Transcript Choosing The Right Dressing For The Would

EENY, MEENY, MINEY, MO
CHOOSING the RIGHT DRESSING
for the
WOUND
Denise McConnell, APRN, CNS, MS, CWOCN
OBJECTIVES
 The attendee will be able to:
 Identify 4 types of dressings based on wound
description
 Identify 3 goals of wound care
 Identify 4 road blocks to healing and how to
resolve them
DECISIONS TO BE MADE
 HEAL THE WOUND(S)
 MAINTAIN THE WOUND(S)
 PALLIATIVE CARE OF PATIENT/
WOUND(S)
THE RIGHT DRESSING
 The appropriate dressing will:
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Protect the wound bed and surrounding tissue
Promote healing
Decrease infections
Control pain
Control costs
THE WRONG DRESSING
 The inappropriate dressing will:
 Inhibit healing
 Leading to stalling or deterioration of wound
 Lead to infection
 Lead to injury of the periwound tissue
 Cause pain
GOALS OF WOUND CARE
 Managing the moisture of the wound bed
 Prevention of infection and bioburden
 Promoting an environment that is
physiologically conducive to healing
 Pain management
 Protection from injury
 Trauma
 Cold
 Improving quality of life
WHAT’S THE PROBLEM
 Treatment should
begin with
identification of
type of wound and
identification of
road blocks
(real/potential) to
healing.
TYPE:
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ARTERIAL
VENOUS
SURGICAL
AUTOIMMUNE
PRESSURE ULCERS
DIABETIC/NEUROPATHIC
TRAUMA/BURNS
ROAD BLOCKS:
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PAD
VENOUS HTN
HYPERGLYCEMIA
SMOKING
OBESITY
PROTEIN-CALORIC MALNUTRITION
PYSCHOSOCIAL ISSUES
WHAT’S NEXT?
 The next step is to remove/correct the
road blocks.
 Angiogram with intervention to improve arterial
circulation
 Diabetic education for better glycemic control
 Compression of lower extremities
 Smoking cessation
 Weight loss
 Adequate protein/calories to promote healing
 Psychosocial support
ASSESSMENT
 Is there:
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Necrotic, slough, bioburden
Infection, inflammation
Tunneling, undermining
Drainage-wet, dry
Periwound intact, skin damage
Presence of pain
TREATMENT DECISIONS
 Debridement
 Antibiotics, antiseptics, bactericidal
 Wound fillers
 Moisture management
 Stimulation
 NPWT
 Grafts/donors/flaps
 Compression
 Pressure relieving/reducing
DEBRIDEMENT
 Debridement-the removal of devitalized
tissue. Wound will not progress if necrotic
tissue present.
 Enzymatic –collagenase
 Hyper-sodium chloride gel, ribbon or pads
 Honey-medical grade
 Hypochlorite solution (Dakin’s 0.25-0.5%)
 Biologics-larvae
 Surgical
DEBRIDEMENT
DEBRIDEMENT
ANTIINFECTIVES
 Use of antimicrobials, bactericidal,
bacteriostatic-used to manage infections
or colonization of wounds.
 Topical
Mupirocin
Cadexomer iodine gel/pad
Silver sulfadiazine Silver dressings
Hypochlorite solution (Dakin's 0.25-0.5%)
Acetic acid 0.25% (Vinegar)
Methylene blue/Crystal violet
 Systemic-IV or P.O.
ANTIINFECTIVES
WOUND FILLERS
 Packing-fills in dead space of tunnels or
undermining.
 Gauze moistened normal saline or medicated
 Packing strips
 Plain
 Plain with the addition of topical medication
 Medicated –iodoform, silver
 Calcium alginates/hydrofibers
 NPWT
WOUND FILLERS
MOISTURE MANAGEMENTWET
 Absorb exudate- excess drainage can lead
to increase bioburden in wound, odor,
maceration of periwound area, or
hypergranulation of tissue
Calcium alginates
Foams
Gauze pads
Hydrogel sheets
NPWT
Hydrofibers
Composites-ABD pads
Hydrocolloids
Polymer-based dressing
Wound managers (ostomy pouches)
MOISTURE MANAGEMENTWET
MOISTURE MANAGEMENTDRY
 Dry wound bed can lead to desiccation of
the cells, platelets and growth factors.
