2. LEARNING OBJECTIVES
1.Understand the “TIME” concept in wound
management
2.Discuss debridement as part of treatment plan.
3.Identify signs of infection and discuss interventions
related measures.
4.Discuss the benefits of maintaining moist wound
environment.
5. Describe the properties of the eight main categories
of wound dressing.
2
3. 6. State indication, precautions and contraindications
of the each of the wound dressings
7. Discuss new advances in wound management
(tissue adhesive, growth factors, biosynthetic dressing
).
8. Compare sterile with clean techniques for wound
care.
9.Identify types of antiseptic agents used for wound
care
3
4. EXPECTED OUTCOMES
By the end of the session you will be able to:
1.Demostrate understanding of wound
management principles related to “TIME” frame.
(wound debridement, managing infection,
keeping moisture wound environment)
2. Recognize types of antiseptic agents used for
wound care
3. Differentiate between the 8 main types of
dressings
4
5. 4.Demonstrate willingness to gain more knowledge
related to advanced methods used in wound care (web
search)
5. Apply learned principles of dressing techniques in
clinical settings
PREREQUISITES
- MYERS (2008) chapters 5 ,6,7 (pp.70-155)
- Potter,P.A.,Perry,A.G.,(2009).Fundamentals of
Nursing.(7th ed).Mosby pp.1313-1321
- Lecture handout
5
6. WOUND BED PREPARATION -WBP
To achieve an effective outcome, a wound should
have:
1. Well-vascularized wound bed
2. Minimal bacterial burden
3. Little or no exudate
6
8. FALANGA (2004) HAS UTILIZED THE WORK OF
SCHULTZER ET AL. (2003) TO DEVELOP A FRAMEWORK
CALLED TIME TO PROVIDE A COMPREHENSIVE
APPROACH TO CHRONIC WOUND CARE.
T Tissue management ( non-
viable)
I Inflammation & infection control
M Moisture Balance
E Epithelial Edge advance 8
9. T-TISSUE MANAGEMENT
PREDOMINAT TYPE OF NECROSIS
ESCHAR SLOUGH FIBRIN HYPERKERATIN GANGRE
OSIS NE
Hard Soft, soggy Soft, soggy Hard Hard
Soft, soggy Soft stringy Soft, Soft, soggy
Mucinous stringy
Black/brown Yellow/tan Mucinous White/gray Black/brow
yellow/whit n
Firmly Firmly e Firmly attached
attached attached Firmly
Attached Surrounds wound attached
Attached base Attached base base adges
Loosely Loosely
attached attached
9
clumps clumps
10. Tissue management
Assessment for non viable tissue.
Wound debridement is the principle intervention
Is the removal of
necrotic tissue, foreign
material and debris
from the wound bed
(Myers, 2008)
10
11. T-TISSUE MANAGEMENT
Purposes of debridement
• Decrease bacterial concentration within the
wound bed and the risk of infection.
• Increase the effectiveness of topical
antimicrobials.
• Improve the bactericidal activity of leukocytes.
• Shorten the inflammatory phase of wound healing.
• Decrease the energy required by the body for
wound healing.
• Eliminate the physical barrier to wound healing.
• Decrease wound odor.
11
12. Debridement options
• Sharp or surgical
• Autolytic
• Enzymatic
• Mechanical
• Biosurgery or larval therapy
12
13. Sharp or surgical: involves using forceps,
scissors, or a scalpel to selectively remove devitalized
tissue, from a wound bed. Fastest and most aggressive.
Autolytic: uses the body’s own (endogenous)
enzymes, including collagenase to digest necrotic tissue
and macrophage to phagocytose debris by applying a
moisture retentive dressing and leaving it in place for
several days (Hydrocolloids, hydrogels, & alignates).
13
14. Enzymatic or chemical debridement: is
the use of a topical exogenous enzyme
(collagenase, elastase, & fibrinolysin) to
remove devitalized tissue.
