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Wound Dressing Considerations & Categories American Medical Technologies Irvine, CA 1 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

Wound Dressing Considerations & Categories Wound...For usage, consider how the dressing contributes to your對 strategies for minimizing resident & wound bed disruption, pain while

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  • Wound Dressing Considerations & Categories

    American Medical Technologies

    Irvine, CA

    1 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesHello…my name is_____________. I am a _________nurse, PT etc…and a certified wound specialist.

    Thank you for this opportunity to present the Latest in Dressings. It is an honor to be here today to provide you information to help guide you in your dressing selections on a daily basis. How many people here are involved in determining the wound products used on a daily basis at your facility?

  • Disclaimer The information presented herein is provided for educational and informational purposes only and to promote the safe-and-effective use of the wound care products provided. It is for the attendees’ general knowledge and is not a substitute for legal or medical advice. Although every effort has been made to provide accurate information herein, laws change frequently and vary from state to state. The material provided herein is not comprehensive for all legal and medical developments and may contain errors or omissions. If you need advice regarding a specific medical or legal situation, please consult a medical or legal professional. Gordian Medical, Inc. dba American Medical Technologies shall not be liable for any errors or omissions in this information.

    2 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesRead the Disclaimer verbatim.

  • Objectives

    • Review dressing considerations for optimal wound healing.

    • Discriminate characteristics of advanced wound products by category.

    3 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesThe objectives for today’s program are to:

    Review dressing considerations for optimal wound healing.

    And to Discriminate characteristics of advanced wound products by category.

  • Optimal Wound Healing

    Wound

    Resident Dressing

    4 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesOptimal wound healing occurs when the wound, resident, and dressing related factors are considered and addressed.

    (click mouse) Wound related factors include the etiology, severity, environment, size, anatomic location & presence of infection

    (click mouse) Resident related factors such as vascular status, medications and nutritional status need to be considered

    (click mouse) And the dressing related factors include availability, durability, characteristics and cost

    Taking all this into account lands you in this gold star (click mouse) area for wound healing to occur.

  • Dressing Considerations

    • Wound Bed

    • Removal

    • Barrier

    • Location

    • Cost effectiveness

    • Sensitivities Bovine, latex, adhesives, fiberglass, sulfur

    5 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesWith over 6,000 products on the market it can be difficult to know which one to choose for optimal wound healing. Items to consider when selecting a dressing are based on what you need the dressing to do- such as create or maintain a moist wound bed, provide for non-traumatic removal, create a bacterial barrier or protect healthy cells.

    You should also consider the ulcer location, cost & frequency of change, how user friendly the product is and whether or not the resident has any sensitivities or allergies to ingredients in the product

    (click mouse) For example, bovine, latex, adhesives, fiberglass, & sulfur are all components of some dressings and topical agents and each of these may cause allergic or sensitivity reactions in many people

  • Dressing Considerations

    Dressing Choice

    Cost & usage

    Dry or Wet?

    Clean?

    Follow manufacturer instructions.

    6 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesWhen considering a dressing ask yourself: Is the wound clean & free from infection? Is the wound dry or wet? (if its dry you would probably want to use a product that adds moisture & if the wound is too wet you would want to absorb excess moisture)….the goal is to achieve a moist, glistening wound bed with a dry, intact periwound area.

    These 2 questions will go far in guiding your selection of dressings, topical agents and the possible use of appropriate adjunctive therapies.

    The 3rd consideration for your dressing choice is related to cost & usage. (click mouse) Cost effectiveness includes nursing time and the costs of different products or interventions used during your treatment plan. For usage, consider how the dressing contributes to your strategies for minimizing resident & wound bed disruption, pain while considering caregiver expertise.

    (click mouse) An important caution is to always follow manufacturer’s recommendations for product usage as the inappropriate use of dressings can cause harm such as dehydration of the wound, maceration of the periwound area, hypergranulation, re-injury fragile healthy granulation and epithelia tissue, granuloma skin stripping or contact dermatitis.