 The dressing should provide a moist
wound environment that functions to
maintain that moisture.
Foam
Hydrofiber
Impregnated gauze
NPWT
Transparent film
Hydrogel gel/sheets
Hydrocolloids
MOISTURE MANAGEMENT DRY
WOUND STIMULATION
 Tissue engineered skin-matrix of collagen,
fibroblasts, keratinocytes and growth
factors. Comes in sheets. Human sources.
 Collagen-stimulates healing. Comes in
pouches, vials, gels, pads, powders
freeze-dried sheets. Source can be
bovine, porcine, sheep or avian.
 Growth factors-cause cell proliferation.
WOUND STIMULATION
NEGATIVE PRESSURE WOUND
THERAPY
 Contact layer-foam, gauze
 Negative pressure
 Purpose:
 Maintain a moist environment
 Stimulation of perfusion-formation of
granulation tissue
 Cell division by mechanical stretching
 Management of bioburden
GRAFTS/DONOR/FLAPS
 Prevent trauma-pressure
reducing/redistribution cushions/beds
 Graft/donor-protect-transparent films, fine
mesh gauze-impregnated
 Use turn sheets-prevent shear
 If an extremity involved, keep elevated and
compression (if indicated)
MISCELLANEOUS
 Skin tears-approximate edges and use
skin bonding product or steristrips. Cover
with absorbent dressing.
 Hypergranular tissue-reduce bioburden,
topical antimicrobial agents, foam
dressings
 Periwound protection-use of absorbent
dressings, skin protectants that will
prevent hydration of skin.
MISCELLANEOUS
MISCELLANEOUS
 Hypothermia-keep area warm, protective
dressing, decrease length of time wound
exposed.
 Fistulas-use of wound managers, ostomy
pouches
 Trauma-use low air loss mattresses, w/c
cushions, heel/feet boots/pads, sacral
dressings
COMPRESSION
 Standard for venous hypertension of lower
extremities
 Increases/augments rate of blood flow in the
calves.
 Discourages leakage of veins into interstitial
tissues leading to edema
 Methods:
Compression wraps
Orthoses
Short stretch wrap
Stockings
pneumatic pumps
PRESSURE
RELIEVING/REDUCTION
 Low air loss mattress
 Wheel chair cushions
 Shoes
 Wheel chair
 Total contact cast/modified cast
COST
 Is patient able to purchase supplies,
medications
 Resources-insurance, family, Medicare,
Medicaid
 Who provides care-home health, clinic,
family, doctor’s office
 Where to obtain supplies-DME, stores,
donations
BIBLIOGRAPHY
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Broussard, C.L. (2007). Dressing decisions. In Drasner,D., Rodeheaver, G.T.,
Sibbald,R.G. (Eds.), Chronic wound care: a clinical source book for healthcare
professionals (4th Ed.) (pp. 249-262). Malvern, PA: HMP Communications
Bryant, R.A., Nix, D.P., Rolstad, B.S. (2012). In Bryant, R.A., Nix, D.P. (Eds), acute
and chronic wounds: current management concepts (4th Ed.) (pp 279-288). St. Louis,
Missouri: Mosby Elsevier.
Cockbill, S.M.E., Turner, T.T. (2007). The development of wound-management
products. In Drasner,D., Rodeheaver, G.T., Sibbald,R.G. (Eds.), Chronic wound care:
a clinical source book for healthcare professionals (4th Ed.) (pp. 233-248). Malvern,
PA: HMP Communications
Krasner, D.L., Sibbald, R.G., Woo, K.Y. (2011). Wound dressing product selection: a
holistic, interprofessional patient-centered approach: a kestrel woundsource white
paper. Retrieved January, 2015, from http://www.woundsource.com
Ovington, L., Rolstad, B.S. (2007). Principles of wound management. In Bryant, R.A.,
and Nix, D.P. (Eds.), acute and chronic wounds: current management concepts (3rd
Ed.) (pp 391-460). St. Louis, Missouri: Mosby Elsevier.
Ramundo, J.M. (2012). Wound debridement. In Bryant, R.A., Nix, D.P. (Eds), acute
and chronic wounds: current management concepts (4th Ed.) (pp 279-288). St. Louis,
Missouri: Mosby Elsevier.