Mechanical: involves the use of force to
remove devitalized tissue, foreign matter, and
debris. Nonselective debridement type that
includes:
- Wet-to-dry dressings
- High Pressure wound irrigation
- Whirlpool baths 14
15. Biosurgical or larval parasitic
1. Mechanical movement loosen surface
debris
2. larvae secrete enzymes into the wound
that break down necrotic tissue to a
semi-liquid form
3. Larvae ingest the dead tissue, leaving
only the healthy tissue.
15
16. GENERAL DEBRIDEMENT INDICATIONS
THE RED-YELLOW-BLACK SYSTEM
COLOR WOUND BED TREATMENT GOALS
DESCRIPTION
RED Pale, pink,beefy red Protect wound
granulation tissue Maintain worm , moist
environment
Protect periwound
YELLOW Moist yellow slough Debride necrotic tissue
Vary in adherence Absorb drainage
Protect periwound
BLACK Thick ,black,adherent Debride necrotic tissue
eschar,
16
17. GENERAL CONSIDERATIONS FOR
DEBRIDEMENT
Wound characteristics- etiology, size, presence of
infection, amount of necrotic tissue
Patient’s general health, nutrition and other
medical conditions (immunosuppression,
thrombocytopenia)
17
19. Specific Treatment Objectives for Infected
wounds
• To identify the infective organism.
• To control and/or eliminate wound infection.
• To remove devitalized tissue from the wound
bed.
• To cleanse the wound surface.
• To absorb excess exudate production.
• To protect the surrounding skin from the
effects of maceration.
• To control pain/discomfort.
19
20. HOW DO WE KNOW THE WOUND IS
INFECTED?
ASSESSMENT:
- five cardinal signs of infection:R.C.T.D.F
- Decline in wound status
- Detect presence of silent infectinos- abcess
Presence of biofilms with incresed bacterial
resistance
Wound cultures (tissue biopsy and swab
cultures)
20
21. HOW DO WE TREAT AN INFECTED
WOUND?
1.Topical antimicrobial therapy- in order
to provide an agent that destroys the offending
organism
- topical ointments or creams are applied to
wound surface, penetrate the wound bed to the site
of infection and inhibit bacterial growth
- use of antimicrobial-impregnated wound
dressings
- use of silver as broad spectrum
antimicrobial
21
22. Advantage of topical antimicrobial use is :
-lower cost than systemic therapy and ease
of application
-it will decrease bacterial load if applied
properly
-they are applied direct to wound bed – better
to treat wounds with compromised circulation
Disadvantage :- needs frequent application
-sensitivity and allergic reactions
- increased chance for microbes to become
resistant
22
23. 2. ANTISEPTIC AGENTS
(ACETIC ACID,
Antimicrobial solution
CHLORHEXIDINE, HYDROGEN that prevents
PEROXIDE, POVIDONE-IODINE) infection by killing
microorganisms
Previously were considered to reduce the rate of
infection and speed wound repair
Research showed that beside being broad-spectrum
anti microbial, antiseptic agents are also cytotoxic to
fibroblast, kerationcytes and neutrophyls
----------increse the duration of inflammatory response
and delay epithelialization and wound contraction 23
24. Used to decrease bacterial growth on inanimate objects
Reduce bacterial concentrations on intact skin- used as
surgical scrub
Can be used for short period of time on open wounds
e.g. patients with bite from animals in
the farm can have short term use of povidone-iodine
because this wounds are multimicrobial
(Myers, 2008;p.104-113)
24
25. 3.SYSTEMIC ANTIMICROBIAL
THERAPY
Prescribed for patients with sepsis or deep space
infections , alone or in combination with topical
antibiotics
Advantage –reduce bacterial load, better patient
compliance with treatment
Disadvantage- more frequent and severe adverse
reactions, development of resistant stains
25
26. REVIEW:
T- TISSUE MANAGEMENT
DEBRIDMENT Sharp or surgical
Autolytic
Enzymatic
Mechanical
Biosurgery or larval therapy
I- INFECTION/ INFLAMMATION
26
27. M
M MOIST WOUND HEALING
Traditional theory says: “wounds should be kept dry and
clean so that scab can form over the wound” Sussman,Bates-
Jensen(2008)
Practice shows that scab is a barrier to healing- because it
interferes with moving of epithelial cells- poor cosmetic
results and scarring
The wounds should be managed in a moist environment so
epithelial cells will be able to move
Moist wound heals 3-5 times faster than dry wound because
moist facilitates the three phases of wound healing process
.Myers (2008) 27
28. The amount of moisture is not known exactly-
-a wound too dry will result in crust formation and will
lack the enzymes and growth factors that facilitate
healing
-a wound that is to wet can delay healing because of the
extra fluid around the wound which will produce
maceration of tissue
28
29. DRESSINGS -FUNCTION
Create a moist wound environment
- if wound too wet-dressing will absorb the excess
exudate
- if wound too dry- dressing will donate moisture
to it
Provide thermal insulation maintain temp.37-
38degrees C
-this temp. increases oxygen saturation and
decreases hemoglobin’s affinity for oxygen.
