Miscellaneous

We have completed our series on wound dressings. We hope you found them enjoyable and informative. We will now be turning our attention to adjunctive therapies in wound care, covering topics as diverse as laser therapy, ultrasound, negative-pressure wound therapy and this week’s topic, whirlpool therapy.

Whirlpool therapy is thought to affect the inflammatory phase of healing, and can be used on a variety of wounds. Whirlpool tanks can be installed (permanent) or portable, and may be used for full-body immersion or for a single extremity. Settings can be adjusted, depending on the direction of turbulence and force of agitation deemed necessary. Different settings of temperature can also be used to differentiate the whirlpool’s effect on circulation.

Indications

• Wounds with moderate to heavy exudate
• Wounds with debris
• Necrotic wounds
• Ischemic wounds
• Wounds with tissue able to withstand increased circulation to the wound

Contraindications

• Clean granulating wounds can be traumatized by even gentle water agitation
• Epithelializing wounds
• Wounds with skin grafts, which may be damaged by agitation of water
• Venous ulcers because, by their very nature, they already suffer problems with circulation
• Diabetic ulcers which are non-necrotic, because the callous formation will be disrupted, and tissue maceration will lead to a wound that may enlarge
• Edema to an extremity
• Upper extremity infection
• Presence of dry gangrene
• In addition, patients who have renal failure, circulatory or pulmonary disease, acute phlebitis, are febrile, lethargic or unresponsive, or who are incontinent of urine or feces should not use whirlpool therapy
• Spinal cord-injured patients and those with peripheral neuropathy are at risk for thermal injury or hypothermia when whirlpool therapy is used

Advantages

• Softens necrotic tissue, facilitating its removal (mechanical debridement)
  Increases blood flow to the wound (improves circulation, which brings an influx of oxygen and nutrients to the tissues)
• Cleanses the wound(s)
• Helps to remove exudate, which decreases risk of infection
• Analgesia is induced by the effects of the warm water on the wound

Disadvantages

• Sensitive patients may develop allergies to the chemical agents used in whirlpool therapy
• Improper cleansing of the whirlpool may lead to wound infection
• Obese persons may not be candidates for whirlpool therapy because of their inability to disperse heat effectively
• Whirlpool therapy is time-consuming (treatments often given for 20 minutes twice a day, after which wounds should be dressed)
• Treatment can be expensive in terms of supplies, dressings, and labour

The temperature of the water used in whirlpool therapy should be based on wound and client condition. Water temperature should not exceed 1 degree above skin temperature in clients with peripheral vascular disease (PVD) and should not exceed 38 degrees Celsius in patients with heart or lung disease. When the water temperature must be lower, take care to ensure the client does not become chilled by keeping the therapy room warm and free of drafts. Where possible, immerse a single limb rather than the entire body.
Join us weekly as we explore the many different treatment modalities available for managing wounds. If you are interested in becoming certified in wound management, please visit www.woundeducators.com.

Sources:
Bates-Jensen & Sussman, C. (1998) Wound Care Collaborative Manual for Physical Therapists and Nurses, Aspen Publishers.

Wound fillers do exactly as their name suggests–they fill an empty space. They come in a variety of formulations and generally require the use of a secondary dressing to hold them in place.

Product Overview

Wound fillers include gels, pastes, foams, powders, ribbons, and other formulations whose major purpose is to fill a space in a cavity. They also help to absorb wound drainage and maintain a moist wound environment.

Indications

• Partial-thickness wounds
• Full-thickness wounds
• Wounds that require packing to fill wound space
• Wounds that have moderate to heavy exudate
• Infected wounds

Contraindications

• Cannot be used in wounds that have tunnelled or have formed sinus tracts due to difficulty of removal
• Should not be used on wounds with minimal drainage (“dry” wounds)
• Should not be used on third-degree burns

Advantages

• Can be used with other types of dressings to help absorb and manage wound exudate (i.e. composites, foams)
• Help to soften necrotic tissue, thus aiding in debridement
• Wound fillers containing antimicrobials help to control infection
• May be very absorbent
• Some are easy to apply and remove
• Help to maintain a moist wound environment