  • Advanced Wound Products (AWP)

    • Moist Wound Healing

    • Bacterial Barrier

    • Thermoregulation

    Advanced

    Active

    Interactive

    7 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesWounds should be kept covered with advanced wound products, except during procedures, in order to reduce the risk of infection & heavy bioburden. Advanced wound products make use of the concept of moist wound healing and utilize moisture retentive dressings, which are often called (Click mouse)“advanced”, “active”, or “interactive” because the dressings interact with the wound bed and do not just sit passively on the wound like gauze. In fact, moisture retentive dressings provide a bacterial barrier & have been associated with lower infection rates than gauze dressings.AWP also protect the temperature of the wound, which I will discuss a bit more in a few slides.

    A brief history on the topic: The first recorded use of an occlusive wound dressing 1615 BC.Wounds were left open to the air to form a scab until Winter advocated the concept of moist wound healing in 1962, based on a pig model.In a 1963 human experiment, Hinman and Maibach showed that occlusive dressings accelerate healing. This was the birth of Moist wound healing (advanced dressings, interactive dressings, moisture retentive dressings…)

    Moist wound healing is the current STANDARD of care. Semi-occlusive dressings ensure moisture retention whereas gauze dressings can dry out rapidly.

    Lawrence JC. Dressings and wound infection. Am J Surg; 1994;167:(Suppl 1A):21S–24S.  

    Lawrence JC, Lilly HA, Kidson A. Wound dressings and airborne dispersal of bacteria. Lancet 1992;339:807.  

  • Consider wound etiology, goals, etc.

    • Dry, stable heel ulcer

    • Dry gangrene

    • Resident status/wishes at end-of-life

    8 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesMoist wound healing is considered to be the standard of care for wound management because it enables the body to heal at peak efficiency & allows for improved epithelial migration.

    Every resident and patient situation is different. At times, moist wound healing can be used with an infected wound when the underlying cause of the infection is being addressed (topical and/or systemic antibiotics) and with regular and frequent re-assessment.

    **There are instances when moist wound healing may not be appropriate. For example, a dry stable heel ulcer covered with non-fluctuant eschar should remain DRY…no dressings or topicals needed unless the ulcer begins to drain, becomes soft/boggy or lyses. (Skin preps are OK and if a dry dressing is used to cover the wound to protect it from being visually disturbing to the patient or family member, this is OK as well.)

    In addition, moist wound healing should not be implemented on patients with dry gangrene for whatever reason (peripheral vascular disease, arterial insufficiency) UNLESS those ulcers begin to lyse or change warranting aggressive intervention. Dry gangrene must remain dry! The body will eventually auto-amputate the area. Swabbing the dry gangrene with betadine or using cadexamer iodine can assist with maintaining dry and stable gangrene. (reference: pg 277 of Bryant & Nix’s: Acute & Chronic Wounds: current management concepts, 3rd edition. 2007. Mosby)

    Beginning moist wound healing will open a Pandora’s box and could lead to septicemia, bacteremia, loss of limb or patient demise.

    Lastly, there are instances where complete wound closure and/or wound healing are not appropriate goals (palliative care, hospice, etc). For these individuals, wound management goals should address quality of life: comfort, odor management, and protection from infection or wound progression. In such cases, moist wound healing may or may not be appropriate.

  • Moist Wound Healing

    • ↓ Pain

    • ↓ Edema

    • Softens eschar

    • Temperature

    • Excludes bacteria

    • May be waterproof

    • May reduce friction

    • ↑ Cosmesis

    • Ease of use

    • Frequency of change

    9 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesThe are several advantages to using moist wound healing practices, these include: decreased edema, softening eschar thus promoting autolytic debridement creating an environment near physiological temperature which optimizes phagocytosis and the exclusion of environmental bacteria

    All of these are processes and outcomes that occur when using the correct dressing category at the right time, thus creating an environment conducive to closure and healing.

    Advanced Wound Products (AWP) are atraumatic to remove, thus they preserve the granulation tissue leading to more rapid healing. Likewise, there is usually decreased pain and fewer dressing changes needed- saving on nursing time and resulting in better cost effectiveness. Lastly, these dressings lend themselves to better cosmetic results.