29
30. -wound dressing should protect against infection
- wound dressing should protect exposed nerve
endings, decreasing the pain
-provide hemostasis, edema control elimination of dead
-dead space=void left by a wound cavity,
undermining or tunneling---it must be avoided to
prevent abscess formation and premature wound
closure
Provide gas exchange between wound and
environment
30
31. TYPES OF WOUND DRESSING
PRIMARY DRESSING
-Comes in direct contact with wound
e.g.Band Eid
SECONDARY DRESSING
-Placed over primary dressing to improve
protection
e.g. Self-adhesive bandage
placed over primary dressing
31
33. MOISTURE RETENTIVE DRESSING
Maintain an ideal wound healing enviromnent
Are specialized synthetic or organic dressings that are
more occlusive than gauze
Describes the ability of a dressing to transmit
moisture ,vapor and gases from wound to
atmosphere
Have a lower moisture vapor transmission rate than
gauze
Allows patients to bathe, swim without contaminating
the wound 33
34. Maintain wound temperature better than gauze
Protect the wound from trauma and infection
Are adhesive---there is no need for secondary
dressing
Are elastic and stay in place for 3-7 days
Stimulate granulation tissue formation, collagen
synthesis and epithelialization
Main risk for using moisture retentive dressing
INFECTION
TRAUMA TO THE WOUND BED
MACERATION OF SURROUNDING SKIN
34
35. 8 TYPES OF DRESSING
1.GAUZE DRESSING
2.IMPREGNATED GAUZE
3.SEMIPERMEABLE FILMS
4.SHEET HYDROGELS
5.SEMIPERMEABLE FOAMS
6.HYDROCOLLOIDS
7.ALGINATES
8.COMPOSITE DRESSINGS
35
36. 1.
. GAUZE DRESINGS
WOVEN GAUZE-
-made of cotton yarn or thread
NONWOVEN GAUZE –
-made of synthetic fibers pressed together (have grater
absorbency)
Loose weave gauze- aids in medical debridement but
should not be placed over granulating tissue
Gauze is highly permeable and nonocclusive and can
be used as primary or secondary wound dressing 36
37. MULTILAYER GAUZE DRESSINGS
- Outer nonocclusive layer ----allows gas exchange
- Middle antisher layer ---------moves with the patient
- Nonadherent contact layer—allows absorbtion of exudates,
reduces moisture less risk for maceration
ANTIMICROBIAL-IMPREGNATED GAUZE
- The use of such products should be limited ----reduce the
potential of developing resistant microorganisms
37
38. COMMON USES
Both infected and noninfected wounds
Large wounds or irregularly shaped
Packing strips to prevent premature closure or keep
away exudates in tunneling or underminig wounds
CAN BE USED ALONE OR IN COMBINATION
WITH ANTIBIOTICS, ENZYMES, GROWTH
FACTORS, ALGINATES,SEMIPERMEABLE FOAMS
OR FILMS
38
39. PRECAUTINONS /CONTRAINDICATIONS
1.woven gauze require more force to remove----
potential wound trauma
2.woven gauze may leave residue to which body will
respond by forming granuloma
rolled gauze should be applied snuggly but without
tension---to prevent a tourniquet like effect
Telfa dressing---nonadherent, little absorption , keeps
wound exudates close to wound---maceration of tissue
39
40. 2
IMPREGNATED GAUZE DRESSING
Mesh gauze non adherent, moderate occlusive,
Impregnated with petrolatum, bismuth, zinc
Petrolatum impregnated gauze might facilitate wound
healing by decreasing trauma during dressing
Can be used as contact layer on granulating wound
beds, combined with secondary gauze dressing
Used to burn wounds because have pain free removal
40
41. PRECAUTIONS/CONTRAINDICATION
S
Bismuth (from xeroform dressings) is cytotoxic to
inflammatory cells-----cause increased
inflammatory response (not advisable for pt with
venous insufficiency ulcer)
Iodine-impregnated gauze cytotoxic to human
cells only mild antimicrobial
41
42. 3.
