. Cytotoxic

drugs2. Break in the integrity of the skin3. Items such as foreign bodies4. Bypassing of defense mechanisms through

devices e.g. Intubations

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S&S of Presence of Infection Wound is swollen. Wound is deep red in color. Wound feels hot on palpation. Drainage is increased and possibly purulent. Foul odour may be noted. Wound edges may be separated with dehiscence

present.

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Wound Complications Infection- S/S purulent drainage, pain, redness

around wound, edema, increased temp, elevated WBC

Hemorrhage – S/S large amts sanquineous drainage + other symptoms of hypovolemic shock.

Dehiscence- S/S wound edges pulling away; not well-approximated. Early sign = increasing serosanquineous drainage

Evisceration- S/S wound opens revealing internal organs. Emergency rx = sterile NS gauze to cover; prepare for OR

Psychosocial impact – Encourage verbalization of feelings; encourage self-care as tolerated

EviscerationDehisence

Types of Wound DrainageExudate is material, such as fluid and cells, that has

escaped from blood vessels during the inflammatory process and deposited in or on tissue surfaces. The Nature and amount of exudate vary according to: Tissue involved, Intensity and duration of the inflammation, and the presence of microorganisms.

1. Serous Exudate Mostly serum Watery, clear of cells E.g., fluid in a blister

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2. A purulent Exudate Is thicker than serous exudate because of the

presence of pus. It consists of leukocytes, liquefied dead tissue

debris, dead and living bacteria. The Process of pus formation is referred to as

suppuration, and the bacteria that produce pus are called pyogenic bacteria.

Purulent exudate vary in color, some acquiring tinges of blue, green, or yellow. The color may depend on the causative organism.

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3. A sanguineous (hemorrhagic) Exudate It consists of large amount or blood cells,

indicating damage to capillaries that is very severe enough to allow the escape of RBCs from plasma

This type of exudate is frequently seen in open wounds.

Distinguish whether the exudate is dark or bright. Bright indicate fresh blood, whereas dark exudate denotes older bleeding.

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Wound Drains Drains are used to keep body fluid away from the

wound so that effective healing can occur

There are several different types of drains

Drainage Tube Dressing (AV)

Penrose Drain Looks like a floppy macaroni noodle This drain is usually covered loosley with a topper

dressing Change the topper dressing frequently and weighs

the gauze and records this as output

Safety pinkeeps drainfrom slippinginto wound

Drain sponge

Jackson-Pratt Drain This drain looks like a gernade There is a plastic ball that is squeezed and the

end is closed. The drain will inflate itself (the squeezed ball opens up) and as it does, it pulls drainage away from the patient

This drain must be empties frequently in order to keep working

Hemovac Drain This drain looks similar to a frisby or a disc

pull the tab to empty the drain and then squeeze the disc down and plug it up.

Again, when the drain inflates, it pulls drainage away from the pt

This must be emptied several times to work effectively

Hemovac

The RYB color code(Stotts,1999)

This concept is based on the color of the open wound rather than the depth or size of the wound.

On this scheme, the goal of wound care is to protect ( cover) red, cleanse yellow, and debride black.

The RYB code can be applied to any wound allowed to heal by secondary intention.

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R=Red Y=Yellow B= Black

Red woundsRed wounds Usually in the late regeneration phase of tissue

repair (ie, developing granulation tissue) and are clean and uniformly pink in appearance

They need to be protected to avoid disturbance to regenerating tissue. Examples are superficial wounds, skin donor sites, and partial- thickness or second – degree burns.

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How to protect red wounds:Gentle cleansingAvoid the use of dry gauze or wet- to-dry saline

dressings.Applying a topical antimicrobial agent.Appling a transparent film or hydrocolloid

dressing.Changing the dressing as infrequently as

possible.49

Yellow wounds

Characterized primarily by liquid to semiliquid ”slough” that is often accompanied by purulent drainage.

Cleanses yellow wounds to absorb drainage and remove nonviable tissue. Methods used may include .Applying wet-to-wet dressing; irrigating the wound;

using absorbent dressing material such as impregnated nonadherent, hydrogel dressing, or other exudate absorbers; and a topical antimicrobial to minimize bacterial growth.

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Black WoundBlack Wound Covered with thick necrotic tissue or Eschar. e.g.. third degree burns and gangrenous

ulcer. Required debridement . When the eschar is removed, the wound is

treated as yellow, then red.

