Chapter 19 Wound Management, Stoma And Incontinence Products

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Chapter 19 Wound Management, Stoma And Incontinence Products

  1. 1. Chapter 19<br />Wound Management, Stoma and Incontinence Products<br />Reporters: Dune Vienis Karen Rafael& MelodelTorculas<br />BS-Pharmacy 4A<br />University of the Immaculate Conception<br />
  2. 2. WOUNDS<br /> - any damage to the skin caused by mechanical injuries, burns and underlying medical conditions giving rise to ulcers.<br />WOUND HEALING<br /> - a process which involves the growth of fibrous and vascular tissue within the wound and the migration of epithelial cells from the edges of the wound.<br />
  3. 3. TYPES OF WOUNDS<br /> 1. Necrotic Wounds<br /> 2. Sloughy Wounds<br /> 3. Granulating Wounds<br /> 4. Epithelializing Wounds<br /> 5. Exuding Wounds<br /> 6. Infected and Malodorous Wounds<br />
  4. 4. Types of Wounds<br />Necrotic Wounds<br /><ul><li>Covered with a hard, dry, black layer of dead tissue known as eschar.
  5. 5. Often occurs in pressure sores.</li></li></ul><li>Types of Wounds<br />Sloughy Wounds<br /><ul><li>Sloughs are formed as white, yellow or brown soft material formed from dead cells on the surface of the wound.</li></li></ul><li>Types of Wounds<br />Granulating Wounds<br /><ul><li>Red, granular and moist due to the granulation tissue which consists of blood vessels, collagen and other connective tissue, being laid down in the base of the wound.</li></li></ul><li>Types of Wounds<br />Epithelializing Wounds<br /><ul><li>Pink in color as a new epidermis is being formed.
  6. 6. Occurs within 24 hours w/ shallow superficial wounds</li></li></ul><li>Types of Wounds<br />Exuding Wounds<br /><ul><li>Wounds where exudates are produced from granulating and epithelial wounds.
  7. 7. Decreases the wound healing process.</li></li></ul><li>Types of Wounds<br />Infected and Malodorous Wounds<br /><ul><li>Often surrounded by red, hot inflamed tissue, and pus as an indication of infection which delays wound healing.</li></li></ul><li>Traditional Dressings<br />Dressings are used to cover and hide the wound but have a little impact on the healing process.<br />
  8. 8. Absorbents<br />Uses and Application Guidelines<br />Absorbent dressings should not be left directly on moist wound for several reasons:<br /><ul><li> Dehydration of the wound surface
  9. 9. Adhesion
  10. 10. Formation of capillary loops as new blood vessels grow
  11. 11. Shedding of fibers into the wound
  12. 12. Absorption of antibacterial exudate
  13. 13. Strike through of exudate to the outer surface of the skin</li></ul>Purpose:<br /><ul><li>Clean and swab wounds
  14. 14. Absorb excess wound exudate
  15. 15. Apply medicaments to the skin
  16. 16. Protect the wound from future knocks</li></li></ul><li>Bandages<br />Retention Bandages<br /><ul><li>They may be extensible or non-extensible or tubular.</li></ul>Retention Bandages are used to:<br /><ul><li> Protect absorbent dressings and keep them in place
  17. 17. Provide light support for minor sprains
  18. 18. Secure splints</li></ul>The British National Formulary 1996 classifies bandages as retention, support and compression and medicated.<br />
  19. 19. Bandages<br />Support and Compression Bandages<br /><ul><li>The support and compression they give increase with the weight of the dressing and its elasticity.
  20. 20. Non-adhesive products of this type provides light support for strains and sprains.
  21. 21. Elastic web and net bandage provides superior support.</li></ul>Support and Compression Bandage Disadvantages<br /><ul><li> Application and removal can be painful and may damage fragile skin.
