WOUND MANAGEMENT GUIDE SONICAID FETAL MONITORS PROUDLY NZ owNED. USL has been built by creating seamless relationships. Since 1984 we’ve built enduring partnerships with customers, suppliers and our community. We set out to create the very best environment for our team so that they might deliver their unique skills to our markets. …with people in mind • Public Hospitals • Sports Clubs and Organising Bodies • Private Health • Veterinary Services • General Practitioners • First Aid Suppliers • Nurse Practitioners • Medical Laboratories • Private Hospitals (Medical, Surgical) • Specialist Clinics • Aged Care • Community and Public Health Services • Accident and Emergency Clinics • Pharmacy Retail • Emergency Services • Industrial and Safety • Occupational Health Services • Dermatologists and Skin Clinics • Community Trusts • Physiotherapists and Sports Medicine Clinics OUR COMPANY AT A GLANCE: • USL is a limited liability company, proudly New Zealand owned • Our annual sales exceed $NZ 48 million • Our head office and main distribution centre are based in Auckland • The South Island is serviced from our Christchurch distribution centre • We service 3,750 customers at all locations throughout New Zealand including all 20 of the national District Health Boards WHAT YOU CAN EXPECT FROM US: • We offer our customers dependability and experience they can rely on and trust. • We deliver under IFOTIS: In-Full, On-Time, In-Specification. • We operate a management reporting system that provides information on the frequency, recency, amount and type of purchases for all customers, and thereby enhancing their business purchasing efficiency. • Normal guarantees apply and are rigorously honoured, and we guarantee to supply our key clients with critical stock items under IFOTIS. • Our product range is comprehensive. It meets our customers’ needs, so they can confidently have a one supplier relationship for all medical products. In addition to the products featured in this catalogue, we also supply wound care consumables from global manyfacturers as follows: 2 CONTENTS WOUND MANAGEMENT The Skin ...............................................6 Leg Ulcer Management ................................32 Wounds and Wound Healing ............................7 Arterial Ulcers ........................................33 Phases of Wounds and Wound Healing ..................8 Diabetic Ulcers ........................................34 Tissue Types of Wounds ................................9 Venous vs Arterial vs Neuropathic Ulcers ................35 Types of Wounds .....................................10 Chronic Wounds .......................................11 COMPRESSION THERAPY Infected Wounds ......................................14 Compression Therapy Overview ........................37 Moist Wound Healing .................................. 15 PRESSURE ULCERS PATIENT ASSESSMENT AND WOUND DOCUMENTATION Pressure Ulcers Overview ..............................40 Patient and Wound Assessment ........................ 17 Wound Documention Chart ............................18 BURNS Burns Overview .......................................46 PAIN AND WOUND MANAGEMENT Pain - The Fifth Vital Sign ..............................20 DRESSING CATEGORIES AND FUNCTIONS Woundcare Guidelines / Summary Chart ................ 51 NUTRITION AND WOUND HEALING Wound Assessment Tools ..............................52 Nutrition and Wound Healing ..........................24 What Dressing For What Wound? ......................54 SKIN TEARS Skin Tears Overview ...................................26 LEG ULCERS Venous Leg Ulcers ....................................30 3 WOUNDCARE PRODUCTS Plasters ..............................................60 CASTING AND BANDAGES ...........................123 Gauze Swabs .........................................62 Contact Layers .......................................63 INSTRUMENTS ......................................129 Island Dressings ......................................64 CONTENTS Films .................................................65 DRAPES ............................................133 Hydrogels ............................................66 Alginates .............................................67 HUNTLEIGH DOPPLERS AND PULSE OXIMETERS ......135 Wound Bed Preparation ..............................68 Hydrocolloids .........................................70 PRESSURE RELIEVING DEVICES .......................141 Multifunctional Dressings .............................. 