1. Basic Wound Treatments
Sean Craig, RN BSN, CWCN
Wound Program Coordinator
Alexandria, LA VA Medical Center

2. OBJECTIVES Describe factors to consider when selecting a dressing
Identify commonly used dressings
Select appropriate dressings based on wound assessment
Describe the advantages and disadvantages of different dressing types

3. “I do wound care.”

7. What am I supposed to do now?
How many of you feel like a monkey with a math problem when you are presented with a chronic wound? Not really sure of which direction to take? Don’t feel bad, this can be a confusing matter. I want to help make it a little simpler for you.

8. V. Vascular status. – (ABI, Venous Doppler,
V Vascular status? – (ABI, Venous Doppler, Consult vascular specialist)
O Off load – (pressure on boney prominences)
I Infection – (Treat infection, biopsy wound)
D Debride – (Remove any devitalized tissue after vascular status is established)

9. Factors to Consider Prior to Selecting a Wound Treatment
What is the causative factor
What is the goal of the treatment
Is the wound bed wet or dry
Is the wound infected
Does the wound have an odor

10. Factors to Consider Prior to Selecting a Wound Treatment
Is there dead tissue in the wound bed
Is there dead space in the wound bed
Where is the location of the wound
Is the selected treatment manageable for staff and patient (Pain, time, ability)
What is the cost of the treatment

11. Dressings and Treatments
Wound Cleansers
Alginates
Hydrofibers
Contact Layers
Foams
Gauze
Hydrocolloid
Hydrogel
Specialty Absorptive
Transparent film
** Some of these dressings must be special ordered and may not be available at all facilities
Antimicrobials
Collagens
Debriding agents
Skin substitutes/grafts
Skin sealants
Moisture barrier ointments
Negative Pressure Wound Therapy
Composites

12. Wound Cleansers
Solutions used to clean and irrigate debris from wound bed
Optimum irrigation pressure is 4-15 PSI
Spray from CarraKlenz
35cc syringe with 19 angiocath

13. Antiseptics
Povidone iodine, ¼ strength Bleach, Acetic Acid, Hydrogen Peroxide.
Cytotoxic to bacteria as well as WBC and fibroblasts
Use with caution short term for microbial control and odor control.

14. Bleach solution Is a type of hypochlorite solution.
It is made from bleach that has been diluted and
treated to decrease irritation. Chlorine,
the active ingredient in this solution, is a strong
antiseptic that kills most forms of bacteria and
viruses.
For wound management, use as an irrigant, cleanser, or the wetting agent for a wet-to-moist dressing ; 0.25% strength
Protect surrounding intact skin with a moisture barrier ointment or skin sealant as needed.
Used to prevent and treat skin and tissue infections that could result from cuts, scrapes and pressure ulcers. It is also used before and after surgery to prevent surgical wound infections.
Controversial among wound care providers

15. Alginates Made from seaweed Absorptive
Non-adhesive, non-occlusive, and conforms to wound bed.

16. Alginates Indications: Contraindications: Moderate to heavy exudate
Hemostasis with minimal bleeding
Promotes autolysis
Change frequency based on manufactures guidelines
Contraindications:
3rd degree burns
Dry wounds

17. Hydrofibers Soft sterile pads or ribbons
Carboxymethylose fibers that turn into a gel when moistened and conform to wound bed.
Maintains moist wound bed.

18. Hydrofibers Indications: Contraindications: Advantages:
Exudating wounds
Moisten dressing and apply to dry wounds
Contraindications:
Patients with sensitivity to dressing components
Advantages:
May remain in place for 7 days
Available in silver
Will not create a foreign body if left in wound

19. CONTACT LAYERS Protect fragile skin or underlying skin grafts.
Non-adherent layer that will not damage new epithelial tissue.
Allows wicking of exudate and changing secondary dressing without disturbing wound bed.

20. Contact Layers Soft porous non-adherent silicone
Allows exudate to pass to secondary dressing
May be left in place for up to 14 days depending on condition of wound
Allows decreased primary dressing change
If you see this dressing on a wound check orders before removing
Can be cut to size.

21. Contact Layers: Petrolatum Gauze
Occlusive dressing
Will not adhere to wound bed.
Maintains moisture
Some are yellow with a bacteriostatic action
May trap heavy exudate underneath causing maceration.

22. Contact Layers
Primary dressing made of porous cellulose acetate impregnated with petroleum.
Prevents secondary dressing adherence
Prevents pooling of exudate.
Can be cut to size.

23. FOAM:
Polyurethane foam with cleansing agent that is activated with exudate and slowly released to clean the wound bed.
Glycerin keeps wound moist, reduces odor, increases comfort.
Keeps wound moist and wicks extra moisture away.
Looses Wick property when saturated.
Use as a primary dressing only. (no enzymes, antimicrobials)
can be used for excessive drainage
Do not clean wound bed between dressing changes.
May adhere to wound bed.
***Photo from Patricia Seemann, BSN, WCC. WOCN 40th Annual Conf.