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Promotion of Wound Healing

Dressings: keep wound covered & clean Wound bed moist / Surrounding skin dry Debridement when necessary Remove exudate:

Drains, Wound VAC, Irrigation Pack wounds loosely Nutritional interventions

Debridement Methods

Surgical Mechanical Enzymatic ( proteolytic enzymes) Autolytic

Sharp Debridement This is the removal of necrotic tissue (non-living tissue) The use of sterile scissors, forceps or other

instruments are used This method is preferred when the wound is infected

because it helps the wound heal quickly This can be painful and the wound may bleed

afterward Can be done in the O.R. or at the bedside

Enzymatic Debridement This involves the use of topically applied chemical

substance that break down and liquefy wound debris

A dressing is used to keep the enzyme in contact with the wound and to help absorb drainage

This is used for people who can’t take the pain from the sharp debridement

Panafil Ointment is an enzymatic debriding-healing ointment which contains standardized Papain, Urea and Chlorophyllin Copper Complex Sodium in a hydrophilic base.

Enzymatic debridement

Autolytic Debridement This is a painless

physiologic process that allows the body’s enzymes to soften, liquefy and release devitalized tissue

It is used for people who have small infections

An occlusive dressing keeps the wound moist

Removal of tissue debris is slow in this process

Mechanical Debridement – 3 types of this

Type 1. This involves physical removal of debris This is done by applying wet-dry dressings The wound is packed with wet gauze and then 6-8 hrs

later, the gauze dries. Debris attaches itself to the wet and then dry gauze and is removed when the dressing is changed

This procedure can be painful and at times, it disrupts the new formation of granulation tissue

Mechanical Debridement 2. Hydrotherapy – the use of agitating water

contains antiseptic and softens the dead skin. Loose debris that remains attached, is then

removed by sharp debridement

Mechanical Debridement, type 3

3. Irrigation – technique for flushing debris

This technique is best used when granulation tissue has formed

Wound Dressing Principles

If exudate is present - Select one that absorbs exudate.

Keep wound bed moist but surrounding skin dry Pack wounds loosely to avoid pressure on new

granulation tissue Fasten securely using tape, binders etc…

OR self-adhesive type dressing materials.

Purposes of wound dressing1. To protect the wound from mechanical injuries2. To protect the wound from microbial

contamination3. To provide or maintain high humidity of the

wound4. To provide thermal insulation5. To absorb drainage and /or debride a wound

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6. To prevent hemorrhage (when applied as a pressure dressing or with elastic bandages).

7. To splint or immobilize the wound site and thereby facilitate healing and prevent injury.

8. To provide psychological (aesthetic) comfort.

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1980 2000

AdvancedMoist Wound HealingChronic & Acute

BC 1980

TraditionalGauze & TapeFirst Aid Dressings

2000+

AdvancedMoist Wound

HealingChronic & Acute

ActiveTissue

EngineeringGrowth FactorsAntimicrobials

Enzymatics

IN 1962 WINTER DEMONSTRATED THAT WHEN WOUNDS ON PIGS ARE KEPT MOIST, EPETHELIZATION IS ABOUT TWICE AS RAPID AS IN WOUNDS ALLOWED TO DRY BY DIRECT EXPOSURE TO AIR.

IN 1963 HINMAN AND MAIBACH CONFIRMED WINTER’S WORK ON HUMAN BEINGS.

MOIST WOUND HEALING IS TWICE AS FAST AS DRY WOUND HEALING

UNTIL MID 20TH CENTURY, DRESSING THAT PROMOTED DRYWOUNDS HAD BEEN THE MAINSTAT OF THE TREATMENT. STUDIES HAVE SHOWN THAT A MOIST WOUND ENVOIRMENT PROMOTE MORE RAPID HEALING.MOLECULAR AND CELL BIOLOGY IS PLAYING A MORE IMPORTANT ROLE IN DEVELOPMENT OF TISSUE REPAIRS METHOD.