Disadvantages

• Require the use of a secondary dressing, which adds to the cost of managing a wound
• Some of these dressings may be difficult to apply and remove

How often these dressings are changed will depend on the size and depth of the wound, as well as on how much the wound is draining. Follow the manufacturer’s instructions for use. Some of these dressings may need to be moistened with normal saline prior to use.
Are you “stuck in a rut” in your career and are contemplating making a change, but are not sure in which direction to go? Becoming certified as a wound care specialist may be an option for you if you enjoy challenging yourself and want to command both the respect of your peers and a higher salary. If you are interested in learning more about what is involved in becoming certified as a wound care specialist, visit www.woundeducators.com.

Sources:
Hess, C. (2002). Clinical Guide: Wound Care. Fourth Edition. Springhouse, PA: Springhouse Corporation
Corbett, L., Dubuc, D. & Milne, C. (2002). Wound, Ostomy and Continence Nursing Secrets. Elsevier Health Sciences ISBN-13: 9781560535232

There are few products designed to absorb large amounts of exudate from wounds. Mesalt, a gauze dressing permeated with crystalline sodium, is made specifically for such wounds. The following will enable you to learn more about these dressings and how to use them.

Product Overview

Mesalt uses a wicking action to draw fluid and debris out of wounds, while still maintaining a moist wound environment. Mesalt can be used on wounds that are infected and draining heavily. Its mechanism of action is to create a hypertonic wound environment, which decreases interstitial edema and allows for wound cleansing and the removal of slough as a result of moist necrosis.

Indications

• Infected wounds
• Wounds with moderate to heavy drainage (exudate)

• Deep cavity wounds

• Pressure ulcers

• Surgical wounds

Contraindications

• Not to be used on wounds that have light drainage, as it may dry out the wound excessively and stick to it

Advantages

• Perpetuates a moist wound environment
• Decreased potential for sticking to the wound

• Easy to apply and remove

• Conforms to any wound configuration (comes in pads and ribbon form)

• Aids in bacterial balance, helping wounds to become more receptive to antimicrobials

Disadvantages

• May need to be changed frequently if the wound is draining heavily

• Requires a secondary dressing

• May damage newly formed tissue if there is not enough moisture available in the wound bed

• May be painful to some sensitive patients

• May not be cost effective due to frequent need for dressing changes

Mesalt dressing are applied dry and removed when saturated. If a Mesalt dressing sticks to the wound, you should consider using a different type of dressing. Mesalt dressings should be discontinued when debridement of the wound is no longer required and new growth of granulation tissue in sufficient amount is present.

We sincerely hope that you are enjoying this series on different dressing types and how they are used. Woundeducators.com is dedicated to providing you with current and useful information that you can use in everyday practice. Should you wish to learn how you can reap the benefits of becoming certified as a wound care management expert, please visit www.woundeducators.com.

Source:

Mesalt Sodium Impregnated Gauze. Retrieved August 7, 2009, from http://www.woundsource.com/product/mesalt-sodium-chloride-impregnated-gauze

Milne, C., Hagan, J. & Ciccarelli, A. An Examination of the Antimicrobial Effects of A 15% Sodium Chloride Impregnated Dressing on Wounds: 121. Journal of Wound, Ostomy and Continence Nursing: May/June 2007 - Volume 34 - Issue 3S - p S10

Collagen is a fibrous protein which is insoluble and is produced by cells called fibroblasts. Dressings formed from collagen serve many purposes. This article describes what makes these dressings different from others, and how they are used.

Product Overview

Collagen is found in many different types of connective tissues, such as cartilage, bone, ligaments and skin. Collagen dressings can stimulate the growth of new tissue in the wound bed. These dressings can be found in many different forms, such as sheets, gels, pads, particles and pastes. They are manufactured from bovine, porcine, or avian sources, and may be purified to prevent reaction. However, some people may still experience a reaction to bovine-based collagen products.