24. Foam Soft foam with absorptive capacity
May combine with enzymes and antimicrobials. (excludes silver foam)
Used for partial and full thickness wounds with exudate.
Silicone backing keeps dressing from adhering to wound bed

25. Foam
Methylene Blue /Gentian Violet provide broad-spectrum bacteriostatic protection against a variety of microorganisms including MRSA and VRE.
Approved for use on all types of wounds except third degree burns
Must be moistened with NS squeezed out and secured to the wound bed with an appropriate secondary dressing
Provides gentle debridement
Provides odor control
Change every 1 to 3 days; may require more frequent change with infected wound, indicated by the dressing changing color from blue to white.
Available in Pharmacy, Physician order

26. Hydrocolloid Elastomeric, adhesive, and gelling agents
Adopted from ostomy products
Absorbs minimal exudate and forms a gel keeping wound moist.
Autolytic debridement
May have an odor with removal, do not confuse with infection
Do not use in wounds that require monitoring more than 2 times a week
Avoid with neutropenic patients, unless pallative

27. Hydrogel
Water or glycerin based gel or sheets that provide moisture to wound bed
Softens necrotic tissue and keeps wound bed moist
Not for heavily draining wounds
Will not adhere to wound.
May macerate periwound skin
Daily dressing changes

28. Absorptive Dressings
Highly absorbent multi-layered cellulose dressing with non-adherent wound contact layer.
Air permeable backing
Some may be cut

29. Transparent film
Polyurethane with porous adhesive layer that allows gas and moisture vapor transmission (semi-occlusive)
Preventative as primary (barrier film)
Secondary dressing for wounds.
Do not use as a primary dressing for skin tears.
Autolytic debridement

30. Antimicrobials Absorbs slough and exudate
Iodine is absorbed and gel absorbs exudate turning white when deactivated
Active up to 72 hours
Do not use on patients with thyroid disorders

31. Antimicrobials: Silvers
Antimicrobial effects
Many types: foams and gels
Not compatible with petroleum and deactivates enymes.
Remove prior to MRI
May stain tissues

32. Debriding Agents: Collagenase
Enzyme that digests collagen in necrotic tissue. Does not effect healthy collagen.
May be mixed with bacitracin to optimize PH.
Do not mix with silvers.
Slow acting
Change daily

33. Debriding Agents: Honey
Keeps wound moist
Low PH and high osmotic activity
Aids in autolytic debridement
Decreases odor
May have antimicrobial effects
Used as a primary dressing/non-adherent
Can be left in wound bed for up to 7 days
May increase wound exudate the first few days of use

34. Composites Dressings made up of a combination of products
Provide multiple functions (Bacterial barrier, absorptive layer, adhesive border)
See manufacturers’ recommendations
May adhere to wound bed
Requires intact peri-wound skin
May be used as primary or secondary dressings
Appropriate for minimal to heavy exudate, granulation, or necrotic tissue

35. Border Dressings
Non-traumatic adhesive, Allowing for routine skin assessments and removal without skin trauma because of the silicone technology
An occlusive outer covering
Shape that covers the sacrum and separates the gluteal folds.
Prevents friction between the gluteal skin folds
Absorbs exudate/moisture
Providing a barrier between the bed surface and the skin for patient positioning, reduces pressure/friction
Resisting minor fecal incontinence due to the occlusive outer layer.
Recommended areas of use: Sacral wounds caused from pressure, friction or shear; prevention. Manufacturer's suggested wear time: Up to 7 days.

36. Border Heel Self-adherent - no tape needed
Shaped to fit heels – no need to cut or adapt/ may also be used on elbow, shoulders
Non-traumatic silicone backing, Minimize pain and trauma at dressing changes
Manages exudate and decreases maceration
Decreases pressure, shear, and friction to area of decreased soft tissue.
Can remain in place for several days depending on the condition of the wound
Can be removed and replaced for assessment without losing its adherent properties
Continue to use heel relief boots.

37. Dressing removal- silicone Adhesive releaser
Easily and rapidly releases dressings or appliances adhered to skin
Helps minimize trauma with “no touch” removal
Helps minimize skin stripping when removing tape

38. Products to assist with repositioning, offloading, and moisture balance
Turn and reposition sheet
Heel Relief boot
waffle cushion

39. Dress this Wound

40. Dress this Wound

41. Dress this Wound

42. Dress this Wound

43. Dress this Wound

44. Dress this Wound

45. Dress this Wound

47. V. Vascular status. – (ABI, Venous Doppler,
V Vascular status? – (ABI, Venous Doppler, Consult vascular specialist)
O Off load – (pressure on boney prominences)
I Infection – (Treat infection, biopsy wound)
D Debride – (Remove any devitalized tissue after vascular status is established)

48. References
Baranoski, S. & Ayello, E.A. (2004). Wound treatment options. In Wound Care Essentials: Practice Principles ( ). Philadelphia, PA: LWW.
Rolstad, B.S.& Ovington, L.G. (2007). Principles of Wound Management. In Bryant,R.A. & Nix, D.P. (eds) Acute & Chronic Wounds: Current Management Concepts ( ). St. Louis, MO: Mosby Elsevier.