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Wound Assessment and Dressing Selection Noreen Campbell RN BScN MA IIWCC Lt CSW TCS Systems North Saanich, BC, Canada.

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Presentation on theme: "Wound Assessment and Dressing Selection Noreen Campbell RN BScN MA IIWCC Lt CSW TCS Systems North Saanich, BC, Canada."— Presentation transcript:

1 Wound Assessment and Dressing Selection Noreen Campbell RN BScN MA IIWCC Lt CSW TCS Systems North Saanich, BC, Canada

2 Wound Healing Process Hemostasis immediate Inflammation Day 1-4 Proliferation Day 4-21 Epithelialisation Maturation/Remodeling Day years Kane

3 Homeostasis – first 24 hours

4 Inflammation 1-4 days

5 Proliferation day

6 Fibrin, Collagen Bridge to Skin Yellow, caramel like surface, pain Granulation peeking, epithelial starting 6

7 Epithelialization

8 Maturation/Remodeling up to 2 years Well healed scar – always a scar…weaker tensile strength Normal Hypertrophic –With incision Keloid –Extends to normal tissue

9 Potential for Healing Individual assessment Wound Care

10 10 Tissue depth? Probe…

11 Infection Heat Redness Swollen Pain –Not with neuropathy –Blood Sugars elevated 11

12 Cochrane Review 2011 water for cleansing Infection: Assess Clean Wound Wound Cleansing –Potable tap water –Saline –Boiled cooled water Mild soap –Dove no dye or perfume

13 Wound Imperatives and Antimicrobials ProductFunctionCost * CDA Promogran Prisma is above with silver MMP binding ON the wound “let it dance with the wound” Promogran 28 sq cm $ sq cm $55.95 Prisma 28 sq cm $26.95 Iodosorb cadexomer iodine Cochrane level support red. Infection, promote healing, but pain reports may limit use Ointment $ Gm Paste $58.95not recommended Inadine povidone iodine Non-adherent sheets9.5x9.5cm $2.30 Silver dressingsSupport of efficacy lackingExpensive 4x4” $18.95 Honey dressingsSupport of efficacy lackingExpensive $ gm Canadian Diabestes Association Store –

14 Eschar: risk infection and delay healing Stable Black Dry Hard Wet Drainage Marbling Breakdown

15 Debride Unstable Eschar Drainage Fluctuance Iodine produce will become paler with release of iodine

16 DebridementAdvantageDisadvantage SurgicalFastSurgery, expensive, pain, non-selective Conservative SharpBedside, pain,Scope of practice Skill MaggotSelective, disinfect wound, stimulate healing Ordering process, $120 treatment, dressing change 48 hours Enzyme (Santyl)Selective$ tube, weeks Mechanical Wet to dry Saline Compresses Irrigation Shower Non-selectivePain (wet to dry) Labour - compresses Autolytic (natural) Moisture (gel) Natural, selectiveSlow 16

17 MDT 4 days 17

18 What type of debridement? 18 92yo anesthetic risk Trauma scooter accident Inner thigh

19 Differentiation: drainage or allergy? Contact Dermatitis –pattern Sensitivity –Localized to wound and product Drainage –Direction of pooling

20 Blister: drain if risk expansion 20

21 Edge: Undermined, rolled edge Packing – think ‘wicking’.

22 Dressing: think ‘Band Aid’ ‘protect, absorb, hold layers’ FunctionProductCost ProtectionSurface protection Silicon (7 days) severe pain or fragile Mepitel $ ”x7” Inadine (antimicrobial+)Inadine $2.30 4”x4” Jelonet (petrolatum mesh)10cmx40cm $3.50 Tin 10 cm x 7M $36.00 Adaptic non-adherent $3.75 3”x8” 3pkg AbsorbAlginates – lowest absorb., sticks if insufficient exudate HydrocolloidMinimal exudate containment and hold Do not recommend There are no standards for stating performance of dressings (i.e. absorption). Standard for approval ONLY safety not efficacy.

23 FunctionProductCost FoamRated high exudate but generally <5ml 4”x4” protection layer built into dressing Fragile skin Adhesive border strength varies and can damage skin, change when drainage at border Mepilex 3”x3” $3.75 Allevyn Gentle 3x3 $3.95 Tegaderm 3.5”x3.5” $4.59 **do not recommend unless dressing one week Acrylicpoor expensiveDo not recommend Absorbent Dressing Classic Pads- incontinent pad 17x20cm can hold 750ml (stay dry) 10x20cm 3 $1.95 Ultra 17x40cm 2 $3.00 Classic super 50 $33.00 Gauze – chronic wound or > 48 hours Clean not Sterile poor absorption Adequate cover dry gangrene 2x2” 200 $1.95 4x4” 200 $6.50 Non-sterile clean package Cast paddingHolds dressings paddingProtouch 17 rolls $17.59 Single roll $1.50

24 FunctionProductCost Tape – peal factor is tension to remove, adhesive is ability to hold Fragile skin may strip or tear. *consider skin strength **how many dressings ***how frequent Order of peal factor Transpore (3M) +++ Kind Removal (3M) ++ Mepitac silicon + Transpore $1.65 roll Kind Removal silicon roll $6.95 Mepitac silicon $11.50 Stockinet - TubiFast Roll or meter* Blue normal limb adult Yellow larger Blue 10M $16.95* Yellow 10M $10M $23.75 Tubigrip elasticSize determines pressure – straight may constrict limb Skin barriersIf you need these the products are not appropriate SteroidsGood for immediate skin reactions i.e venous excema

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