Wound Dressing Considerations & Categories American Medical Technologies Irvine, CA Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 1 Disclaimer The information presented herein is provided for educational and informational purposes only and to promote the safe-and-effective use of the wound care products provided. It is for the attendees’ general knowledge and is not a substitute for legal or medical advice. Although every effort has been made to provide accurate information herein, laws change frequently and vary from state to state. The material provided herein is not comprehensive for all legal and medical developments and may contain errors or omissions. If you need advice regarding a specific medical or legal situation, please consult a medical or legal professional. Gordian Medical, Inc. dba American Medical Technologies shall not be liable for any errors or omissions in this information. Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 2 Objectives • Review dressing considerations for optimal wound healing. • Discriminate characteristics of advanced wound products by category. Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 3 Optimal Wound Healing Wound Dressing Resident Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 4 Dressing Considerations • Wound Bed • Location • Removal • Cost effectiveness • Barrier • Sensitivities Bovine, latex, adhesives, fiberglass, sulfur Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 5 Dressing Considerations Dry or Clean? Wet? Cost & Follow usage manufacturer instructions. Dressing Choice Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 6 Advanced Wound Products (AWP) Advanced • Moist Wound Healing • Bacterial Barrier Active • Thermoregulation Interactive Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 7 Consider wound etiology, goals, etc. • Dry, stable heel ulcer • Dry gangrene • Resident status/wishes at end-of-life Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 8 Moist Wound Healing • ↓ Pain • May be waterproof • ↓ Edema • May reduce friction • Softens eschar • ↑ Cosmesis • Temperature • Ease of use • Excludes bacteria • Frequency of change Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 9 Advance Wound Products (AWP) Bacterial Barrier • Inherent Barrier – Bacteria – Liquid http://durable-medical- equipment.blogspot.com/2009/01/hydrogel-dressings.html • Preserve phagocytic function Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 10 AWP - Thermoregulation • Limit the Effects of Tissue Cooling – Vasoconstriction – Hypoxia – ↓ Leukocyte mobility – ↓ Phagocytic ability Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 11 AWP- Moisture Vapor Transfer • Moisture Vapor Transfer Rates (MVTR) – Loss of water vapor from intact skin is 240 – 1920 g/m2/24 hours – Loss of water vapor from an open wound, 7000+ g/m2/24 hours Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 12 Dressing Categories • Primary dressing • Direct contact with wound bed • Interacts with wound tissue • Therapeutic & Protective function • Secondary dressing • Secure primary dressing • Increases ability of treatment to meet the wound needs • Therapeutic & Protective function Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 13 Amount of Drainage Slight Heavy Hydrogel Hydrocolloid Calcium Alginate Transparent Gauze Film Collagen Composites Foam variable based on When used as primary component ingredients Dressing Options Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 14 Transparent Film • Semi-permeable • Waterproof • Bacterial barrier • Autolytic debridement • Light exudate • May be difficult to apply or tear fragile skin Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 15 Transparent Films Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 16 Hydrogel • Hydrate wound bed • Autolytic debridement • Atraumatic • Light exudate • Can dehydrate if not covered • Maceration possible Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 17 Hydrogels Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 18 Gauze • Mechanical debridement • Conformable • Use in combination with other products • Can be painful to remove • More frequent dressing changes • Permeable to bacteria • ? Cost effectiveness Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 19 Gauze Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 20 Hydrocolloid • Self –adherent • Bacterial barrier • Autolytic debridement • Decrease pain • Cost effective • NOT for infected wounds, tracts or over exposed tendon/ bone Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 21 Hydrocolloids Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 22 Collagen • Absorbent, non-adherent • Easy application • Stimulate new tissue • Support autolytic debridement • NOT for full-thickness, 3° burns or eschar Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 23 Collagens Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 24 Foam • Absorption • Oxygen permeability • Minimal trauma • Autolytic debridement • NOT for use on dry eschar Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 25 Foams As Primary Dressings Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 26 Foams As Secondary Dressings Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 27 Calcium Alginate • Absorbent • Biocompatible • Atraumatic removal • Autolytic debridement • Cost-effective Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 28 Calcium Alginate Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 29 Composite Dressings • Combine two physically different components into one dressing • Features MUST include: – bacterial barrier – absorptive layer other than alginate, foam, hydrocolloid, or hydrogel – a semi - or non-adherent wound covering Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 30 Composite Dressings Advantages Disadvantages • facilitates autolytic • requires debridement intact/healthy skin • may be safe with infected wounds border – check mfr instructions • easy application & removal • can be primary or secondary dressing Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 31 Composites Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 32 Amount of Drainage Slight Heavy Hydrogel Hydrocolloid Calcium Alginate Transparent Gauze Film Collagen Composites Foam variable based on When used as primary component ingredients Dressing Options Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 33 Review Questions 1. Moist wound healing practices provide the following advantages EXCEPT: A. Decreases pain B. Promotes autolytic debridement C. Lowers the temperature of the wound environment D. Increases cosmesis 2. Name one indication when moist wound healing would not be appropriate. 3. Match the following AWP to its most common role in wound therapy: A. Hydrogel ______ Absorption of fluid B. Collagen ______ Hydrate wound bed C. Calcium Alginate ______ Stimulates new tissue Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 34 Questions? For more information about this presentation or other educational activities, please contact [email protected] Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 35 References • Slide 7: – Lawrence JC. Dressings and wound infection. Am J Surg; 1994;167:(Suppl 1A):21S–24S. – Lawrence JC, Lilly HA, Kidson A. Wound dressings and airborne dispersal of bacteria. Lancet 1992;339:807 • Slides 10 & 11: – Ovington LG. Hanging wet-to-dry dressings out to dry. Home Healthcare Nurse. 2001;19(8):477-484. Copyright © 2012 Gordian Medical, Inc. dba American Medical Technologies. www.amtwoundcare.com 36 .