  • Advance Wound Products (AWP) Bacterial Barrier

    • Inherent Barrier – Bacteria – Liquid

    • Preserve phagocytic function

    http://durable-medical-equipment.blogspot.com/2009/01/hydrogel-dressings.html

    10 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesA Bacterial barrier is inherently provided with semi-occlusive dressings. Studies have shown that wounds dressed with moisture retentive dressings have lower infection rates than those dressed with gauze. This may be contributed to the maintenance of a moist wound environment which protects the cellular function necessary for wound healing.

    (click mouse): In fact, Studies show that bacteria can penetrate 64 layers of dry gauze 4x4s (as demonstrated in this photo) and moist gauze may be even more susceptible.

    Advance Wound Products (AWP) also allow moisture vapor to escape but are not penetrated by liquids, allowing for hygiene such as showering & bathing.

    Source: Ovington…hanging wet to dry out to dry

  • AWP - Thermoregulation

    • Limit the Effects of Tissue Cooling

    – Vasoconstriction

    – Hypoxia

    –↓ Leukocyte mobility

    –↓ Phagocytic ability

    11 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesChronic wounds are hypothermic and are about 6 degrees below body temperature due to fluid evaporation which is not improved with traditional gauze dressings. Hypothermia is further impacted by the cooling of wounds that occurs with frequent dressing changes which is needed when using saline moistened gauze (particularly if the saline is cool or room temperature).

    Tissue temperatures in wounds dressed with moistened gauze have been found to be 10 degrees below normal tissue temperature (24-27 deg C). Whereas, wounds dressed with semi-occlusive dressings have closer to normal tissue temperatures (33-35 deg C). The effects of tissue cooling impede wound healing and increase susceptibility to infection. Advance wound products promote Normothermia – which increases metabolic function and expedites the healing processes.

    (Hanging wet to dry out to dry…Ovington)

  • AWP- Moisture Vapor Transfer

    • Moisture Vapor Transfer Rates (MVTR) – Loss of water vapor from intact skin is 240 – 1920

    g/m2/24 hours

    – Loss of water vapor from an open wound, 7000+ g/m2/24 hours

    12 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesAdditionally, AWP have different moisture vapor transfer rates- which is the characteristic of how much water vapor is allowed to evaporate through the dressing.

    Normally, the loss of H20 vapor from intact skin is in the range of 240 – 1920 g/m2 per day increasing up to over 7,000 g/m2 with an open wound.

    The more occlusive the dressing, the lower the MVTRGauze has a very HIGH MVTRAdvanced products have “GOOD” or low MVTRs

  • Dressing Categories • Primary dressing

    • Direct contact with wound bed • Interacts with wound tissue • Therapeutic & Protective function

    • Secondary dressing • Secure primary dressing • Increases ability of treatment to meet the wound

    needs • Therapeutic & Protective function

    13 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesSeveral categories of products can be utilized as primary or secondary dressings. A primary dressing is the product that comes into contact with the wound bed whereas a secondary dressing is used to cover & protect the primary dressing. Other dressing categories include: biosynthetics, contact layers and specialty absorptive. These are primarily used in burn wound management.

    An example of a dressing that serves as a primary or secondary:

    A Hydrocolloid used as a primary over a shallow, minimal draining wound.A Hydrocolloid used as a secondary when it is used to cover and secure a wound filler.

  • Heavy

    Transparent Film

    Hydrocolloid Calcium Alginate

    Foam

    Gauze

    Hydrogel

    Collagen

    When used as primary

    Slight

    Composites variable based on

    component ingredients

    Amount of Drainage

    Dressing Options 14 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesThis schematic shows general dressing categories based on the amount of wound exudate. When choosing a product, consider what you want the dressing to do, the wound location, if its painful, how wet or dry the wound is and whether its clean, or has bioburden or infection.

  • Transparent Film • Semi-permeable

    • Waterproof

    • Bacterial barrier

    • Autolytic debridement

    • Light exudate

    • May be difficult to apply or tear fragile skin

    15 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesTransparent Film dressings are made of an adhesive polyurethane membrane that is semi-permeable. As a group, they are waterproof, retain moisture and create a bacterial barrier. The advantages of using transparent films inlcudethey facilitate autolytic debridementyhey allow for visualization of the wound& they don’t require a secondary dressing

    Disadvantages are:They are only indicated for wounds with light exudateThey may tear fragile skinThey can be difficult to applyThey may dislodgeThe adhesive backing can weaken with moisture& the drainage may be mistaken for infection

  • Transparent Films

    16 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesExamples of wound that may benefit from transparent dressing include this wound on the Left which is mostly healed. It its primarily in the remodeling phase. And Needs to be protected. This wound has minimal/slight drainage

    The wound on the right: Roughly all of the burned area has re-epithelialized. Small area of deep partial thickness burn mid-shin. That would benefit from being covered.

