Wound care - Revision history

Aidan at 13:29, 29 July 2025

2025-07-29T13:29:49Z

@@ Line 1: / Line 1: @@
 ==Assessment==
@@ Line 9: / Line 38: @@
 **Reevaluate (monitoring of all parameters regularly)
 **Edge (condition of edge and surrounding skin)
 ==Management==
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 ===Local Wound Care===
 ====Wound Cleansing====
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 * Hydrocolloid: Tegaderm Hydrocolloid Dressings
 * Non-adherent: Adaptic, Inadine

Aidan: /* Locally-Availble Brands */

2022-04-03T18:38:29Z

Locally-Availble Brands

← Older revision		Revision as of 18:38, 3 April 2022
Line 150:		Line 150:
	** Calcium alginate (except for tunneling wounds), specialized foam dressings, gauze, gelling fibre, hypertonic gauze ribbon		** Calcium alginate (except for tunneling wounds), specialized foam dressings, gauze, gelling fibre, hypertonic gauze ribbon

	==== Locally-~~Availble~~ Brands ====		==== Locally-Available Brands ====

	* Acrylic: Tegaderm Absorbent Clear Acrylic Dressings		* Acrylic: Tegaderm Absorbent Clear Acrylic Dressings

Aidan at 02:48, 9 January 2021

2021-01-09T02:48:52Z

← Older revision		Revision as of 02:48, 9 January 2021
Line 105:		Line 105:
	*The goal is for the wound to be moist enough to promote healing without being so wet as to promote maceration and irritation		*The goal is for the wound to be moist enough to promote healing without being so wet as to promote maceration and irritation
	*Primarily done using occlusive dressings		*Primarily done using occlusive dressings

			=== Wound Dressing ===

			* The '''primary dressing''' is that which is in direct contact with the wound bed, and is covered by the '''secondary dressing''' which may help to contain exudate

			==== Selection ====

			* By tissue type
			** Epithelium or granulation tissue
			*** Healing wound
			**** Dressing or combination that can remain in place as long as possible to maintain an appropriate moisture balance
			**** Acrylic, calcium alginate, film/membrane, foam, gauze (used for daily dressing changes only), gelling fibre, hydrocolloid, hydrogel, non-adherent synthetic contact layer
			*** Non-healing wound: acrylic, film/membrane, foam, gauze (used for daily dressing changes only), hydrocolloid
			*** Non-healing wound with friable or inflamed tissue: biologic dressings with protease inhibitors, calcium alginate, silver compounds ibuprofen-impregnated dressings
			*** Non-healing wound without inflamed tissue: iodine compounds, honey
			** Slough or eschar
			*** Healing wound
			**** Support autolytic debridement and absorb excess exudate
			**** Acrylic, calcium alginate, film/membrane, foam, gauze (for mechanical debridement), gelling fibre, hydrocolloid, hydrogel, hydrophilic dressing, hypertonic
			*** Non-healing
			**** Gauze ± chlorhexidine derivative
			**** Non-adherent synthetic contact layer ± iodine compound
			* By amount of exudate
			** Wound too dry
			*** Add moisture, require less frequent dressing changes, and prevent trauma with changes
			*** Acrylic, film/membrane, hydrocolloid, hydrogel, hydrophilic dressing, non-adherent synthetic contact layers
			** Wound too wet
			*** Absorb moisture, more frequent dressing changes, protect surrounding tissue from moisture
			*** Calcium alginate, foam, gauze (daily dressing changes), gelling fibre, hypertonic
			* By type of exudate
			** Serous: foams, gauze, gelling fibres
			** Serosanguineous: calcium alginate, absorbable hemostatic agents, non-adherent synthetic contact layers
			** Purulent: charcoal, antimicrobial dressings
			* By periwound tissue
			** Macerated or excoriated
			*** Dry and protect the periwound tissue
			*** Films/membranes, hydrocolloids, hydrophilic dressing
			* For infection, consider antimicrobial agents and hypertonic dressings
			* For wound pain
			** Choose primary dressing to prevent adherence to the wound bed or prevent periwound maceration
			** Foam dressing with ibuprofen, hydrogel, non-adherent synthetic contact layer
			* For deep, undermining, or tunneling wounds
			** Dead space should be filled by packing
			** Calcium alginate (except for tunneling wounds), specialized foam dressings, gauze, gelling fibre, hypertonic gauze ribbon

			==== Locally-Availble Brands ====

			* Acrylic: Tegaderm Absorbent Clear Acrylic Dressings
			* Foam: Mepilex Foam, Aquacel Foam
			* Hydrocolloid: Tegaderm Hydrocolloid Dressings
			* Non-adherent: Adaptic, Inadine