SEMI PERMEABLE FILMS
Thin flexible transparent sheets with adhesive backing
Permeable to water vapor, O2, CO2 but impermeable
to bacteria and water
Have little absorptive capabilities , but are comfortable
because of elasticity
Should be applied without tension and wrinkles and
can stay in place for 5-7 days
Should NOT be used in cavity wounds or when heavy
drainage is noted
42
43. •COMMONLY USED FOR SUPERFICIAL
WOUNDS (TEARS, LACERATIONS,
ABRASIONS), INTRAVENOUS CATHETER
SITES, AREAS OF FRICTION
to prevent maceration ---apply on areas of intact skin
-skin should not be oily or wet
-if a channel or wrinkle forms----change dressing
-NOT to be used on infected wounds
43
44. 4.
SHEET HYDROGELS
80-90% water or glycerin based wound dressing
Absorb minimum amount of fluid by swelling
Donate moisture to dry wounds
Decrease pain by cooling the wound bed
Are permeable to gas and water---less effective
bacterial barrier
44
45. PRECAUTIONS/CONTRAINDICATIONS
Are not able to absorb heavy drainage
Are absorbing very slowly----should not be used on
bleeding wounds
Require secondary dressing
: USE minimal or moderate draining wound
-can be used within casts or splints to decrease
pressure
- Effective at softening eschar to facilitate autolytic
debridment
45
46. 5.
SEMIPERMEABLE FOAMS
Made of polyurethaine, permeable to gas but not
to bacteria
have high moisture vapor transmission
Provide thermal insulation
Effective in treatment of stage II and III pressure
ulcer
46
47. - WOUNDS WITH MINIMAL AND HEAVY
USES EXUDATES
-GRANULATING OR SLOUGH COVERED
PARTIAL AND FULL THICKNESS WOUND
-SEMIPERMEABLE FOAMS –USED IN DONOR
SITES , OSTOMY SITES, MINOR BURNS,
DIABETIC ULCER
PRECAUTIONS
-Not recommended in dry or eschar-covered wounds
-not indicated for arterial ulcers---because of enhancing
dryness
- Not indicated for area of high friction—heel ulcers
47
48. 6.HYDROCOLLOIDS
Contain hydrophilic colloid particles like gelatin,
pectin,
Have various absorption abilities
Absolves exudates by swelling into a gel-like
mass
Provide thermal insulation to wound bed
Impermeable to water, oxygen ,bacteria
48
49. Uses- indicated for partial and full-thickness wounds
-can be used on granular and necrotic wounds
-used on minor burns, and pressure ulcers
Duo Derm- effective
barrier against urine,
stool, MRSA,
hepaB,HIV and
Pseudomonas
Arginosa
49
50. 7. ALGINATES
Contain salts of alginic acid from sea weeds and
covered in calcium/sodium salts
When placed on wound, it reacts with the serum and
forms a hydrophilic gel
Are highly permeable and non occlusive----require
secondary dressing
Stimulate macrophage activity
Uses: highly draining wounds
-partial and full-thickness wound
-granular and eschar-covered wounds
50
51. PRECAUTIONS/CONTRAINDICATIONS
Not recommended for use on full thickness burns
Not to be used on wounds with exposed tendon, joint
capsule, bone
Use with moisture barer to protect periwound skin
from maceration
51
52. 8.