    Transparent Film Dressings can stay in place for 5-7 days depending on drainage.

  • Hydrogel

    • Hydrate wound bed

    • Autolytic debridement

    • Atraumatic

    • Light exudate

    • Can dehydrate if not

    covered

    • Maceration possible

    17 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesHydrogels are primary wound dressings made up of water or glycerin based gels packaged in a sheet, in an amorphous consistency or impregnated into a gauze form. Their role is to contribute moisture to the wound bed.

    Advantages: Facilitate autolysis Soothing & atraumatic to wound tissue Hydrate wound bed

    Disadvantages: Dehydrate if not covered May macerate the periwound area if it extends to the skin outside the wound margins Poor ability to absorb exudate Require a secondary dressing

  • Hydrogels

    18 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesLeft wound – by adding moisture to the wound, will promote autolytic debridement and help decrease the amount of necrotic tissue.

    Bottom wound – arterial insufficiency. Exposed bone is drying, requires added moisture to help promote any chance of healing.�Top right – also arterial. Exposed tendons may require a non-adherent hydrogel – either amorphous or sheet hydrogel to provide moisture. Care must be taken to help tendon sheaths remain intact and viable.

  • Gauze • Mechanical debridement

    • Conformable • Use in combination with

    other products

    • Can be painful to remove • More frequent dressing

    changes

    • Permeable to bacteria

    • ? Cost effectiveness 19 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesGauze dressings are the most variable dressing category with products that come in both sterile & non-sterile forms, packaged as pads, fluffs, strips, & rolls that can be impregnated with solutions & they can come with or without adhesive borders.

    Advantages:Mechanical debridementPermeable to allow exudateConformable, fillersEasy to combine with other dressings

    Disadvantages:Can be ineffective for healing if causing damage viable tissue with traumatic removal from the wound bedCan be painful to removeMay allow dehydration or contribute to maceration of the wound bedNot necessarily cost effective due to frequency of changesPermeable to bacteria therefore does not prevent infections

  • Gauze

    20 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesLeft – infected, draining moderately to heavily. May use wet to dry gauze dressings to barbarically remove the necrotic tissue from the wound bed. This will be very painful to the resident and traumatize healthy cells and tissues.

    Top right – undermining, tunneling, and necrotic tissue in an acute care setting. Multiple physicians looking at wound on a daily basis. Gauze may be appropriate for a short period of time. Loosely adherent necrotic tissue.

    Bottom – deep wound, necrotic tissue in wound base, undermining around borders. Need one contiguous dressing for packing. Recommend a saline soaked roll gauze for packing in acute setting with daily or BID dressing changes for a short period of time.

    You may need to be able to justify use of gauze dressings as they are a form of non-selective mechanical debridement.What are some better dressing options you might consider selecting?

  • Hydrocolloid • Self –adherent

    • Bacterial barrier

    • Autolytic debridement

    • Decrease pain

    • Cost effective • NOT for infected wounds,

    tracts or over exposed tendon/ bone

    21 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesHydrocolloids are occlusive or semi-occlusive products made of various compositions of gelatin, pectin and carboxymethylcellulose. They come in various sizes, shapes and forms(pads, pastes, powders). Some with high MVTR

    Advantages:Self-adherentGood bacterial barrierFacilitate autolysisAbsorb moderate exudateDecrease painCost effective

    Disadvantages:Most don’t allow for Direct visualization of woundDressing residue is sometimes difficult to remove because it is adherent or tackyNOT indicated for use on infected wounds, tracts or over exposed tendon/bone

  • Hydrocolloids

    22 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesLeft – partial thickness skin loss on the buttocks secondary to friction/shear/moisture. Decrease the friction/shear component and wound will most likely heal well. Hydrocolloid can remain intact for several days.