Indications

• Wounds that have “stalled” in the healing phase
• Partial thickness burns
• Pressure ulcers
• Diabetic ulcers
• Skin graft donor sites
• Dehisced surgical wounds
• Infected wounds, providing the infection is managed locally or systemically

Contraindications

• Dry wounds
• Wounds with necrosis
• Third-degree burns
• Sensitivity to bovine products

Advantages

• Absorb fluids (exudate)
• Help to maintain a moist wound environment
• Can be used with topical agents
• Accelerate the repair of wounds
• Conform to any shape of wound
• Non-adherent; will not stick to newly granulated tissue
• Easy to apply and remove
• The dressing can be left in place for up to 7 days

Disadvantages

• Require a secondary dressing
• Can be expensive to use
• May be unpleasant for the patient due to unusual odor
• Application may be difficult

If used on dry wounds, collagen dressings should be pre-moistened with normal saline. Manufacturer’s directions for use should be followed, and the expiration date on collagen products should be checked, as some of these products are not heat-stable when stored improperly.

Woundeducators.com is committed to bringing you the most current and evidence-based wound care information available. Should you be interested in becoming certified as a wound care specialist, wound educators.com offers a comprehensive online program designed with the busy health care professional in mind. Visit our site and see what we have to offer!

Sources:

Worley, C. (2005). So, what do I put on this wound? Wound dressing puzzle: part 1: collagen dressings. Dermatology Nursing, 17(2):143-144.

Corbett, L., Dubuc, D., & Milne, C. (2002). Wound, Ostomy and Continence Nursing Secrets; A Hanley and Belfus Title, ISBN 1560535237

Composite dressings are dressings that combine the advantages of multiple layers, providing more than one function in wound care management. Each layer of dressing is physiologically distinct. To learn how to use these dressings, and when not to, read on.

Product Overview

Most composite dressings have three layers. The bottom layer is usually composed of a semi- or non-adherent material, which allows moisture to travel though to the next layer while preventing the dressing from sticking to the freshly granulating tissue of the wound bed. The middle layer is generally composed of an absorptive material which pulls moisture away from the wound bed, keeping it moist but preventing maceration of the skin. It also helps to inhibit bacterial growth and assists in the process of autolytic debridement. The outermost layer protects the wound from bacterial invasion and allows air to circulate. The outer layer also prevents moisture from leaking through to the top layer of dressing, allowing for less frequent dressing changes.

Indications

• Partial- and full-thickness wounds
• Wounds that have minimal or heavy exudate
• Wounds with granulating tissue
• Wounds that are necrotic (have necrotic tissue)
• Wounds that have a combination of necrotic and granulating tissue

Contraindications

• Patients who are very dehydrated
• Patients who have fragile skin ie. the elderly

Advantages

• Can be used as both primary and secondary dressings
• Can be used on a variety of wounds with varying degrees of exudate
• Easy to remove, as the bottom layer is usually non-adherent
• Prevent maceration of the surrounding skin
• Have antibacterial properties
• Facilitates autolytic debridement
• Shape well to different wounds on different parts of the body
• Can be cost-effective, owing to less frequent dressing changes

Disadvantages

• Some of these dressings are not appropriate for use on infected wounds (check the manufacturer’s directions for use)
• Composites with an adhesive border require that there be intact skin around the wound edges
• Some insurers will not reimburse for these types of dressing when they are used as secondary dressings

As each of these dressings are different, it is important to read the manufacturer’s instructions for use. They should be changed when saturated, or when recommended by the manufacturer. To learn more about these dressings and others, you may want to consider becoming certified as a wound care specialist. The benefits to you and your patients are immeasurable, and woundeducators.com is dedicated to helping you take this all-important step in your career. Because Medicare and other government entities are now holding health care professionals responsible for outcomes in wound care, the time has never been better to consider becoming a wound care specialist, able to handle any type of wound you may encounter in your practice.

Hydrofiber dressings are a relatively new concept in dressings, and can be very cost effective because they can be worn for several days at a time. In this article, we will explore how and when these dressings can be used.