COMPOSITE DRESSING
Multilayer dressing that can be used as primary
or secondary wound dressings
3 layers
1. -inner contact-non adherent,
prevents trauma to wound bed when dressing
changes
2.-middle layer-absorbs moisture and keeps it
away from wound bed to prevent maceration
3.-outer layer-bacterial barrier
52
53. SILVER DRESSING
-silver is antiseptic
-dressings may be primary or secondary, adhesive or
non-adhesive
-release of silver ions----blue-black wound discoloration
No evidence that silver is effective in presence of slough
or eschar
Silver is cytotoxic to fibroblast
53
54. CHARCOAL DRESSING
Key function of dressings is to control wound odor by
absorbing odor producing gases released by bacteria----
--improve the quality of life for patients by allowing
them to share with normal social activities
54
56. WHEN CHOOSING TYPE OF
DRESSING USED WE HAVE TO
CONSIDER ALSO THE
SURROUNDING SKIN
EDGE ,EPITELIAL ADVANCEMENT
E
Signs of epithelial (edge) advancement
1. WB filled with granulating tissue.
2. Epithelialization at the wound margins.
56
57. THE FOLLOWING QUESTIONS
SHOULD BE ANSWERED PRIOR TO
THE CLEANSING OF ANY WOUND:
1. What is the purpose of wound
cleansing?
2. What method of wound cleansing would
be most appropriate?
3. Does the wound require cleaning at
each dressing change?
4. What type of wound cleansing product
would be most appropriate? 57
58. 1.THE PURPOSE OF WOUND CLEANSING:
• Wound infection.
• Excessive exudate.
• Presence of foreign bodies, debris,
eschar or slough.
• A need to reduce contamination or
devitalised tissue prior to suturing,
in wounds healing by delayed
primary intention (i.e. tertiary
intention). 58
59. DECIDING TO CLEANSE A WOUND
SHOULD BE BASED ON THE
FOLLOWING:
• The size, shape and location of the
patient’s wound.
• The condition of the wound and
stage of healing.
• The availability and effectiveness of
different methods of cleansing.
• The availability and effectiveness of
different cleansing agents.
• The patient’s perceptions and needs
59
60. CLEANSING TECHNIQUE
• Clean versus sterile technique
• Use of Normal saline and tap water
• Hand washing is essential to reduce infection
• Wound field concept
• Dirty hand & clean hand
60
61. IRRIGATION VS.
SWABBING
Swabbing the wound surface of a wound
may mechanically dislodge loose,
devitalised tissue but does not actively
remove pathogens from the wound.
Irrigation under pressure is an effective
method of cleansing wounds that are
infected or heavily contaminated. High
pressure irrigation using a 30ml syringe
and an 18-20G needle lowers the infection
rates in contaminated wounds. 61
62. STERILE VS.CLEAN TECHNIQUE
Sterile technique -is defined as use of sterile
equipment, ( gloves,wound dressing, instruments) in
order to reduce exposure to microorganisms.
-----------only sterile items may contact the pt’s wound,
------------use of sterile gloves and sterile field
------------meticulous set-up and maintenance of sterile
field
( review table.6-8,p.117 text book)
62
63. Clean technique- procedures that reduce overall
number of microorganisms
-------------------hand, washing, sterile instruments
-------------------use of clean gloves and maintenance of
clean field
-------------------use clean hand dirty hand dressing
procedure
(see table 6-
10,p.117,text book)
63
64. CONCLUSION OF RESEARCH
- No difference in the rate of wound
healing was found when comparing
sterile with clean technique dressing
-clean technique less expensive---
-clean technique----standard in wound
management
-sterile technique---reserved for wounds
that require packing, severe burns,
wounds of immunosupressed patients
64
66. ANTISEPTICS
• Defined as a non-toxic disinfectant, which can be
applied to skin or living tissues & has the ability to
destroy vegetative compounds, such as bacteria, by
preventing their growth.
• If antiseptics are simply used to wipe across the wound
surface, they will have little effect.
• They need to be in contact with bacteria for about 20
min. before they actually destroy them.