    Right wound – shallow areas of deep partial and full thickness can be covered with hydrocolloids and left in place for 3-5 days depending on exudate amounts. Promotes autolytic debridement.

    Bottom wound – healing BKA. Small areas on distal end of residual limb that need only to epithelialize. Hydrocolloid will allow epithelialization and protect the wound.

  • Collagen

    • Absorbent, non-adherent

    • Easy application

    • Stimulate new tissue • Support autolytic

    debridement

    • NOT for full-thickness, 3° burns or eschar

    23 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesCollagen is a fibrous, insoluble protein found in connective tissues. Collagen dressings are typically derived from bovine collagen and may encourage the deposition & organization of collagen in wound beds, thus promote granulation tissue formation.

    Advantages:Absorbent, non-adherent biodegradable productsEasy to applyFacilitate autolytic debridement & moist wound environment

    Disadvantages:Not recommended for full thickness third-degree burns or eschar, debridement of eschar must take place first before applying collagen.Require secondary dressing

  • Collagens

    24 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesTop left – mixed etiology – absorb drainage, promote granulation and epithelialization.

    Top right – chronic inflammation – need collagen to combat the body’s “bad enzymes” (I.e. too many MMPs in wound). Promote granulation.

    Bottom left – fascial plane exposed – minimal granulation. Use collagen to fill wound, absorb drainage and promote granulation.

    Bottom right – hyperkeratotic rim, minimal to no granulation, chronic wound. Needs collagen to “jump start” healing process and promote granulation.

  • Foam • Absorption

    • Oxygen permeability

    • Minimal trauma

    • Autolytic debridement

    • NOT for use on dry eschar

    25 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesFoam dressings may come with or without an adhesive border and may be a primary or secondary dressing. Foams are non-linting and have varying thicknesses & absorptive capabilities. Some foams have a polyurethane film coating. Foams can help to provide thermal insulation to the wound.

    Advantages:Good to excellent absorptionGood oxygen permeabilityMinimal if any trauma upon removalSupport autolytic debridement

    Disadvantages:Don’t allow for direct visual monitoring of the wound bedMay desiccate the woundMay require a secondary dressingNot for use on dry eschar

  • Foams As Primary

    Dressings

    26 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesReferring back to the dressing options schematic by drainage level, you can see we are moving along to the right for dressings that handle more drainage.

    top wound – mixed etiology wound. Moderate drainage.

    bottom wound – very painful to touch, moderate drainage. Need a dressing that will be atraumatic on removal and absorb drainage.

    Foams as primary dressings are reimbursed by Medicare @ 3X per week dressing changes as generally indicated by the LCD.

  • Foams

    As Secondary Dressings

    27 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesLeft wound – infected, moderate drainage – but using a primary dressing that promotes debridement.

    Right wound – using calcium alginate, enzyme, and cover with a foam.

    Foams as secondary dressings may be able to be changed at the same frequency as the primary dressing.

  • Calcium Alginate • Absorbent

    • Biocompatible

    • Atraumatic removal

    • Autolytic

    debridement

    • Cost-effective

    28 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesCalcium alginate is made from a derivative of seaweed that can absorb up to 20 times its weight in fluid- so they are for use on moderately to heavily draining wounds. Products are biodegradable & come in sheet, ribbon or rope forms. Hydrofiber dressings are in the same billing category as Calcium alginate but they differ in that they are made from carboxymethylcellulose. Also available are collagen alginate dressings that combine the effects of both dressing categories.

    Advantages of using Ca alg are:It is an absorbant filler that’s biocompatable with the periwound tissue. It does not traumatize the wound bed upon removalFacilitates autolytic debridementCost effective when used appropriately

    Disadvantages:Unable to visually monitor the wound“gel” that forms when absorbing exudate can have a slight odor & be mistaken for infectionNot for use on desiccated woundsThey require a secondary dressing

  • Calcium Alginate

    29 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesTop wound – s/p infected ilio-fem bypass graft. Using calcium alginate in conjunction with enzyme in the photo. Moderate to heavy drainage.

    Bottom wound – note the exudate (no-wound is not infected) when expressing fluid in the undermined areas. This is how the alginate interacts with wound fluid.