Effect of air drying and dressings on the Effect of air drying and dressings on the surface of woundsurface of wound

Porcin modelPorcin model2.5 cm2.5 cm2 2 woundswoundsAfter 3 daysAfter 3 days

99 %99 %

41 %41 %

18 %18 %

Occlusiv dressingOcclusiv dressing

Air dryer (hot)Air dryer (hot)

Without any dressing (air exposed)Without any dressing (air exposed)

Dehydrated dermisDehydrated dermis

epidermisepidermis

exsudateexsudate

Wound Wound healinghealing

Moist wound healingMoist wound healing

Dry dermis

Dry exudate

Moist wound bed

Slow epithelial migrationBelow crust

dermisFast epithelial migration

On moist wound bed

epidermis

Occlusive dressing

Exposed woundStratum corneum

No crust or scabCrust

Or scrab

The Principal Reasons for Applying a Dressing

To produce rapid and cosmetically acceptable healing,

To remove or contain odour, To reduce pain, To prevent or combat infection, To contain exudate, To cause minimum distress or disturbance to the

patient, To hide or cover a wound for cosmetic reasons. A combination of two or more of the above.

Wound Wound DressingsDressings

Types of DressingALGINATEHYDROGELFOAM OINTMENT / CREAM / PASTE / LIQUID / SPRAY / POWDERCOLLAGENBIOLOGICSHYDROCOLLOID / HYDROFIBERCOTTON / ABSORBENT / GAUZE

Dressings for DRY wounds

Transparent: gas exchanged between wound & environment but bacteria prevented from entering. Creates moist healing environment Example: Tegaderm

Hydrogels: High water content enhances epithelialization and autolytic debridment.Needs cover dressing and wound edge barrierExample: Carrasyn

Wet – to- Moist Gauze dressings: keeps wound bed moist. Minimizes trauma to granulation tissues

Dressings for DRY wounds

Wet – to Moist Gauze

Dressings for MOIST wounds

Hydrocolloid: hydrophilic particles mix with water to from a gel... wound stays moist. DO NOT use in infected wounds.Example: Duoderm

Absorption Materials: beads, powders, rope or sheets that absorb large amount of exudateExample: Calcium Alginate

Foam: Made of hydrophilic material. Highly absorbent.Example: Allevyn

Dry Gauze: Can absorb wound drainage. Can be impregnated with agents to promote healing

Dressings for MOIST wounds

Wound colorBlack

)Eschar(Yellow

)Slough(Red

)Granulation(

HydrocolloidExduateQuantityHydrogeland transparent Film

Heavy Exduate

Moderat Exdudate

Little

Alginate and Absorbent Foam

Hydrogell and Absorbent Foam

Hydrocolloid

Selecting the correct dressing as Selecting the correct dressing as the wound changesthe wound changes

Wound conditionProduct selected why

Moist red

Pink/red

Exuding yellow

Hard dry black

Absorb exudate,autolytic Debridement

Hydrate,separate Eschar

Alginate xerogel

Amorphous Hydrogel

Hydrocolloid

Transparent

Film

Provide barrier &control humidity

Allow Epithelialization, Reduce shear

Wound Wound DressingsDressings Types of Dressing

Wound Wound DressingsDressings Composition of the dressing

Sodium CarboxymethylcelluloseGelatin, Pectin and Carboxy-methylcellulose Sea WeedPolyurethane, Polyacrylate Fibers, Soft SiliconeAnti-Microbial : Silver based, Polyhexanide, Betaine, Iodine etc.Collagen: Bovine, Porcine, Human and Type I, II, IV etc

Wound Wound Management Management Strategies - Strategies - DressingsDressings

Hydrogels

HydrogelsPlain Hydrogel is generally clear viscous gel made with condensed water or glycerin. Glycerin based Hydrogels are also available in a non-adhesive sheet or impregnated gauze form. Hydrogels are used on wounds with low to moderate exudates. A secondary dressing is always required when applying a gel or impregnated gauze. Hydrogel sheets are commonly used on the Radiation skin irritations.

Products classified as hydrating gels include DuoDERM Gel, Intrasite Gel, Comfeel Purilon Gel and Aquasorb Hydro Gel.

Purpose• Keep wound moist, prevent and protect it from desiccating• To promote autolytic debridement• Barrier against wound contamination from external sources

Hydrogels

Alginates

AlginatesAlginate is a naturally occurring polysaccharide found in brown seaweed. Alginate are non-toxic and soluble in body fluids, which interacts with the exudates from the wound to form a hydrophilic gel. Alginate dressings vary in absorbency but typically they will absorb up to 15-20 times their own weight in exudates. Alginate dressings are commonly used in moderate to high exudating wounds.

Products in the alginate category are Kaltostat and Kaltostat Fortex (Convatec), Biataine (Coloplast), Kalginate (DeRoyal).

Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing/manage moisture /prevent

maceration• Permit gaseous exchange

Alginates

Alginate : Indication• For moderate to heavily

exudating wounds• Help to debride (in addition

with mechanical debridement)

Alginate : Indication

•For moderate to heavily exudating wounds

• Help to debride (in addition with mechanical debridement

Foams

FoamsMost of the foam dressings are made of hydrophilic polyurethane, viscose and acrylate fibers or particles of superabsorbent poly-acrylate, or which are silicone-coated for non-traumatic removal. Foams are recommended for wounds producing low, moderate to heavy exudate.

Allevyn (Smith & Nephew) Baitain (Coloplast) are all foams Dressing.

Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing /manage moisture/prevent

maceration• Permit gaseous exchange • Provide thermal insulation • Barrier against wound contamination from external sources.

Foams

• For light to medium exuding wounds

• Granulating and epithelializating wounds

Foam dressing : Indication

For Cavity Wounds

Cavity Wounds(Healthy Granulation )

Hydrocolloids

HydrocolloidsHydrocolloids are a type of dressing containing gel-forming agents, such as sodium carboxymethylcellulose (NaCMC) and gelatin. The hydrocolloid dressing is occlusive or semi occlusive. impermeable to fluids and bacteria. Hydrocolloids are semi-permeable to gas and water vapor. Hydrocolloids are appropriate for wounds with light to medium exudates. Hydrocolloids should not be applied to infected wound or wounds with moderate to heavy exudates.

Products which are considered to be hydrocolloid include Comfeel (Coloplast), Restore (Hollister), Duoderm( ConvaTec).

Purpose• Hydrocolloids absorb liquid and form gels to

promote moist wound healing.• Barrier against wound contamination from

external sources.• To promote autolytic debridement• Require changing only every 2-4 days• Protect skin against shear & friction

Hydrocolloids

Hydrocolloid : Indication

For low to moderate exuding wounds

For clean, granulating, superficial wounds

With safe surrounding skin

Hydrocolloids : Advantage• Require changing only every

3 - 7 days• Provide effective occlusion

and barrier (prevent the spread of Infection

• Cost effective • More effective than

traditional dressings

1 week1 week

Extra-thinExtra-thin hydrocolloidhydrocolloid

Occlusive dressing

21 days

Diabetic ulcer for 5 month

Hydrocolloid

loids

Hydrocolloid

Semi-Permeable Membranesor Films

Semi-permeable membranes / FilmsSemi-permeable film dressings are synthetic adhesive film dressings that are waterproof but which are also permeable to limited oxygen and water vapor to and from the wound site.

Films are frequently used as IV dressing and for skin tears. Opsite (Smith & Nephew) and Tegaderm (3M) are all film dressing.

Purpose:• Promote moist wound healing• Promote autolytic debridement• Protect skin against shear & friction• Require changing only every 24-72 hrs.• Barrier against wound contamination from external sources.

Semi-Permeable Membranesor Films

.

- For low exuding superficial wounds. - Decrease pain at dressing removal.

URGOTUL

SILICONE DRESSING

Mepitel

Mepilex

CollagenCollagen Dressing / Extracellular Matrix (ECM)Collagen is one of the most abundant with its essential role in the wound management. Several different collagen dressings are available utilizing sources including porcine, bovine, equine or human. Collagen plays a critical role in all phases of wound healing homeostasis, inflammation, proliferation, and remodeling.

Purpose:• Promotes fibroblast production• Organize collagen fibers in the wound• Help preserve leukocytes, macrophages, fibroblasts, and

epithelial cells.• Assist in the maintenance of the chemical and thermostatic

microenvironment Regulate proteases (MMPs). Promotes granulation

Collagen

HydrofibersHydrofibers

Hydrofiber dressing is composed of sodium carboxy-methylcellulose fibers. Hydrofiber dressing is conformable, and capable of absorbing a large amount of drainage. Hydrofiber dressing transforms into a soft gel form after absorbing fluids, which creates a moist environment to support the body's healing process. Silver-impregnated hydrofiber dressings are commonly used due to their antimicrobial action.

Purpose:• Fill wound cavities• Absorb exudates in highly exudating wounds• Promote moist wound healing / manage moisture / prevent

maceration• Permit gaseous exchange • Antimicrobial effect

Hydrofibers

Hydrofibre : Aquacel• CMC fiber : gel formation• Same indications than

alginate• Non haemostatic

Impregnated GauzeImpregnated / Petrolatum/Antimicrobial

Gauze DressingGauze dressings infused with a variety of substances are also commonly used for the management of different types of wounds. Most commonly; Gauze saturated with the petroleum-derived, gelatinous substance petrolatum blend with 3% Bismuth Tribromophenate (Antimicrobial) is used to prevent, infection, unnecessary dressing adherence (stickiness) to the wound bed, and maintain a healthy and moist wound environment. This type of dressing is recommended for light exudative wounds.