• They can applied in the form of soaks or incorporated
into dressings, ointments, or creams.
66
68. LOTIONS - ANTISEPTICS
1. Cetrimide
• Useful for its detergent properties, particularly for
the initial cleansing of traumatic wounds or the
removal of scabs & crusts in skin disease.
• It is mostly only used in ER for initial cleansing of
wounds rather than a routine cleanser
• Two dangers should be noted:
- Skin irritation & sensitivity
- Very easy to become contaminated by bacteria, especially Pseudomonas
aeruginosa.
(Dealey, 2005)
69. LOTIONS - ANTISEPTICS
• It is available as a cream or as a lotion in combination
with chlorhexidine.
69
(Dealey, 2005)
70. LOTIONS - ANTISEPTICS
2. Chlorhexidine
It is effective against G-ve & G+ve.
It could maintain its antimicrobial levels for a
period of time when impregnated into a dressing.
However, its efficacy is rapidly diminished in the
presence of organic material such as pus or blood.
70
(Dealey, 2005)
71. LOTIONS - ANTISEPTICS
It is more suitable for
disinfection & hospital
hygiene rather than
wound care
71
(Dealey, 2005)
72. LOTIONS - ANTISEPTICS
3. Hydrogen Peroxide 3%
• Effective against anaerobes
• It loses its effect when comes in contact with
organic material such as pus or cotton gauze.
• Cytotoxic to fibroblast unless diluted to a
strength of 0.003%. This dilution is not effective
against bacteria. But, this dilution still inhibits
keratinocyte migration & proliferation.
(Dealey, 2005)
73. LOTIONS - ANTISEPTICS
It is no longer widely used as there is
no evidence to demonstrate its
efficacy & there are number of
other more alternatives.
(Dealey, 2005)
74. LOTIONS - ANTISEPTICS
4. Iodine
• Broad-spectrum antiseptic
• Used in wound care as povidine iodine 10% which
contains 1% iodine.
• Used as a skin disinfectant & to clean grossly
infected wounds.
• Effective against MRSA.
(Dealey, 2005)
75. LOTIONS - ANTISEPTICS
Debate…?
Lineaweaver et al. (1985) found that it is Cytotoxic
to fibroblasts unless diluted to 0.001%, retards
epithelialization & ↓ the tensile strength of the
wound.
However,
Bennet et al. (2001) found that it significantly ↑
fibroblast proliferation slightly ↑ neodermal
regeneration & epithelialization.
(Dealey, 2005)
76. LOTIONS - ANTISEPTICS
• In 2003, Selvaggi et al., have reviewed &
appraised the role of iodine & concluded that
povidine iodine is an effective antibacterial that
is superior to other products & has no problems
with resistance.
Iodine should not be used for the patients with
thyroid disease or those who are sensitive to the
product.
76
(Dealey, 2005)
77. LOTIONS - ANTISEPTICS
Povidine iodine is available in ointment, spray, &
powder form & impregnated into dressings.
Betadine
77
(Dealey, 2005)
78. LOTIONS - ANTISEPTICS
5. Potassium Permanganate 0.01%
• Used on heavily exuding
wounds.
• Generally, associated with leg
ulceration.
• Found in the form of tablets; to
be dissolved in 4 L of water.
(Dealey, 2005)
79. LOTIONS - ANTISEPTICS
6. Proflavine
• Has a mild bacteriostatic effect on G+ve, but no
effect on G-ve.
• It is available as a lotion
79
(Dealey, 2005)
80. LOTIONS - ANTISEPTICS
7. Silver
• Has a bactericidal effect on a wide range of
bacteria (Dealey, 2005)
Problem
• It is extremely caustic, stains the skin black.
• Prolonged use causes ↓Na, ↓K, & ↓Ca (Dealey,
2005)
Solution
• To overcome these problems → a cream,
silver sulphadiazine, was developed →
successful in controlling burn wound
infections (Lansdown, 2004)
82. LOTIONS - ANTISEPTICS
8. Sodium Hypochlorite
Originally used in the 1st World
War.
Have few beneficial effects & do
much harm.
