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08.03 Different Dressings

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Overview

  1. Dressing uses
    1. Stop bleeding
    2. Ease pain
    3. Protect from infection
    4. Absorb exudate
    5. Wound debridement
    6. Reduce patient stress
  2. Primary dressing
    1. Applied directly to wound
    2. Help healing process
  3. Secondary dressing
    1. Secure primary dressing
    2. Do not come in contact with wound

Nursing Points

General

  1. Dressing uses
    1. Stop bleeding
    2. Ease pain
    3. Protect from infection
    4. Absorb exudate
    5. Wound debridement
    6. Reduce patient stress
  2. Primary dressing
    1. Applied directly to wound
    2. Help healing process
  3. Secondary dressing
    1. Secure primary dressing
    2. Do not come in contact with wound

Assessment

  1. Types of dressings
    1. Gauze
      1. Woven and nonwoven
        1. Square
        2. Rolls
        3. Sheets
        4. Packing strips
      2. Advantages
        1. Non-occlusive
        2. Permeable
        3. Inexpensive
      3. Disadvantages
        1. Drying out effect
        2. May need topical agent
      4. Primary or secondary dressing
      5. May be called
        1. 4×4
        2. ABD (Abdominal dressing)
    2. Transparent films
      1. Clear polyurethane and adhesive
      2. Thin, flexible
      3. Advantages
        1. Allows visualization of wound
        2. Highly elastic
        3. Contours to body
      4. Disadvantages
        1. Patient allergy to adhesive
      5. Primary or secondary dressing
      6. May be called
        1. Tegaderm™
        2. Opsite™
    3. Hydrogels
      1. Water or glycerin based
      2. Forms
        1. Sheets
        2. Gels
        3. Impregnated gauze
      3. Advantages
        1. Gives moisture to dry wounds
      4. Disadvantages
        1. Absorbs minimal water
        2. Less effective barrier to bacteria
        3. Requires a secondary dressing
        4. May dehydrate easily
    4. Foam
      1. Advantages
        1. Comes in various shapes/sizes
        2. Does not adhere to wound
          1. Easy removal
      2. Disadvantages
        1. Expensive
    5. Alginates
      1. Made from seaweed
      2. Reacts with wound to form gel
      3. Advantages
        1. Moist wound environment
        2. Highly permeable
        3. Non-occlusive
      4. Disadvantages
        1. May trap bacteria
        2. Gel sometimes confused for infection
        3. Require secondary dressing
    6. Composites
      1. Multi-layer dressing
        1. Inner layer – Protects wound
        2. Middle layer – Wicks away moisture
        3. Outer layer – Bacterial barrier
      2. Advantages
        1. Used as primary or secondary dressing
        2. Moist wound environment
      3. Disadvantages
        1. Expensive
      4. May be called
        1. Stratasorb
    7. Hydrocolloids
      1. Absorbs exudate slowly
      2. Advantages
        1. Absorbtion capability
        2. Variety shapes/sizes
        3. Lower infection rates than gauze
      3. Disadvantages
        1. May injure fragile skin
        2. Cannot be used with infected wound
      4. May be called
        1. Honeycomb
    8. Pressure
      1. Advantages
        1. Controls bleeding
      2. Disadvantages
        1. Patient discomfort
      3. May be called
        1. Compression dressing
    9. Negative pressure
      1. Vacuum dressing
      2. Advantage
        1. Enhance/promote wound healing
      3. Disadvantage
        1. Expensive
        2. Patient discomfort

Therapeutic Management

  1. Indications
    1. Gauze
      1. Various wound types
    2. Films
      1. Wounds in awkward locations
      2. Partial thickness wounds with minimal drainage
      3. Friction protection
        1. Bony prominences
    3. Hydrogels
      1. Dry wounds
      2. Minor burns
      3. Wounds with granulated tissue
      4. Partial to full thickness wounds
    4. Foams
      1. Infected wounds
      2. Wound cavities
      3. Leg ulcers
      4. Surgical wounds
      5. Skin grafts
    5. Alginates
      1. Pressure ulcers
      2. Diabetic foot ulcers
      3. Cavity wounds
      4. Surgical wounds
      5. Partial thickness burns
    6. Composites
      1. Partial and full thickness wounds
    7. Hydrocolloids
      1. Clean, non-infected wounds
      2. Dry wounds
    8. Pressure
      1. Bleeding wounds
    9. Negative-pressure
      1. Second and third degree burns
      2. Acute and chronic wounds
        1. Pressure ulcers
        2. Diabetic ulcers

Nursing Concepts

  1. Comfort
  2. Infection control
  3. Tissue/skin integrity

Reference Links

Video Transcript

Hey guys today we are going to talk a little bit about the different dressings that are out there in the clinical world! I’m going to go over some of the most common but just know there are a ton of dressing types and brands.  I personally have noticed that each facility refers to dressings as different names and thats ok its just something to get used to! With that said dressings will be most commonly the providers choice but are typically chosen based on the patient, procedure or surgery, or the type and severity of wound.