Purpose:• Protective layer i.e. cover fascia, bone, tendon etc.• Absorb exudates in lightly exudating wounds• Promote moist wound healing • Permit gaseous exchange • Antimicrobial effect• Prevent dryness of the affected area

Impregnated Gauze

Impregnated Gauze

« Traditional dressing » Contact dermatitis

are frequent

• Adherent• Pain and bleeding at

removal

Impregnated Impregnated GauzeGauze

Silver DressingSilver Dressing

•SilverceSilvercell (Alginate+sliver) (Alginate+sliver)

•AquacelAquacel((Ag(hydrofibre+silvAg(hydrofibre+silver)er)

•ActicoatActicoat (Nanocrystalline (Nanocrystalline silver-based dressing)silver-based dressing)

Platelet-Derived Growth Factors(pdGF)• Activates endothelial cells and fibroblasts• Stimulates vascular proliferation, migration,

new blood vessel formation• Recruits smooth muscle cells and pericytes to

stabilize newly formed vessels

Oxidized Regenerated Cellulose (ORC)/Collagen

Modulates protease activity

Growth factor remains active while bound

Growth factors delivered back to wound over time

Modifies hostile proteolytic environment

of chronic wound Applied every 2-3 days

Wound Wound Management Management Strategies - Strategies - IrrigationIrrigation

Irrigations Cleanses a wound using pressure Sterile Normal Saline = usually prescribed Avoid caustic agents ie: peroxide, iodine etc. Pressure between 4-15 pounds per square inch

(psi) i.e. 60ml syringe with catheter tip

Wound Wound Management Management Strategies – Strategies –

Other therapiesOther therapies

Other Therapies Wound V.A.C. – negative pressure vacuum

assisted closure system. Removes drainage and helps wounds close.

Hydrotherapy – Pulse lavage, WhirlpoolAids in debridement and cleansing, warm water vasodilation.

Hyperbaric Oxygen Electrical Stimulation

Other Therapies

Electrical Stimulation:- electrical signals direct cell migration in wound healing

Bandages & Binders Secures dressings in place

Determine size needed

Outer covering must cover entire wound

Tape to secure (initial,date time)

Comfort Measures for Wound care patients

Heat & Cold Applications Ice Bag & Ice Collar Chemical Packs Compresses Aqua-thermia pads Soaks & Moist packs Therapeutic Baths

Heat & Cold Therapy Heat- reduces pain & promotes healing

through vasodilation Increases oxygen and nutrients to aid in

inflammatory response Reduces edema by promoting removal

of excessive interstitial fluid Promotes muscle relaxation

Heat & Cold Therapy Cold- decreases pain by vasoconstriction Decreased blood flow to the area decreases

inflammation and edema Raises the threshold of pain receptors thereby

decreasing pain Decreases muscle tension

Safety Precautions Heat & Cold Therapy

Very young and very old Peripheral vascular disease Decreased LOC Spinal cord injury Presence of edema and/or scar tissue NO LONGER than 20-30minutes at a time.

Rebound phenomena

Heat vs. Cold Heat Cold Provides warmth reduces fever Promotes circulation prevents swelling Speeds healing controls bleeding Relieves muscle spasms relieves pain Reduces pain numbs sensation

Cold Treatment (Ice Packs)

Come as disposable sacs that can fill, empty out and re-fill

These provide comfort to pts and have various uses

Moist Heat

Sitz Bath

A container is placed under the rim of the toilet seat to allow warm water to squirt onto the pt’s underside for example to alleviate hemorrhoids or vaginal tear after delivery

The water soothes the perineum, or anus

Heating Pad (K-Pad) This is a device used to provide comfort The machine is filled with water that heats and the the

water filters into a blanket and the pt can either sit on the blanket or lay the blanket over them

Temperature is pre-programmed to deliver one temperature, the water never seems to get warm enough

Heating Blanket Again, usually the pt can lay on this to

provide comfort

Chemical warm or cool packs

These provide temporary relief and may decrease swelling

These can be used if an IV falls out of place and the fluid is in between spaces causing pain

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