Product Overview

Hydrofiber dressings gel upon contact with moisture, locking in fluid that is absorbed by the dressing. In this manner, they help to maintain a moisture balance in the wound bed that is not too wet or too dry, protecting the edges of wounds from becoming macerated. They provide a passive method of wound control by filling in dead spaces where bacteria tend to proliferate. The addition of silver to some of these dressings can provide antimicrobial protection for infected wounds. The main component of these dressings is sodium carboxymethylcellulose. These dressings may come in a sterile, soft non-woven pad or as a ribbon dressing.

Indications

• Partial thickness burns
• Diabetic foot/leg ulcers
• Pressure ulcers
• Traumatic wounds
• Surgical wounds left to heal by secondary intention

Contraindications

• Hydrofiber dressings containing silver should not be used on those patients sensitive to silver
• Not compatible with oil-based products, such as petrolatum jelly

Advantages

• Can be used with compression bandages
• Can be used on dry wounds (wet with sterile normal saline)
• Conforms to irregularly shaped wounds easily
• Comfortable for the patient to wear
• Easy to remove; painless and does not damage granulating wound tissue
• Can be worn for several days, therefore these dressings can be quite cost-effective
• Helps to balance the inflammatory response
• The addition of silver provides sustained antimicrobial response over time

Disadvantages

• Secondary dressing may be needed for wound that are highly exudative i.e. oncologic wounds

Hydrofiber dressings have been shown to be effective in the management of both acute and chronic wounds, as well as wounds that are infected.  For dry wounds, the dressing should be moistened with sterile normal saline, and then an occlusive dressing that traps moisture should be applied as a secondary dressing, such as a transparent film. For wounds that are extremely moist, a secondary dressing to “catch” any excess fluid should be applied.

This article on the use of hydrofiber dressings continues our series on dressings types and use. We hope that you find these articles informative. Perhaps, as you read these articles, you will discover that you have an interest in becoming certified as a wound care specialist. If so, please visit www.woundeducators.com to find out more about how you can take the next step in becoming an expert in wound care management.

Source:
Bowler, P., Jones, S., Parsons, D. & Walker, M. (2004). Microbial properties of a silver-containing hydrofiber dressing against a variety of burn wound pathogens. Burn Care Rehabilitation, Mar-Apr; 25(2), pg. 192-196.

Looking for a dressing that will absorb large amounts of drainage? Alginate dressings are capable of absorbing up to 20 times their weight in fluid! In this article, we will discuss the indications and advantages of using these dressings.

Product Overview

Alginate dressings, as their name implies, are derived from brown seaweed. They are composed mainly of alginic acid, which is then converted into calcium and sodium salts (water-insoluble and water soluble, respectively). These dressings are composed of soft fibers shaped as pads or ropes. When these dressings come in contact with moisture, they absorb the moisture, forming a gel that helps to maintain a moist wound environment.

Indications

• Partial or full-thickness wounds
• Wounds that have moderate to heavy drainage
• Tunnelling wounds
• Infected wounds (also noninfected wounds)
• Moist yellow or red wounds

Contraindications

• Wounds with light exudate (may dehydrate the wound)
• Wounds with dry eschar (may dehydrate the wound)

Advantages

• Can conform to the wound shape
• Can absorb up to 20 times their weight
• Aid in autolytic debridement
• Useful to fill in dead space
• Easy to remove, non-sticking
• Comfortable for the patient

Disadvantages

• Can dry out the wound bed, which may delay healing
• Require a secondary dressing, adding to the expense of using alginate dressings

A secondary dressing is often necessary to help the dressing stay in place. Petrolatum gauzes or foams help prevent the alginate dressing from drying out. A nonoccluding dressing should be used if the wound is infected, allows visualization and monitoring of the wound.  When the alginate has formed a gel, it can be easily removed; if it is difficult to remove, it may indicate that the wound bed is too dry.

The world of wound care is one that is expanding rapidly, and keeping up with such change can be difficult. Woundeducators.com is dedicated to providing you with the most current information available. Interested in becoming certified as a wound care specialist? Visit www.woundeducators.com today to begin the journey to a more rewarding career.

Source:
Hess, Cathy. When to use alginate dressings. Advances in Skin and Wound Care, May/June 2000.