(Dealey, 2005)
83. LOTIONS - ANTIBIOTICS
• D’Arcy (1972) recommends that any antibiotic that
is used systematically should not be applied to the
skin.
However, antibiotics that are not appropriate for
systemic use may be developed for use on the skin
or in wound care.
• → creams, gels, ointments or impregnated
dressings containing gentamicin, tetracycline,
fusidic acid, or chlortetracycline. Should not be
used as these antibiotics are used systematically
(Dealey, 2005).
• Mupirocin could be used for treatment of
MRSA
(Dealey, 2005)
84. LOTIONS - ANTIBIOTICS
• A range of antibiotics is available in topical form.
• There is considerable risk of sensitization to the
patient as well as the development of resistance
organisms.
• Systematic antibiotics are the treatment of choice
when treating infected wounds.
(Dealey, 2005)
85. LOTIONS - HONEY
Honey has been used in wound care since ancient
times.
Mole (1999) discussed the role of honey & its
properties:
Antibacterial action
Deodirising action
Debriding action
Anti-inflammatory action
Stimulation of wound healing
Pain relief (Dunford & Hanano, 2004)
86. LOTIONS – TAP WATER
• Is being used more frequently on wound
areas already colonized such as wounds
following rectal surgery of foot ulcer.
• Using tap water to clean wounds did not differ from
using sterile normal saline in respect of wound
infection and healing rates.
(Fernandez, Griffiths, & Ussia, 2002)
86
87. LOTIONS – SALINE 0.9%
• The only completely safe
cleansing agent & is the
treatment of choice for use of
most wounds.
• It is used in conjunction with
many of the modern
products.
• It is presented in sachets,
small plastic containers, &
aerosols.
(Dealey, 2005)
89. DRESSING TYPES REVIEW
Application:
• Clean wound base
• Place shiny side of dressing to wound.
• May require soaking if exudate strikethrough
has occurred.
Contraindications/Possible Side effects:
• Harsh debridement of the wound bed if
exudate dries
• Limited use as a primary dressing
• Dries out the wound bed
(Carville, 2005; Dealey, 2005)
91. Application:
• Clean wound base
• Prepare peri-wound area with a protective barrier wipe.
• Apply adhesive side to wound and remove outer layer.
• Adhesive strongest in first 24 hours; can remain for 7 days.
• Observe for maceration, remove if this occurs.
Contraindications/ Possible Side effects:
• Do not apply to infected wounds or if allergic to tapes.
• NB: Green sided Opsite is for wounds, orange sided Opsite is
for vascular access devices.
91
(Carville, 2005; Dealey, 2005)
93. Application:
• Clean wound base
• Read packaged for insertion side (patterned or shiny side up)
• Sheet foam left insitu up to 7 days (24 hours if infected)
• Cavity foams left insitu up to 14 days (daily washing of foam if
infected)
Contraindications/ Possible Side effects:
• Avoid covering with occlusive dressings.
• Avoid wounds dressed with antibacterial solutions.
93
(Carville, 2005; Dealey, 2005)
94. DRESSING TYPES REVIEW
4. Hydrogel dressings
Solugel®
Intra site® Gel
Solosite® Gel
Clear-Site®
Duoderm® Gel
Aquaflo®
Primary dressing:
• Slough or necrotic wounds requiring chemical
debridement.
• Light/moderate exudating wounds, hydrate dry wounds.
94
(Carville, 2005; Dealey, 2005)
96. Application:
• Clean wound base, wipe peri-wound with barrier wipe.
• Warm product in hands to activate adhesive.
• Place adhesive side to wound.
• Leave at least 2 cm border around wound.
• Can be left insitu up to 7 days, dependant on exudate
level.
• Dressing becomes opaque when due for change.
Contraindications/ Possible Side effects:
• Do not apply to infected wounds or if client is allergic.
• Remove if patient complains of discomfort.
96
(Carville, 2005; Dealey, 2005)
98. Application:
• Clean wound base
• Lightly pack or line the wound, product swells with
exudate.
• Avoid pre-moistening the product.
• Discontinue use if the dressing remains dry.
