DRESSING SELECTION
Selecting the correct dressing for a wound is a complicated process that requires knowledge of the various wound types and their differing characteristics, the dressing types available and any specific needs of the patient.
A holistic approach to assessment is essential before choosing a wound dressing.
Accurate wound assessment depends on the understanding of several key factors:
- Cause of the wound
- Site
- Shape of wound
- Size and depth of wound
- Tissue types / clinical appearance of the wound
- Surrounding skin
- Exudate
- Factors that delay wound healing
- Identification of infected wounds
The aim of wound management is to promote the optimum wound environment for the natural healing process to occur. The goals of wound care should include:
- Promoting wound healing by controlling or eliminating causation
- Preventing or managing infection
- Removal non-viable tissue (debridement)
- Ensuring adequate blood supply
- Providing nutritional and fluid support
- Establishing and maintaining a clean, moist, protected wound bed
- Managing wound exudate and drainage
- Maintaining surrounding skin to ensure that it remains dry and intact
(Vuolo, 2009)
Clean and dress the wound using aseptic technique. The cleansing of a wound is to remove debris any contaminates from the wound, without damaging healthy tissue. The purpose of a dressing is to provide an optimal environment in which the body can heal itself. Principle functions for applying dressings:
- Dressing selection should be based on promoting moist wound healing
- Addressing issues identified within the wound bed and surrounding skin
- Using the least costly dressing to meet the requirements of the wound
(Jeffcoate et al, 2009)
Other aspects which may influence application of dressings include: continence status, known sensitivities, fragile skin, washing frequency, social circumstances and the patient’s ability or desire to comply with the treatment. Patient preference is important and influences concordance with regards to their treatment. Clinicians should have a flexible approach and select dressings with which the patient is happy.
The categorisation of wound dressings is becoming more complicated, however, the main groups of dressings that provide an optimal moist wound healing environment, will when used in the right circumstances, assist with healing and the debridement of wounds.
CHOOSING A WOUND DRESSING
Before applying any dressings the nurses should ask:
- What is the action of the dressing?
- When should it be used?
- What are the limitations/ contraindications to its use?
- Do I know the correct method of application and removal?
- Do I have sufficient knowledge about the dressing?
(Benbow, 2004)
The patient’s needs and wound characteristics will also determine which type of dressing can be used on a wound.
WOUND TYPE | TREATMENT AIM | NIL/LOW EXUDATE | MEDIUM/HIGH EXUDATE | |
---|---|---|---|---|
NECROTIC | Necrotic wounds are typified by black dead tissue. | To soften and remove necrotic tissue by rehydration and debridement to allow granulation. NB – Do not debride necrosis to feet without checking Vascular status. Refer to appropriate Team | Primary: Hydrogel, Honey Hydrocolloid, SWCL Secondary: Hydrocolloid Foam | Primary: Honey, Hydrogel Secondary: Foam or Absorbent Pad, with the addition of Alginate or Gelling Fibre if required. NB- Potential for Larvae therapy, Refer to TVN |
SLOUGHY | Mixture of dead white cells, dead bacteria, rehydrated necrotic tissue and fibrous tissue. | To soften and remove slough by rehydration and debridement. | Primary: Low adherence, Hydrogel, Honey, Hydrocolloid, SWCL Secondary: Hydrocolloid Foam | Primary: Honey, Alginate, Gelling Fibre Secondary: Foam or Absorbent Pad |
GRANULATING | Granulating tissue usually deep pink in colour at the base with red ‘lumps’ over the surface. | To maintain ideal environment for granulation | Primary: Hydrocolloid, Low adherence, Seocndary: Foam | Primary: Alginate, Gelling Fibre Secondary: Foam or Absorbent Pad |
EPITHELIASLING | Typified by pink/ pale mauve coloured tissue. | To protect epithelialising tissue until established. To promote an ideal environment for epithelialisation and contraction | Primary: Low adherence, Film, Hydrocolloid, SWCL Secondary: Foam (Unlikely to be high exudates | Unlikely to be high exudate |
INFECTED | Maybe identified by signs including oedema, swelling, increased exudate, pungent odour, inflammation and pain. | To control and manage infection. Consider use of Antimicrobials. | Primary: Antimicrobial to clean and as dressing (refer to formulary) Secondary: Foam | Primary: Antimicrobial ( refer to formulary) Alginate, Gelling fiber, Foam Secondary: Foam, Absorbent pad. |
FUNGATING/ MALODORUSS | Has an offensive odour indicating infection or colonisation of bacteria. Palliative. | To manage odour, bleeding and exudate. | Odour Primary: Low adherence, SWCL, Honey Secondary: Charcoal Dressing Bleeding Primary: Low Adherence, SWCL, Alginate Secondary: Silicone Foam, Adsorbent Pad Exudate Primary: Alginate, Gelling fiber, Silicone Foam Secondary: Silicone Foam, Adsorbent Pad |
|
CAVITY | Wound extends to tissues deep into the epidermis and dermis. | To promote granulation from the base of the wound. | Primary: Low adherence, Alginate, Alginate & Foam | Primary: Alginate, Gelling fiber, Secondary: Foam or Absorbent Pad *Potential for Topical Negative Pressure refer to TVN |
DRESSING PRODUCTS
ANTIMICROBIAL DRESSINGS
CONCLUSION
Correct dressing selection will create an ideal environment for wound healing.
Wound care products are just tools to help promote healing, a thorough wound and patient assessment is required to make informed choices with regards to the correct product selection. It is also important to read the manufacturer’s instructions to assist in selection and to provide optimum benefit for the patient.
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