Foam dressings are ideal to maintain a moist wound environment and to absorb drainage. They are generally made from hydrophilic polyurethane foam. They offer many advantages and are used commonly as both primary and secondary dressings. Read on to learn about the many qualities that foam dressings offer, as well as the disadvantages of using these dressings.

Product Overview

One of the best qualities of foam dressings is their absorbency, and also the fact that they leave nothing behind in the wound bed when removed. Foam dressings come in many shapes, sizes, and thicknesses. You will find them in pad, sheet and pillow form. They do not stick to wounds, due to a nonadherent layer, making removal easy and painless.

Indications

• Partial and full-thickness wounds
• Wounds with minimal to heavy drainage
• Can be used to absorb drainage around tubes
• Used as a primary dressing to absorb drainage
• Provide insulation
• Used as a secondary dressing for wounds with packing, deep cavity wounds
• Weeping ulcers, such as venous stasis ulcers

Contraindications

• Wounds with dry eschar
• Wounds with little or no drainage

Advantages

• Will not stick to wounds
• Do not allow contaminants to settle in wound bed
• Easy to apply and remove
• Absorb exudate effectively, even when drainage is heavy
• Can be used with compression
• Less frequent dressing changes means foam dressings can be very cost effective
• Very comfortable for the patient

Disadvantages

• May cause maceration of periwound skin if not changed often enough
• May require tape, wrap or net to hold them in place if they do not have an adhesive border
• May cause a drying effect if there is little drainage from the wound

This article addressing the use of foam dressings is one of many in a series that we at WoundEducators.com hope will keep our readers up to date on the latest information in wound care management. If you would like to learn more about how you can become certified as a wound care specialist, please visit www.woundeducators.com for more information, or feel free to email us at support@woundeducators.com. We will be happy to answer any questions regarding becoming certified in wound care management.

Source:
Hess, C. (2002). Clinical Guide: Wound Care. Fourth Edition. Springhouse, PA: Springhouse Corporation.

You may have used hydrocolloid dressings in your practice, but perhaps you are wondering if you have been using them correctly. The following guide will help you to decide which wounds hydrocolloids may be used on, and under what circumstances they should not be used.

Product Overview

Hydrocolloids are dressings composed of varying materials such as carboxymethylcellulose, pectin and gelatin. The substance that comprises the layer that comes in contact with the wound may be different, depending on the type of hydrocolloid dressing. What they all have in common is that they provide a moist healing environment that is conducive to autolytic debridement and the formation of granulation tissue. These dressing come in many different shapes and sizes and may be found in paste, powder and wafer form.

Indications

• Pressure ulcers
• Partial and full-thickness wounds
• Necrotic wounds or wounds with slough
• Wounds with light to moderate drainage (exudate)

Contraindications

• Wounds with heavy exudate
• Wounds containing sinus tracts
• Wounds with fragile skin surrounding the wound
• Wounds with exposed structures (i.e. bones or tendons)

Advantages

• May be used as either a primary or a secondary dressing
• Do not allow bacteria to enter the wound
• Encourage autolytic debridement
• Variety of shapes and sizes allow you to choose one which adheres well to the wound being treated
• Slight to moderate absorptive properties
• Minimal skin trauma
• Minimal disruption of healing
• Allow wound visualization (if transparent)
• Can be used in conjunction with compression products

Disadvantages

• May leave a sticky residue on the wound edges, or may leave a residue in the wound itself
• Opaque hydrocolloids make wound assessment difficult
• Heavily draining wounds may cause dressing to become dislodged
• Occlusive nature of these dressings minimizes gas exchange between the wound and the environment
• Edges of the dressing may curl
• Can injure fragile skin when removing the dressing

At woundeducators.com, we understand that life is hectic, and keeping up to date on all the latest industry news can be difficult. This is why we have dedicated ourselves to becoming the one resource that you can turn to in order to keep you up to speed in the rapidly developing field of wound care management. If you are interested in becoming a certified wound care specialist, visit us at www.woundeducators.com to find out more about how you can advance your career, earn more money and enjoy greater job opportunities.

Source:
Hess, C. (2002). Clinical Guide: Wound Care. Fourth Edition. Springhouse, PA: Springhouse Corporation.