Dressing Products Pat Sinasac CNC Wound / Stoma Management Subacute and Ambulatory Services 2014

Types of Dressings TULLE – GAUZE – SEMI PERMEABLE FILMS – HYDROGELS – FOAMS – HYDROCOLLOIDS – HYDROACTIVE – CALCIUM ALGINATES - SILICONE - ANTIMICROBIAL – SILVER – NEGATIVE PRESSURE WOUND THERAPY – SKIN/CELL THERAPY

Ideal Dressing REMOVES EXUDATE MAINTAINS MOIST ENVIRONMENT ALLOWS GASEOUS EXCHANGE THERMAL INSULATION BARRIER TO PATHOGENS DOES NOT PROMOTE INFECTION NO SHEDDING OF FIBERS, OR LEAKING SENSITIVITY OR ALLERGY PROTECT FROM SHEAR, FRICTION OR FORCE REMOVAL WITHOUT TRAUMA TO NEW TISSUE EASY TO APPLY EASY TO WEAR ADAPTABLE TO BODY PARTS NO INTERFERENCE WITH BODY FUNCTION COST EFFECTIVE FOR PATIENT AND HEALTH CARE SYSTEM $$$

FILM - Adhesive, thin, polyurethane film ADVANTAGES Permeable to gases Impermeable to liquids and bacteria Reduces pain, keeps nerve endings moist Allows inspection of wound through dressing DISADVANTAGES Non-absorbent; exudate may pool around wound causing maceration Not suitable for moderate to highly exudating wounds If not correctly removed, may be traumatic to tissues

FOAM - Polyurethane foam - SHEETS ADVANTAGES Available as non-adherent and adherent dressing Non occlusive and semi-occlusive / water repellent Facilitates a moist wound environment Highly absorbent Provides protection Conforms to uneven body surfaces DISADVANTAGES Moist wound environment may not be sufficient to allow autolysis (debridement of hardened eschar to occur

FOAM - Polyurethane foam - CAVITY ADVANTAGES Reduce dead space in the wound Conform to cavity shape Absorb large amounts of exudate and reduce need for frequent dressing changes DISADVANTAGES Requires a secondary dressing

CALCIUM ALGINATE – Natural polysaccharide from seaweed ADVANTAGES Active ion exchange at wound surface forms a soluble sodium alginate (gel) that provides a moist wound environment Keeps nerve endings moist, reduces pain Very low allergenic Biodegradable in wounds May be used to pack sinuses and cavities in order to reduce dead space Absorbent, useful in exudating wounds Promotes haemostasis in bleeding wounds because of their haemostatic properties DISADVANTAGES Requires secondary dressing Alginates attached to a semi-permeable or occlusive dressing are not recommended for wounds infected with anaerobic bacteria Gel may be confused for pus or slough in wound Not suitable on dry wounds or in the presence of hard eschar

SILVER - Nanocrystaline silver ADVANTAGES Bactericidal – MRSA, Psuedomonas Less frequent dressing changes Reduces edema Improves healing time Burns DISADVANTAGES Requires secondary dressing Mild absorbency Staining Sensitivity May stick to wound bed Special application technique required

HYDROCOLLOIDS – Hydrophillic/ hydrophobic polymer ADVANTAGES Absorb exudate Gel formation, moist wound environment Water repellent Prevents pathogen invasion Conforms to body parts Reduced pain Reduced dressing changes Cleans and debrides by autolysis Safe debridement, granulation and epithelialisation Powders, paste forms (dead space filler), size, shapes, borders DISADVANTAGES Not to be used on clinically infected wounds Caution on fragile or compromised skin Gel may be mistaken for wound infection Deep wounds may require cavity filling Difficulty keeping insitu on areas affected by friction, eg. Heels Edges may roll, tape to prevent

HYDROGELS - COLLOID POLYMER ADVANTAGES Moist wound environment for cell migration Absorbs exudate Rehydrates eschar Autolytic debriding or desloughing agent No harm to granulating or epitheliating cells Fills dead space, easily irrigated from wound Gel sheets, conform, absorb, visual, reduce dressing changes DISADVANTAGES Wound base should be visible Requires secondary dressing Maceration can occur Sensitivity

ODOUR ABSORBING - Activated charcoal ADVANTAGES Absorbs bacteria and eliminates odours May be primary dressing ACTISORB with 0.15% silver aims to kill surface bacteria DISADVANTAGES Secondary dressing Do not cut

WOUND HONEY - Leptospermum species ADVANTAGES Promotes moist wound healing Autolytic and osmotic debridement Antimicrobial activity – slow release of low level hydrogen peroxide (psedomonas, staph aureus Controls malodour DISADVANTAGES Allergy Frequent dressing 1-3 X’s/day Store at <30C to maintain integrity Stinging sensation Maceration secondary dressing

TULLE GRAS - CLOTH WITH PARAFIN,WAX, LANOLIN ADVANTAGES Atraumatic dressing removal Moist wound environment that facilitates epithelial cell migration DISADVANTAGES Non absorbent Secondary dressing Sheds fibers Allergy Removal of excess paraffin

Negative Pressure Wound Therapy - controlled negative pressure device ADVANTAGES Moist environment Reduces bacterial colonisation Reduces local edema Reduces dead space in wound Promotes granulation and epithelialisation Exudate collection Reduced dressing frequency DISADVANTAGES Contraindicated for fistulae management, eschar, osteomyelitis & malignant wounds Caution in potential bleeding wounds or with anticoagulant use Power source Specialist equipment

SILICONE ADVANTAGES Atraumatic dressing removal Absorbent Conformable Moist wound environment for cell migration Adherent Waterproof Less frequent dressing changes

CADEXOMER IODINE ADVANTAGES DISADVANTAGES Moist environment Antibacterial Supplied in 3 mediums DISADVANTAGES Allergy / sensitivity Daily application Secondary dressing Painful at times