71 Beds ................................................142 Foams ...............................................80 Mattresses ...........................................143 Exudate Management .................................81 New Technology ......................................82 SCAR MANAGEMENT ................................145 MEBO® Ointments .....................................83 Medihoney™ .........................................84 NEGATIVE PRESSURE THERAPY ......................147 COLOPLAST® WOUNDCARE PRODUCTS ...............92 SIGVARIS COMPRESSION STOCKINGS. .150 Biatain® Foam Dressings ...............................93 Comfeel® Hydrocolloid Dressings .......................97 POSTGRADUATE WOUND COURSES ..................154 Biatain® Alginate Dressings (Previously Seasorb). .100 RETENTION AND FIXATION DRESSINGS. .103 SKIN INTEGRITY PROTECTION AND WOUND MAPPING Skin Protection ......................................108 Wound Mapping ......................................111 Patient Hygiene .......................................112 COMPRESSION BANDAGING ..........................117 4 WOUND MANAGEMENT 5 THE SKIN The skin is the largest organ in the body. It accounts for 2.5 - DERMIS 3.5kg of a person’s body weight and has a surface area of more The dermis - the thick, deeper layer of the skin is composed of than 2 square metres. Maintaining its integrity is a complex collagen and elastin fibres, and an extra cellular matrix, which process. contributes to the skin’s strength. It is very vascular and contains nerve fibres, hair follicles, and the THE LAYERS fibroblast cells which are critical for the formation of collagen The skin is divided into two primary layers; epidermis (outermost and elastin. layer) and dermis (innermost layer). These two layers are It is also composed of two layers of connective tissue separated by a structure called the basement membrane. • the papillary (collagen and reticular fibres) Beneath the dermis is a layer of connective tissue called • reticular dermis (network of collagen bundles) the hypodermis. Major functions of the skin are protection, immunity, thermoregulation, sensation metabolism and communication. The skin forms a protective barrier from the external environment while maintaining a haemostatic internal environment. Skin also reflects the body’s general physical health. EPIDERMIS • Epidermis is avascular and is made up of five layers. • stratum corneum (horny layer) • stratum licidum (clear layer) • stratum granulosum (granular layer) • stratum spinosum • stratum basale HYPODERMIS Hypodermis forms a subcutaneous layer below the dermis. This is made up of adipose tissue which in turn provides insulation for the body. A ready energy reserve, providing additional cushioning and skin mobility over underlying structures (e.g. joints/bones). A wound is defined by any break to the skin’s surface, resulting in tissue damage. 1 Horny layer 2 Prickle cell layer 3 Basal cell layer 4 Meissner’s tactile corpuscles 5 Sweat gland 6 Hair follicle with hair muscle 7 Sebaceous gland 8 Free nerve ending 6 WOUNDS AND WOUND HEALING TYPES OF wound HEALING WOUND management PRINCIPLES A wound is classified by the way it closes. A wound can close by • define aetiology - work towards a diagnosis three ways; primary, secondary or tertiary. • develop a management plan in conjunction with patient/family/caregiver Primary • assess and manage factors affecting wound and patient Re-epithelialisation, in which the outer layer grows closed. Mostly • choose appropriate dressing regimen superficial involving only the epidermis with no loss of tissue. • plan for maintenance Heals within 4-14 days with minimal scarring. Secondary Involves some degree of tissue loss with edges that can’t be easily brought together. Depending on depth of damage determines whether it is a partial or full thickness wound. “To maximise healing, minimise Wounds that heal by secondary intention fill with granulation pain and prevent cross infection tissue, then a scar forms and re-epithelialisation occurs. Primarily from the wound edges. through wound management Pressure ulcers, burns, dehisced surgical wounds and traumatic that is supported by current injuries are all examples of this type of wound. research and best practice” Typically these wounds take longer to heal, result in scarring and have more complications. TERTIARY (DELAYED PRIMARY) Wounds that are intentionally kept open to allow oedema or infection to resolve. These wounds are then later closed with either staples, sutures or adhesive skin closures, and can result in more scarring, due to more tissue damage. 7 PHASES OF WOUNDS AND WOUND HEALING The healing process begins at the instant of injury and proceeds through a repair “cascade” until healing occurs following epithelialisation. The wound healing process involves four phases which tend to overlap: • haemostasis • inflammation • proliferation • maturation Haemostasis occurs immediately after injury and releases a multitude of growth factors into the wound to