Wound Dressings

Question 1

How do dressings maintain homeostasis?

Answer 1

• Degree of hydration (wound bed and person)
• Sufficient blood perfusion
• Availability of growth factors
• Appropriate oxygen partial pressure
• Acceptable levels of microflora (cells and growth in wound)
• Maintain voltage gradients

Question 2

Factors to consider with dressings

Answer 2

• Moisture (Soak up or provide)
• Gaseous exchange (O2)
• Thermal insulation
• Impermeability to micro-organisms

Question 3

One degree increase in skin temperatue by one degree increases wound healing by ____%

Answer 3

33

Question 4

What is strike through? Why is it bad?

Answer 4

• Strike through is when drainage gets out of the dressing
• Create a bacteria cross bridge (Change immediately!)

Question 5

What is an occlusive dressing? What are the advantages to using one?

Answer 5

• Means to occlude wound (block something off)

Advantage:
* Faster healing
* Autolytic debridement
* Decreased pain at wound site
* Control exudate drainage
* Cost effective (person that changes dressing)

Question 6

Water Vapor Permiability - Occusive to Non-Occlusive

Answer 6

Question 7

Can you cover an infected wound? What dressing should you use on it?

Answer 7

• No, you cannot cover an infected wound
• Must be semi-occlusive or non-occlusive

Question 8

Gauze Dressing

Answer 8

• Primary or Secondary
• Open weave or Fine Mesh
  – Open weave will get stuck in granulation tissue (unless special dressings)
  – Fine mesh will not get grow into; can be used for tunnels
• Plain, pre-moistened or impregnated

Question 9

Primary vs Seconday Dressing

Answer 9

Primary: Next to the wound bed
Secondary: What goes over the top of it

Question 10

Calcium Alginate/Hydrofiber Dressings - Advantages

Answer 10

• Absorb up to 20X weight in exudate
• Form a gel over wound
• Supports enzymatic debridement
• Fill in dead space
• Easy to apply and remove

Primary Dressing

Must stay in wound bed or it will macerate the skin.

Question 11

Calcium Alginate/Hydrofiber Dressings - Disadvantages

Answer 11

• Not recommended for light exudate or dry eschar
• Requires 2nd dressing as a cover dressing
• Can dehydrate wound

Question 12

Calcium Alginate needs to be changed every ____ hours

Answer 12

24-72 hours

Question 13

Silver Impregnated Dressings

Answer 13

AQUACEL® Ag is the first antimicrobial dressing that:
* Provides immediate and sustained antimicrobial activity to kill many types of bacteria and fungi.
* Offers the unique gelling properties of Hydrofiber® technology enabling dressing to gel on contact with the wound fluid creating a large fluid-absorption capacity
* Locks bacteria within the gelled AQUACEL® Ag fibres7 away from the wound bed.
* AQUACEL® Ag is indicated for use on acute and chronic wounds including burns, surgical wounds, diabetic foot ulcers, pressure ulcers and leg ulcers.

Question 14

What is Impregnated Gauze - MeSalt

Answer 14

NaCl solution in fine mesh gauze

Question 15

Impregnated Gauze - MeSalt
Advantages

Answer 15

• Permeable to oxygen
• Can be used with infected wounds
• Excellent absorption (30x weight)
• Suppresses growth of E coli, staph, pseudomonas
• Easy to apply and remove
• Does not allow granulation to grow into dressing

Question 16

Impregnated Gauze - MeSalt
Disadvantages

Answer 16

• Must be pre-moistened with dry eschar or lightly exudating wounds
• Requires a 2nd dressing as a cover dressing

Question 17

Impregnated Gauze - MeSalt must be changed every ____ days

Answer 17

1-3

Question 18

Impregnated Gauze - Aquaphor
Advantages

Vaseline impregnated gauze

Answer 18

• Permeable to oxygen
• Can be used with infected wounds
• Easy to apply and remove
• Does not stick to wounds
• Can be used for burns or graft sites

Question 19

Impregnated Gauze - Aquaphor
Disadvantages

Answer 19

• Does NOT absorb drainage
• Requires a secondary cover dressing

Question 20

Impregnated Gauze - Aquaphor needs to be changes every ____ days

Answer 20

2-3

Question 21

Semi-permeable Film (SPF)
Advantages

Answer 21

• Impermeable to bacteria
• Maintains moist environment
• Promotes autolytic debridement
• Allows visualization of wound
• Less trauma with changes unless done too soon
• No secondary dressing needed

