Advances in Wound Care - ANNA

Lori Dwyer , DNP, CRNP, NP-C, CWCN
The Science of Selecting Dressings
 Basic guidelines for wound healing:
 Prepare the wound bed
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Any non-viable tissue must be removed
 Moist wound healing
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Dressing selection is based upon the appearance and
characteristics of the wound bed
 Address the bioburden
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Bioburden across the wound bed must be treated
Major Categories
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Protective Barriers
Hydrocolloids
Thin Films
Foams
Hydrofibers
Alginates
Specialized Dressings
Debriding Agents
Hydrogels
Non-Adherent
Moisture Barriers
 Aloe Vesta Skin Protective Ointment
 Petrolatum 43%
 No limit to frequency
 Indicated as a protective barrier for intact skin
 Sensicare
 Zinc Oxide base
 Stoma powder
 Excellent for sealing/protecting skin pH
 No limit to frequency
 Difficult to remove/visualize wound base
 Sage Wipes
 Dimethicone Barrier
Incontinent Associated Dermatitis (IAD)
 Superimposed fungal rash from urine or fecal material
 Rash may present as excoriated or diffuse
 Red or erythemia
 Painful/Burning
 Products:
 Nystatin Powder--Rx
 Aloe Vesta Antifungal Ointment
Incontinent Associated Dermatitis (IAD)
Prescription Products
 Vasolex
 Indications-Skin Protectant
 Balsam Peru, Castor Oil, Trypsin
 Frequency limitations-BID
Non-Adherent Dressings
 Designed for non-traumatic removal.
 Vaseline Petrolatum Gauze, Oil Emulsion Dressings and
Xeroform.
 Absorption issues
 Require secondary dressings.
 Indications:
 Skin tears, painful wounds, vascular wounds
Enzymatic Debriding Agents
 Santyl--Rx
 Indications-Selective debriding
 Collagenase--enzyme
 Highly effective on slough
 Can be used with polysorin powder
 Frequency daily
 Best used with moist dressing on the
collagenase
Alternate Debriding Agents
 Mesalt**
 Indications-Debridement
 Hypertonic Saline dressing that debrides wound bed of
necrotic material.
 Frequency-once or twice daily
 Primary dressing—requires secondary dressing to cover.
Silver Dressings
 Indications-Wound that require local antimicrobial
support
 Address bioburden which frequently cause wounds to
stall.
 Release silver to wound bed to remove bio-film.
 Aquacel Ag*
 Silversorb
 Acticoat
 Silver powder
 Silvercel
Other Antimicrobial Dressings
 Hydrofera Blue
 Indications-Draining wounds/Antimicrobial support
 Provides bacteriostatic environment. Broad spectrumMRSA and VRE.
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Utilizes Crystal Violet and Methylene Blue to inhibit the
growth of microorganisms.
Normal wear time 2-3 days.
Category-Foam
Requires secondary dressing.
Cadexomer Iodine
 Iodosorb
 Indications-Maybe be used for heavy or lightly
draining wounds. Topical antimicrobial support
 Release iodine molecules to wound bed.
 Removes bio-film from wound
 Potent dressing
 Contraindicated with Iodine allergies.
 Appropriate on all wound types.
Calcium Alginates
 Indications-Highly draining wounds.
 Contain seaweed components.
 Contain anti-coagulation properties.
 Not indicated for post-operative wounds
 Can be difficult to remove.
 Kaltostat**
 Algisite M
 Silvercel
 Medihoney
Hydrofibers
 Indications-Highly draining wounds.
 Less painful to remove.
 Can be difficult to remove.
 May be used in post-operative wounds.
 Aquacel**
 Aquacel Rope
 Aquacel Ag Rope
Hydrogels
 Indications-Hydrate wound bed. Promote moist wound healing.
 Contain Purified water, Propylene glycol USP, Carbomer 940 NF,
Triethanolamine, Boric Acid NF, Sodium/Calcium Alginate,
Potassium Sorbate (Saf-Gel)
 May be used on all types of wounds.
 Most commonly used daily.
 Saf-Gel*
 SolositeH
 Curasol
 Hydogel sheets
Foam Dressings
 Indications-Highly draining wounds. Maybe be used
to protect wound—padded.
 May be left in place for extended wear times.
 Balance the wound bed moisture.
 Highly effective on heavily draining wounds
 Hydrocellular foam chips
 Mepilex **
 Mepilex Border
 Allevyn
Hydrocolloid Dressings
 Indications-Superficial wounds, Autolytic debridment,
protectent.
 Extended wear times up to 3 days.
 Duoderm
 Duderm thin
 Replicare
Silicone Dressings
 Indications-Moist wound healing, draining wounds,
skin tears
 Molnlycke Healthcare
 Mepilex
 Mepilex Border
 Mepitel
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Safetec layer that maintains moist wound environment
Foam-Prolonged wear time
Patient comfort
Primary Dressing
Maggot Therapy
 Biotherapy-use live organisms to assist in the medical
management of wound.
 Remove necrotic and devitalized tissue from wound
bed.
 Live Organisms
 Phaenicia sericata, Phormia regina or Lucilia illustris
placed into wound.
 Must have written consent.
Pulse Lavage
 Form of hydrotherapy delivered by hand-held device.
 Provides pressurized, pulsed solution to wound bed
for purpose of irrigating and debriding the wound bed.
 Effective for cleaning thick exudate, slough and
necrotic material.