So what is a dressing used for?  Well probably the most important use of a dressing is to protect the patient from infection.  We also use dressings to make a patient more comfortable, absorb any fluid from the wound, and also guys patients really don’t want to look at wounds or bleeding so dressings actually reduce stress.  If the dressing is impregnated it can also decrease pain and also stop bleeding and debride wounds if necessary. Also guys for your knowledge dressings can be considered primary or secondary. Primary dressings come in direct contact with a wound while secondary dressings secure a primary dressing and do not come in contact with the wound.

Lets jump in to some of the different types of dressings.  I’m sure you have all seen and heard of gauze dressings as these are super common and used all the time for a variety of reasons. Gauze can be woven or nonwoven, non-occlusive which means that it may require a secondary dressing or something to keep it in place.  It’s permeable and inexpensive which is definitely an advantage but it may dry out the wound and may need a topical agent. You might hear gauze be called a 4×4 or even an ABD or abdominal pad which is also made of gauze.

Transparent films are another very common dressing as most places use these dressings sometimes they are called a tegaderm or opsite as seen here in the picture to secure an IV site.  These dressings are made of clear polyurethane and adhesive, they are great to use because of their flexibility and they allow us to see the wound without removing anything although I will say sometimes I see providers cover these up to ease the patient’s mind a little.  These dressings are used for wounds in awkward locations, partial thickness wounds, and also sometimes to protect bony areas on patients. Keep in mind if a patient is sensitive to adhesive this dressing might not be the best choice!

Hydrogel dressings, as I am sure you can guess by the name are water or glycerin based.  They are great because they give moisture to dry wounds but they are not great because they are not the most effective as a barrier to bacteria.  Hydrogel dressings do require a secondary dressing to secure them. They come in many forms like the gauze you see here that can be impregnated to create a hydrogel dressing.  Keep in mind these dressings absorb very minimal water, they may dehydrate easily and they are often used for dry wounds, minor burns, and partial to full thickness wounds.

Foam dressings as you can see here come in various shapes and sizes.  The area that does not have adhesive, as you can see here, will not adhere to the wound which makes it easy to remove but they definitely can be expensive.  Foam dressings are used for infected wounds, in wound cavities, surgical wounds, and skin grafts.

Alginate dressings are super interesting because they are actually made from brown seaweed as you can see here.  The seaweed reacts with the wound to form a gel. Alginates are good because they provide a moist wound environment, they are highly permeable and non-occlusive to the wound so it will require a secondary dressing.  A disadvantage of alginates is they can trap bacteria but this can be washed away when changing dressings and sometimes the gel that is created is confused with an infection! Alginates are often used for pressure and diabetic ulcers, cavity and surgical wounds, and partial thickness burns.


Composite dressings are multi-layer dressings as you can see in this picture I took!  The inner layer protects the wound, the middle layer wicks away moisture, and the outer layer is a bacterial barrier.  Composites create a moist wound environment but they can be expensive. We use composite dressings most commonly for partial and full thickness wounds.


Hydrocolloid dressings come in many shapes and sizes and one of them may be referred to as a honeycomb dressing because it looks just like a honeycomb.  Hydrocolloid dressings absorb exudate or drainage slowly and they do have a lower infection rate than other dressings. Keep in mind though that hydrocolloid dressings can injure a patient who has thin or fragile skin and this is super important they can only be used on clean wounds that are not infected.


Pressure dressings are just like they sound, they apply pressure to a wound to most commonly control any bleeding a patient may have.  They can be uncomfortable for patients but they are inexpensive and serve a super important purpose of inducing clotting!


Negative pressure dressings are typically used to chronic wounds although sometimes acute wounds using a vacuum system as you can see here to enhance and promote healing.  Negative pressure wound therapy can definitely be expensive and uncomfortable to a patient.


Okay guys lets review!  Gauze dressings are woven or nonwoven, they are non-occlusive, and may dry out a wound while transparent fims are occlusive, you can visualize the wound, and they are thin and flexible and contour to the body.  Hydrogel dressings are water/glycerin based and they moisturize the wound while foam dressings do not ahere to the wound but are expensive. Hydrocolloid dressings absorb exudate and they must be used on clean, uninfected wounds.  Composite dressings are multi-layer, they provide a moist environment and are expensive. Alginates are made from seaweed that creates a gel, permeable but may trap bacteria. Pressure dressings control bleeding while negative pressure dressings use a vacuum to promote healing of chronic wounds.


When we think of the nursing concepts that we can apply to the many, many dressings that exist out there, there are definitely a few that come to mind!  Infection control for sure as that is a huge purpose of dressings, keeping the patient comfortable, and protecting the surrounding tissue and skin integrity.


We love you guys! Go out and be your best self today! And as always, Happy Nursing!

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