Wound care Dressing and

Products

BY

Ranganathan.D

B.Sc.,operation theatre technology

JIPMER.

OBJECTIVES

• State the three primary classifications of wound care products in maintaining the wound bed

• Identify three criteria in choosing a wound care product• Explain at least four wound care products that should be

in a basic wound care formula• Describe three products that can be used for treatment

of a pressure ulcer• Identify at least two resources for wound care product

information

Wound Care Product ClassificationBased on Wound Base Color

• Red (Granulation)• Maintain wound moisture and protect

tissue• Pink (Healing Epithelial)

• Protect new tissue• Yellow (Devitalize Slough or Non-viable

Fibrin)• Remove/Debride

• Purple (Ecchymotic/DTI)• Protect intact skin

• Black (Eschar or Necrotic Tissue)• Remove/Debride

Wound Care Product ClassificationBased on Wound Moisture Level

• Dry• Re-hydrate• Reduce pain

• Wet• Remove excess fluid/exudate• Prevent hypertrophic tissue formation• Reduce bacterial load/odor

• Balanced• Maintain a moist wound environment• Maintain to prevent tissue dryness or

maceration

Wound Care Product ClassificationBased on Wound Depth

• Partial Thickness• Shallow Abrasions/Denuded

Skin/Excoriations• Skin Tears• Stage 2 pressure ulcers (Including blisters)

• Protect tissue from further damage• Maintain moisture balance• Approximate skin edges if appropriate

Wound Care Product ClassificationBased on Wound Depth

• Full Thickness• Deep cavity/Dead space• Undermining • Tunneling/tracking• Stage 3 & 4• Exposed bone, tendon• Biofilm present

• Fill in wound spaces (cavity/tunnel/undermining)• Maintain moisture level• Remove non-viable tissue/debride and/or biofilm• Protect exposed bone, tendon• Control odor

Wound Care Product Selection

Principles of “MEASURES”

• M = minimize trauma to wound bed• E = eliminate dead space (tunnels, tracts, undermining)• A = assess and manage the amount of exudate• S = support the body’s tissue defense mechanism• U = use non-toxic wound cleansers• R = remove infections, debris, and necrotic tissue• E = environment of wound is maintained including

thermoregulation and moisture• S = surrounding tissue is protected from injury and bacteria

Barnanoski, S. (1999, January) Wound Dressings: Challenging Decisions, Home Healthcare Nurse

Characteristics of an Ideal Dressing• Maintain moisture balance• Facilitate autolytic debridement• Be comfortable for the patient and eliminate pain• Eliminate dead space• Be absorbent• Provide thermal regulation• Act as a bacterial barrier• Be cost effective• Ease of dressing application and removal and maintenance• Ease of understanding for caregiver to use• Available in numerous shapes and size or can be cut into an

appropriate shapes.

Basic Wound Care Formulary

• Absorptive dressing• Alginates (Calcium)/Hydrofibers• Contact layers• Foams• Gauze• Hydrocolloids• Hydrogels• Skin Barriers• Tape• Transparent film• Wound Cleansers

Absorptive Dressings

• Description: Multilayer dressings that consist of fiber layers such as cellulose, cotton or rayon that can manage moderate to heavy drainage usually for full thickness wounds

• Advantage: • Can be used as a primary or secondary dressing and

are easy to apply and remove• Help with autolytic debridement

• Disadvantage: May adhere to base causing pain• Examples: Abdominal (ABD) pad, Exu-Dry

Alginates (Calcium)/Hydrofiber• Description: Alginates are primarily from brown seaweed and is

manufactured into soft nonwoven fibers twisted into ropes or pads or a composite of a cellulose-like polysaccharide that is highly absorptive that forms a gel with wound fluid that conforms to shape of the wound. Can absorb up to 20-30% of fluid weight

• Advantages: • Used to fill wound cavity/dead space• Used for autolytic debridement• Maintains moist wound environment• Helps with pain management and some odor control

• Disadvantages:• May be expensive if dressing is changed frequently• Not to be used on dry or low exudate wounds that could dehydrate• Requires a secondary dressing

• Examples : Algisite M, Aquacel, Carboflex Odor, Melgisorb, 3 M-Tegen

Contact Layer• Description: Single mesh layer of non to low tissue adherence dressing

that is impregnated with a substance such as petroleum, zinc, bismuth, silver or aqueous saline in which exudate can pass through

• Advantages:• Protects the wound base from injury and reduce pain• May include some antimicrobial properties• May be left in place when changing the secondary dressing

• Disadvantages:• Needs a secondary dressing• May disrupt wound healing if it dries out• Not to be used with heavy exudating wounds can cause maceration• Not to be used on non-viable tissue

• Examples: Adaptic, Cuticerin, Xeroform, Petroleum gauze, Mepitel

Foams• Description: Hydrophilic polyurethane or gel film-coated dressing that is

highly absorptive that come in a variety of thickness with or without an adhesive/silicone border that fill a wound cavity and is designed for non-traumatic removal. Designed for maintaining moist wound environment and thermal regulation.

• Advantages:• Non-adherent reducing pain for friable tissue/fragile skin• Easy to apply and remove• Can leave in place up to seven days• Good for partial thickness wounds

• Disadvantages:• May need a secondary dressing, tape or gauze wrap• Not for dry/eschar wounds• May cause maceration

• Examples: Mepilex, Allevyn, Polymem, Tielle, Lyofoam, 3M Foam

Tape

• Description: Tape is one way of securing a cover dressing to the skin to keep dressing in place over wound. Tape are made with a variety of materials (paper, plastic, cloth, foam) and come in different widths, shapes, adhesives and hypoallergenic and antimicrobial property.

• Indication: primary closure,staple closure,complement sutures,subcuticular suture,skin closure

• contraindication: deep wound,bleeding o wounds, deep tissue wounds.

Tape conti.,,• Advantages:

• Can be inexpensive• Can be used to approximate wound edges• Rapid application• Cost cost ,no risk of needle stick injuries• Donot cause any tissue ischaemia,necrosis.• Least drainage to host defence

Tape conti.,,• Disadvantages:

• Can cause skin stripping/blistering• Can cause allergic reactions• May not adhere to skin • Requires a skin protectant barrier before

application• Can contribute to wound infection

Examples: Medipore, Hypafix, Transpore, Micropore, Dermapore, Steristrips

Transparent Films• Description: A polyurethane or co-polymer with a porous adhesive layer

that allows oxygen to pass through the semipermeable membrane between wound and environment. It act as a moisture vapor barrier by being impermeable to water, leaking of wound fluids and entry of bacteria as long as it remains intact to the skin. Used as a primary or secondary dressing.

• Advantages:• Aids in autolytic debridement• Can visualize wound base for inspection• Prevents or reduces friction/shear • Waterproof for bathing

Tansparent films conti.,,

• Disadvantages:• Not to be used on heavy exudating wounds• May cause skin shear on fragile skin and

dislodge on high-friction areas• May need a skin protectant for some

adhesives• May be difficult to apply or handle

• Examples: Tegaderm, Mefilm, Opsite, Comfeel

RESOURCES• http://www.worldwidewounds.com/2007/may/Fletcher/Fletcher-

Dressings-Cutting-Guide.html• http://www.worldwidewounds.com/• http://www.medicaledu.com/prodindx.htm• http://www.woundcareresources.net/ProductsList.pdf• http://www.dressings.org/• http://www.woundsource.com/

• http://www.woundcareprotocols.com/links.htm