Wound care

1
Wound care

• Susie Pease
• Return to Practice (Nursing)
• School of Healthcare Studies
• The University of Leeds

2
Assessment

• Assess
• individual
• wound
• environment
• Plan
• Implement
• Evaluate - Re-assess

3
Wound cleansing

• Normasol
• Saline 0.9 - (Normal Saline)
• Room temperature
• Irrigate wound gently using syringe
• Antiseptics rarely used
• Tap water, bath, shower may be appropriate
• DO NOT CLEAN WOUND UNLESS NECESSARY

4
Aseptic Technique

• Cross infection must be prevented
• The principles of asepsis should be followed
• Ritualistic techniques are not necessary
• Handwashing is vital

5
Characteristics of the ideal wound dressing
(Bale and Morrison 1997)

• Non - adherent
• Impermeable to bacteria
• Maintain high humidity
• Thermally insulating
• Non - toxic, non - allergenic
• Comfortable and conformable
• Protect from further trauma
• Require infrequent changes

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Low adherent dressing

• Release
• Low adherent rather than non- adherent
• Provides some protection
• Allows gaseous exchange
• Free from particulate contamination
• Does not provides a moist environment

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Adhesive Island Dressings

• Primapore / Cicaplaie
• Non woven
• Use on clean incisions or as secondary dressings
• Little absorbent capacity
• Do not use on granulating wounds
• Do not stretch can cause blistering

8
Hydrofibre Dressings

• Aquacell
• Soft non woven fibre sheet or ribbon dressing
• Can be used for acute and chronic wounds
• Can absorb high amounts of exudate into fibres
• When exudate is absorbed converts from soft
  conformable dressing to cohesive gel
• Appears to reduce wound pain
• Change when saturated or after 7 days

9
Vapour Permeable Film Dressings

• Mefilm / Tegaderm
• Provide a moist environment
• Allows excess moisture to escape through the film
• Impermeable to micro organisms
• Can be used as a primary or secondary dressing
• Can be left in place for several days
• Remove by releasing edge and stretching to
  release adhesive.
• Opsite IV 3000 or Tegaderm HP highly permeable
  to prevent moisture retention

10
Alginate Dressings

• Kaltostat
• Made from seaweed
• Used as haemostatic dressing
• On contact with exudate form a gel
• Can be used for flat wounds or those which
  require packing
• Irrigate with saline 0.9 if nec.before removal
• Do not use where exudate is low

11
Charcoal / Odour Control Dressings

• Carboflex / Clinisorb
• Contains activated charcoal
• Do not cut dressing choose size larger than
  wound
• Wound contact layer absorbs exudate
• Non adhesive
• Acts like a filter absorbing odour

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Debridement

• Surgical
• Enzymatic varidase
• Chemical hydrogen peroxide / EUSOL
• Larva

13
Hydrogel Dressings

• Aquaform
• Suitable for sloughy/ necrotic wounds
• Aids rehydration of necrotic tissue which helps
  debridement
• Secondary dressing required

14
Foam Dressings

• Allevyn / Trufoam / Transorbent
• Provide a warm moist environment
• Absorbent, use on moderate to heavily exuding
  wounds
• Can be left in situ for 7 days depending on
  exudate

15
Hydrocolloid Dressings

• Hydrocoll / Granuflex
• Occlusive dressing
• Provide ideal moist environment
• Exudate absorbed forms a gel
• Used for treating necrotic, sloughy and
  granulating wounds
• Can be left in situ for 7 days
• a week or til it leaks

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Impregnated dressings

• Inadine (beware iodine sensitivity)
• Contains 10 povidone iodine which is released
  directly into the wound
• Use on contaminated or infected wounds
• Can be left for 5 days
• Jelonet (non-medicated paraffin tulle)
• Granulating wounds trauma on removal

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Cavity Conforming

• Cavi-Care (Silastic Foam)
• Aquacell packing
• Keep wound edges apart to allow healing by
  secondary intention
• Foam dressings can be managed by patients
• Aquacell ribbon requires nurse to change
  dressings

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Polysaccharide Dressings

• Debrisan / Iodosorb
• Beads which absorb exudate
• Form a gel
• Provide a moist environment
• Use in sloughy infected wounds
• Remove gel with gentle irrigation
• Require secondary dressing

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Antimicrobials

• Silver Sulphasalazine Cream (Flamazine)
• Povidone Iodine Ointment
• Aquacel Ag (silver impregnated Hydrofibre
  dressing)
• Metronidazole Gel

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Specialist bandages

• Compression bandaging for the management of
  patients with venous leg ulcers
• Paste bandages
• Zinc paste with ichthammol
• Zinc paste with calamine

21
New developments

• Silicone dressings
• Mepitel and Mepilex
• Combination dressings
• Versiva hydrocolloid, hydrofibre and foam filled
• Growth factors wound healing growth factors
  produced by many cells including platelets and
  macrophages

22
Vac (Vacuum assisted closure therapy)
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Prevention of Infection

• Leave wound undisturbed unless signs of infection
• Avoid ritualistic daily dressings
• Observe principles of asepsis
• Avoid communal use of equipment -scissors,tapes
• Barrier Nursing if necessary
• Antiseptics not used routinely
• HANDWASHING

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Summary

• Modern wound dressings are designed to promote
  normal wound healing and allow
• Moist wound / dressing interface
• Less frequent dressing changes
• More comfort and less toxicity
• Assessment of the needs of the individual patient
  is essential
• Assessment, planning and evaluation should be
  documented and available

25
References and Bibliography

• Bale S, Harding K Leaper D (2000) An
  introduction to wounds. Emap Healthcare
• Bale S Jones V (1997) Wound Care Nursing A
  patient-centred approach. Bailliere Tindall
• Bale S Morrison M (1997) Wound Dressings. In
  Morrison M, Moffat C, Bridel-Nixon J et al. A
  Colour guide to the Nursing Management of Chronic
  Wounds. Mosby, London.

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References Bibliography cont.

• Dealey C (1999) The Care of Wounds. A Guide for
  Nurses. (2nd Edition) Blackwell Science.
• Naylor W, Laverty D Mallett J (2001) Handbook
  of wound Management in Cancer Care. Blackwell
  Science.
• Winter G.D. (1962) Formation of the scab and the
  rate of epithelialisation of superficial wounds
  in the skin of the domestic pig. Nature, 193, 293
  - 294