Tegaderm

Question 22

Semi-permeable Film (SPF)
Disadvantage

Answer 22

• Do not use for large exudates
• Requires intact dry borders for adhesives
• Difficult to handle
• May not stay in place in high friction areas

Question 23

Semi-permeable Film (SPF) needs to be changes every ____ hours

Answer 23

24-72

Question 24

Semi-permeable Foam
Advantages

Answer 24

• Faster healing
• Moist wound environment
• Good exudate absorption
• Fair moisture vapor transmission
• Fair oxygen permeability
• Maintains body temperature in wound

Question 25

Semi-permeable Foam Disadvantages

Answer 25

* Non-adhesive * Clinician must supply tape or covering * Easily displaced by mechanical forces * More expensive than SPFs, but still cost effective vs. gauze

Question 26

How often does Semi-permeable Foam need to be changed?

Answer 26

1-3 days

Question 27

Hydrocolloid Thin Advantages | Semipermeable

Answer 27

* Impermeable to bacteria * Maintains moisture * Autolytic debridement * Self-adhesive, molds well * Provides limited to moderate absorption * May be left in place for long time * Minimal trauma when removed * Waterproof * Lowest oxygen gradient that may promote granulation tissue

Question 28

Hydrocolloid Thin Disadvantages | Semipermeable

Answer 28

* Do not use if heavy exudate or eschar * Not transparent

Question 29

Hydrocolloid Thins need to be changed every ____ days

Answer 29

3-7 days

Question 30

Hydrogels (HDG) Advantages

Answer 30

* Soothing, reduce pain * Rehydrate wound bed * Autolysis * Minimal/moderate absorption * Easily removed (without borders) * Leaves no residue in the wound bed * Transparent

Question 31

Hydrogels (HDG) Disadvantage

Answer 31

* **Cannot be used in infected wounds** * Do not use if heavy exudate * May required secondary dressing (non-boarded) * Some may dry out

Question 32

Hydrogels need to be changes every ____ hours

Answer 32

8 to 72

Question 33

What dressings can be used with an infected wound

Answer 33

Gaze to Hydrocolloid Thin

Question 34

Hydrocolloid Thick (HDCi) Advantages | Impermeable

Answer 34

* Impermeable to bacteria * Maintains moisture * Autolytic debridement * Self-adhesive, molds well * Provides moderate absorption * May be left in place for long time * Minimal trauma when removed * Waterproof

Question 35

Hydrocolloid Thick (HDCi) Disadvantages

Answer 35

* May **not be used on infected wounds** * May **not be used on arterial insufficient wounds (ABI <.8)** * Not transparent * May tear fragile surrounding skin when removed * Leaves adhesive residue on surrounding skin

Question 36

Hydrocolloid Thick (HDCi) needs to be changed every ____ days

Answer 36

3-7

Question 37

Growth Factor Stimulation

Answer 37

Regranex Gel * Recombinant human platelet-derived growth factor (rh-PDGF) * Actively stimulates angiogenesis and granulation tissue formation

Question 38

Types of Grafts: Autograpft Allograft Homograft Heterograft

Answer 38

* Autograpft: tissue from same patient * Allograft: tissue from another person * Homograft: tissue from same species * Heterograft: tissue from different species; SIS is good forepithelialization for diabetic and AI patients.

Question 39

The "VAC"

Answer 39

* Vacuum Assisted Closure * Continuous assisted drainage from wound bed prevents maceration * Physically assists neovascularization and wound contraction through positive pressure * Can prepare wound bed for skin grafts

Question 40

VAC precautions

Answer 40

* Active bleeding (anticoagulation) * Difficult hemostasis in the wound bed * Patients on anticoagulants

Question 41

VAC Contrindications

Answer 41

* Large amounts of necrotic tissue in the wound bed * Cancer in the wound margins * Untreated osteomyelitis * Fistulas to organs or body cavities

Question 42

Collagenase and ____ can never be used together

Answer 42

Silver Dressings