Celleration-Mist Therapy
 MIST Therapy
 Utilizes innovative ultrasonic sound waves to heal
wounds.
 Noncontact device
 Removes bacteria from wounds using sterile saline to the
wound bed. Transfers ultrasound to wound bed without
direct contact.
Mist Therapy
Negative Pressure Systems
 KCI-VAC Therapy
 Utilizes negative pressure (Vacuum) at wound site to
promote granulation at cellular level.
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VAC GranuFoam Dressings
 Silver, white, black, heel, thin, round, hand and bridge
dressings
 3 Components
 Unit/SensaTRAC Pad/GranuFoam Dressing
KCI VAC Therapy
Specialty Dressings
 Regranex
 Indicated for treatment of lower extremity diabetic
wounds
 Contraindicated in patients with known neoplasm's
Skin Substitutes
 Integra
 Utilized mostly for burns.
 Biolayered dermal regeneration template.
 Dermal replacement layer made of bovine collagen and
serves as a matrix.
 Outer silicone layer serves as a temporary epidermal
covering.
 Placed in OR setting.
 Costs
Bio-Engineered Dressings
 Oasis-Healthpoint
 Comprised of porcine-derived acellular small intestine
submucosa (SIS) material to form a matrix-based
product.
 Indications
Partial and Full thickness wounds
 Contraindications
Porcine allergies and 3rd degree burns
Specialty Dressings
 Apligraf
 Bio-active wound healing
 Indicated for venous leg ulcers and diabetic foot ulcers.
 Kicks the body’s natural healing process into gear
 Bio-engineered cell therapy-fibroblasts
 Normally requires one-two applications.
 Maybe be placed on OR or Out-patient setting.
HBO Therapy
 Hyperbaric oxygen Therapy-inhalation of 100% oxygen delivered at
pressures of more than 1 atmosphere . (ATA)
 Placed in enclosed chamber-single or multiplace.
 Typical treatment consists of inhalation of 100% oxygen at pressures 23 times the pressure at sea level.
 Scuba divers at @ 30-60 feet below ocean surface.
 Indications Refractory Osteomyelitis, ischemia, diabetic foot ulcers (Wagner
Grade 3 or higher), compromised flaps/grafts, burns, necrotizing
soft tissue infections, radiation late effects.
 Risks Bar o Trauma, Pneumothorax, Middle ear damage, seizures, Low BS
Surgical Debridement
 Trained qualified healthcare professionals utilize
surgical instruments to debride necrotic tissue from
the wound bed.
 Scalpel, forceps, curette, scissors
 Excisional or Non-excisional (Selective)
 Requires Anesthetic before procedure
Compression Dressings
 Utilizes multi-layer bandage system to achieve
sustained therapeutic compression to treat venous
stasis leg ulcers.
 Available in 2-3-4 layer systems.
 Wear time up to one week.
 Contraindicated in the presence of arterial disease.
 Coban or Coban Lite**
Compression Dressings
Contact Cast
 Adjunct modality for diabetic or neuropathic wound
for offloading.
 Wet cast placed on the patient—dries hard
 Allows the patient to walk with complete offloading of
the wound
Contact Cast
Stage 1
 Barrier Creams
 Aloe Vesta Protective
 Sensicare
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Goals: Prevention
 Turning/offloading heels/surface
Stage 2
 Treatment Creams
 Sensicare
 Mepilex foams
 Saf-gel
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Goals:
Hold the wound at current stage and begin tissue repair
Adjunct devices
Stage 3
 Debridement Options:
 Santyl
 Mesalt
 Exudate Control:
 Aquacel
 Kaltostat
 Foams—Mepilex
 Infection:
 Iodosorb
 Dakins Solution/Acetic Acid
 Goals: More aggressive
Stage 4
 Debridement Options:
 Santyl
 Mesalt
 Exudate Control:
 Aquacel
 Kaltostat
 Foams—Mepilex
 Infection:
 Iodosorb
 Dakins Solution/Acetic Acid
Suspected DTI
 Vasolex
 Foams-Mepilex
 Sensicare
 Consider treatment goals
 Is care palliative
 Skin failure concern
Unstageable
 Debridement Options:
 Santyl
 Mesalt
 Exudate Control:
 Aquacel
 Kaltostat
 Foams—Mepilex
 Infection:
 Iodosorb
 Dakins Solution/Acetic Acid
Venous Wounds
 Goals:
 Fluid Management
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Kaltostat
Aquacel
Foams
 All highly absorptive dressings
 Gold Standard* -Compression therapy
 Lymph Pumps
Arterial Wounds
 Treatment Goals:
 Defend in place until vascular status has been reported.
 Vascular work up
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Options:
 Foam dressing
 Oil emulsion
 Non-adhering dressings
Diabetic Wounds
 Treatment Goals:
 Strict Offloading
 Options:
 Foam/ Contact casting
 The wound appearance dictates the treatment plan!
Neuropathic
 Treatment Goals:
 Strict Offloading
 Options:
 Foam/ Contact casting
Surgical
 Wet-dry dressing are not a standard of Care!
 Aquacel
 Aquacel Ag rope
 Mesalt
 AMD packing
Skin Tears
 Non-Adhering dressing
 Foams—Mepilex white
Vasculitis
 Trouble: Call for assistance
 Identification of trigger is important piece of puzzle
 Options: Depends on wound appearance
Enjoy the Conference