Aidan: /* Topical Antimicrobials */

2021-01-09T02:17:27Z

Topical Antimicrobials

← Older revision		Revision as of 02:17, 9 January 2021
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	*Includes gential violet, methylene blue, honey, iodine, PHMB, silver, and hydrophobic agents		*Includes gential violet, methylene blue, honey, iodine, PHMB, silver, and hydrophobic agents
	**These reduce bacterial burden or disrupt biofilm		**These reduce bacterial burden or disrupt biofilm
	***May be used prophylactically, as well		**May be used prophylactically, as well
	****Iodine is contraindicated in breastfeeding and pregnant women, and in renal disease, and should be used with care in patients with thyroid disease		**Iodine is contraindicated in breastfeeding and pregnant women, and in renal disease, and should be used with care in patients with thyroid disease

	====Moisture Balance====		====Moisture Balance====

Aidan at 02:16, 9 January 2021

2021-01-09T02:16:12Z

Show changes

Maintenance script: Imported from text file

2020-07-04T01:18:02Z

Imported from text file

New page

== Assessment ==

* MEASURE acronym
** Measure (length, width, depth, and area)
** Exudate (quantity and quality): serous, serosanguineous, sanguineous, seropurulent, purulent
** Appearance (wound bed, including tissue type and amount): granulation, fibrin, slough, eschar
** Suffering (pain type and level)
** Undermining (presence or absence)
** Reevaluate (monitoring of all parameters regularly)
** Edge (condition of edge and surrounding skin)

== Management ==

=== Care Plan ===

* Appropriate management includes patient factors, local wound factors, and environmental measures, and requires regular reassessment

==== Patient factors ====

* Manage comorbidities (e.g. diabetes, arterial disease, etc)
* Address risk factors when possible
* Optimize nutrition and hydration
* Manage other infections
* Treat symptoms
* Provide psychosocial support
* Prescribe appropriate antibiotics
* Create and individualized management plan
* Educate the patient and family

==== Local wound factors ====

* See below for more information
* Prevent infection using aspetic technique and universal precautions
* Drain wounds
* Ensure good wound hygiene and protection
* Manage exudate
* Optimize wound bed
** Debride non-viable tissue
** Disrupt biofilm
** Clean with each dressing
** Use appropriate antimicrobial dressings
** Use appropriate antiseptic therapy (each should have at least a 2 week trial)

==== Environmental factors ====

* Ensure a clean environment for wound care
* Store equipment safely
* Educate patient and caregivers
* Review policies and procedures

==== Regular reassessment ====

* Follow wounds over time for changes
* Make adjustments as necessary to management plan

=== Local Wound Care ===

==== Wound Cleansing ====

* Saline, sterile water, tap water, or liquid antiseptics (povidone-iodine, etc)
** The antiseptic solutions often disrupt or penetrate biofilm
** Antiseptics include povidone-iodine, PHMB, OCT, HOCl/NaOCl
* If infection suspected, use antiseptic or surfactant
* Irrigate with gentle pressure; do not scrub

==== Debridement ====

* Removing necrotic or devitalized tissue, including slough, pus, debris, etc, can help healing
** Moist necrotic tissue is an excellent medium for bacteria
* '''Selective''' (only non-viable tissue) generally preferred over '''non'''-selective debridement
* Specific techniques include:
** '''Mechanical:''' most common. Physically removes the tissue.
*** Wet-to-dry dressing: apply wet tissue, allow to dry, then remove. This causes pain and is discouraged
*** Irrigation: with 4-15 psi can dislodge bacteria and debris. Can be done with syringe and 18-19 gauge needle
*** Polyacrylic microfibre pads: now out of favour
*** Low-frequency ultrasound
** '''Autolytic''': allows body's own immune system to get rid of dead tissue (e.g. liquefaction of eschar)
*** Scoring or crosshatching the eschar with a scalpel
*** Using dressings that promote autolysis
*** Must keep wound clean
** '''Enzymatic:''' the use of exogenous proteolytic substances such as collagenase
*** Dry eschar must be kept moist for the enzymes to work
** '''Surgical:''' converts a chronic non-healing wound into an acute wound by a surgeon in an OR
** '''Conservative sharp:''' removal of devitalized tissue with a scalpel or scissors
** Chemical: e.g. sodium hypochlorite (NaOCl), but is non-selective and can damage healthy tissue
** Hydrosurgical: uses specialized tools and a surgeon
** Biological/biosurgical: maggots

==== Bacterial Balance ====

* Antimicrobial includes both antibiotics and antiseptics
* Bacterial burden ranges from contamination to colonization, local infection, spreading infection, and finally systemic infection
** Intervention is required for any infection
** Biofilm should be considered for any infection

===== Topical antimicrobials =====

* Includes gential violet, methylene blue, honey, iodine, PHMB, silver, and hydrophobic agents
** These reduce bacterial burden or disrupt biofilm
*** May be used prophylactically, as well
**** Iodine is contraindicated in breastfeeding and pregnant women, and in renal disease, and should be used with care in patients with thyroid disease

==== Moisture Balance ====

* The goal is for the wound to be moist enough to promote healing without being so wet as to promote maceration and irritation
* Primarily done using occlusive dressings