  • Composite Dressings • Combine two physically

    different components into one dressing

    • Features MUST include: – bacterial barrier – absorptive layer other than

    alginate, foam, hydrocolloid, or hydrogel

    – a semi - or non-adherent wound covering

    30 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesComposite dressings combine two physically different components into one dressingFeatures MUST include: bacterial barrier absorptive layer other than alginate, foam, hydrocolloid, or hydrogel a semi- or non-adherent wound covering

    Borders on composites may be adhesive or non-adhesive

  • Composite Dressings Advantages • facilitates autolytic

    debridement • may be safe with infected

    wounds – check mfr instructions

    • easy application & removal • can be primary or secondary

    dressing

    Disadvantages • requires

    intact/healthy skin border

    31 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesComposite dressings facilitate autolytic debridement, may be safe to use on infected wounds based on components. Due to the fact that composites are combination dressings made of various components, always read & follow the manufacturer instructions for use.

    They generally are easy to apply & remove and composites may be primary or secondary dressings.

    A disadvantage is that they require intact skin around the wound if there is an adhesive border and they should be used cautiously with fragile skin.

  • Composites

    32 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesYou may want to use a composite as a primary (upper left) to absorb drainage and be non-adherent…OR…as a secondary dressings (bottom right) with an enzyme underneath.

  • Amount of Drainage

    Dressing Options

    Heavy

    Transparent Film

    Hydrocolloid Calcium Alginate

    Foam

    Gauze

    Hydrogel

    Collagen

    When used as primary

    Slight

    Composites variable based on

    component ingredients

    33 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesSo to summarize your dressing selection you need to consider each of these questions individually as each person & wound will present uniquely.

    What do you want the dressing to do?Where is the wound located?During a dressing change, is the wound wet, moist or dry?Is the wound clean or infected?What tissues are present in the wound?Granulation, slough, eschar, deep tissue structuresHow painful is the wound and surrounding tissues?What is the quality of the periwound?What are your wound management goals?What are the residents/family members goals?

    Consider what you want the dressing to do & the wound location. How wet or dry the wound is and whether its clean, has bioburden or infection or is painful. Remember to document objectively & be able to justify your dressing choices.

  • Review Questions 1. Moist wound healing practices provide the following advantages EXCEPT: A. Decreases pain B. Promotes autolytic debridement C. Lowers the temperature of the wound environment D. Increases cosmesis 2. Name one indication when moist wound healing would not be appropriate. 3. Match the following AWP to its most common role in wound therapy: A. Hydrogel ______ Absorption of fluid B. Collagen ______ Hydrate wound bed C. Calcium Alginate ______ Stimulates new tissue

    Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 34

    PresenterPresentation NotesCOne of the following responses: Dry stable intact eschar; dry gangrene; patients wishes/end-of-life issuesC --- Absorption of fluid A --- Hydrate wound bed B ---- Stimulates new tissue

  • Questions? For more information about this

    presentation or other educational activities, please contact

    [email protected]

    35 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    PresenterPresentation NotesThank you for your time.

  • References • Slide 7:

    – Lawrence JC. Dressings and wound infection. Am J Surg; 1994;167:(Suppl 1A):21S–24S.

    – Lawrence JC, Lilly HA, Kidson A. Wound dressings and airborne dispersal of bacteria. Lancet 1992;339:807

    • Slides 10 & 11: – Ovington LG. Hanging wet-to-dry dressings out to dry.

    Home Healthcare Nurse. 2001;19(8):477-484.

    36 Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com

    Wound Dressing Considerations & CategoriesDisclaimerObjectivesOptimal Wound HealingDressing ConsiderationsDressing ConsiderationsAdvanced Wound Products �(AWP)Moist Wound HealingMoist Wound HealingAdvance Wound Products (AWP) Bacterial BarrierAWP - ThermoregulationAWP- Moisture Vapor TransferDressing CategoriesSlide Number 14Transparent FilmTransparent FilmsHydrogelHydrogelsGauzeGauzeHydrocolloidHydrocolloidsCollagenCollagensFoamFoamsFoamsCalcium AlginateCalcium AlginateComposite DressingsComposite DressingsCompositesSlide Number 33Review QuestionsQuestions?References