• Can be left insitu up to 4 days, dependant on exudate
level.
• Requires a secondary dressing.
Contraindications/ Possible Side effects:
• Do not use on dry wounds as it dehydrates the wound
bed. 98
(Carville, 2005; Dealey, 2005)
100. Application:
• Clean wound base.
• Line the wound base with product.
• Cover with a secondary dressing.
• Can be left insitu up to 7 days, dependant on
exudate level.
Contraindications/ Possible Side effects:
• Heavily infected wounds require Hydrofiber
impregnated with Silver.
• Do not use in people allergic to hydrocolloids.
100
(Carville, 2005; Dealey, 2005)
102. Application:
• Clean wound base.
• Moisten product with sterile water, daily if not enough
exudate.
• Cut to wound size and shape, apply blue side down.
• Cover with a secondary dressing.
• Can be left insitu up to 7 days, dependant on exudate
level.
Contraindications/ Possible Side effects:
• Do not use on people going for a Magnetic Resonance
Imaging.
• Do not use in people allergic to silver. 102
(Carville, 2005; Dealey, 2005)
103. WOUND DRESSING REVIEW
9. Zinc dressings
Steripaste®
Viscopaste®
Flexidress®
Gelocast®
Primary dressing:
• Slough wounds, epithelializing wounds and
to protect limbs at risk of skin tears or
degloving. 103
(Carville, 2005; Dealey, 2005)
104. Application:
• Cut length as required, usually 3-4 times the size
of the wound .
• Fold to make a patch and place over wound.
• Requires a secondary dressing.
• Can be left insitu up to 7 days.
Contraindications/Possible Side effects:
• Allergy to zinc
104
(Carville, 2005; Dealey, 2005)
106. REFERENCES
Schultz, G.S., Sibbald, R.G., Falanga, V., Ayello, E.A.,
Dowsett, C., Harding, K., Romanelli, M., Stacey, M.C.,
Teot, L., Vanscheidt, W. (2003) Wound bed preparation: a
systematic approach to wound management. Wound Repair
and Regeneration, 11(2), S1-S28.
Watret, L. (2005). Teaching wound management: a
collaborative model for future education. Retrieved 6
September 2009, from World Wound Wide:
http://www.worldwidewounds.com/2005/november/Watret/T
eaching-Wound-Mgt-Collaborative-Model.html
106
107. REFERENCES
Falanga, V. (2000). Classification for wound bed preparation
and stimulation of chronic wounds. Wound Repair and
Regeneration, 8(5), 347-352.
Falanga, V. (2004). Wound bed preparation: science applied to
practice, in European Wound Management Association
(EWMA) Position Document, Wound Bed Preparation in
Practice, London: MEP Ltd.
Lansdown, A.B.G. (2004). A review of the use of silver in
wound care: facts and fallacies. British Journal of Nursing,
13(6), S6-S19.
Lineaweaver, W., Howard, R., Soucy, D., McMorris, S., 107
Freeman, J., Crain, C., Robertson, J., & Rumley, T. (1985).
Topical antimicrobial toxicity. Archives of Surgery, 120,
267-270.
108. REFERENECE
Myers,A.B, (2008).Wound management. Principles and practice.(2nd
ed.)Pearson Education Australia PTY.( pp.71-155)
Bennett, L.L., Rosenblum, R.S., Perlov, C., Davidson, J.M.,
Barton, R.M., & Nannet, L.B. (2001). An in vivo comparison
of topical agents in wound repair. Plastic and reconstructure
surgery, 108(3), 674-685.
Carville, K, (2005). Wound Care Manual (5th ed.). Osborne Park,
Australia: Silver Chain.
D’Arcy, P.F. (1972). Drugs on the skin: a clinical and
pharmaceutical problem. Pharmaceutical Journal, 209, 491-492.
Dealey, C. (2005). The Care of Wounds: A Guide for Nurse (3rd ed.).
Oxford, UK: Blackwell Publishing.
108
Fernandez, R., Griffiths, R., Ussia, C. (2002). Water for wound
cleansing. Cochrane Database Systematic Review, 4.