  22. 22. Possible sensitivity to ingredients of the adhesive (e.g. rubber).</li></ul>Bandages may be:<br /><ul><li>Self – adhesive
  23. 23. Diachylon – the bandage is warmed prior to application in order to produce adhesion
  24. 24. Cohesive – the bandage adheres to itself but not to the patient’s skin.</li></ul>Support and Compression Bandages<br /><ul><li> Useful in the treatment of fractured ribs and collar bones, leg ulcers, and varicose veins especially in patients who are mobile.</li></ul>The British National Formulary 1996 classifies bandages as retention, support and compression and medicated.<br />
  25. 25. Bandages<br />Medicated Bandages<br /><ul><li> Consist of a cotton bandage impregnated with a medicament formulated in a moist paste (zinc).
  26. 26. Used in the treatment of dermatological conditions (e.g. eczema and inflamed leg ulcers).
  27. 27. Usually covered by a support and compression bandage.</li></ul>The British National Formulary 1996 classifies bandages as retention, support and compression and medicated.<br />
  28. 28. Elastic Hosiery<br />Elastic hosiery performs a similar function to support and compression bandages, but in a more controlled manner.<br />Graduated Compression Hosiery<br /><ul><li>Designed so that the compression is greatest at the ankle and decreases up the leg.
  29. 29. Classified according to the pressure exerted at the ankle.</li></ul>Measurements required for elastic hosiery are:<br /><ul><li>Mid-thigh circumference
  30. 30. Widest part of the calf
  31. 31. Around the ankle
  32. 32. Length of foot.</li></ul>Compression Hosiery<br /><ul><li>Indicated for the treatment of varicose veins, varicose ulcers and venous insufficiency</li></li></ul><li>Class I hosiery is also used prophylactically during pregnancy. Class II and II are used for support of soft tissue injuries. <br />
  33. 33. Adhesive Tapes and Dressings<br />Consist of a backing material coated on one side with an adhesive mass.<br />Different Permeabilities:<br /><ul><li>Permeable to air, water and bacteria
  34. 34. Vapor-permeable
  35. 35. Permeable to air and water vapor
  36. 36. Impermeable to liquid water and bacteria
  37. 37. Occlusive or impermeable.</li></ul>They are used:<br /><ul><li>For securing dressings and appliances
  38. 38. As skin closures for small incisions
  39. 39. For covering infected wounds to prevent contamination</li></li></ul><li>Non-adherent Dressings<br />Paraffin Gauze Dressing/Tulle Gras Dressing<br /><ul><li>Made of cotton and/or viscose gauze impregnated with white or yellow soft paraffin.
  40. 40. Antimicrobial medicaments, e.g. chlorhexidine, may also be included.
  41. 41. Used mainly to treat partial thickness wounds, where soft paraffin reduces dehydration of the</li></ul>wound surface.<br />Non-adherent, or more accurately low-adherent dressings are either a single layer over which another dressing is placed, or multi-layered with the non-adherent layer in direct contact with the wound.<br />
  42. 42. Non-adherent Dressings<br />Knitted Viscose Dressing<br /><ul><li> A dressing having an open structure which allows liquid exudate from the wound to pass through to a superimposed absorbent pad.
  43. 43. Can also be impregnated with povidone-iodine
  44. 44. Used for infected superficial burns and other injuries.</li></ul>Perforated Film Absorbents<br /><ul><li>Consists of three layers with the layer in contact with the wound being a perforated plastic film.
  45. 45. The film minimizes adherence to the wound while the perforations allow excess exudate to pass through to the middle absorbent fibrous layer.
  46. 46. Has four types</li></ul>Non-adherent, or more accurately low-adherent dressings are either a single layer over which another dressing is placed, or multi-layered with the non-adherent layer in direct contact with the wound.<br />
  47. 47. Melolin: Type 1 Perforated Film Absorbent<br />Description<br />Melolin consists of a film of poly(ethylene terephthalate), onto which is bonded an absorbent layer consisting of a mixture of cotton and polyacrylonitrilefibres, backed with a layer of an apertured non-woven cellulose fabric. The plastic film is present to prevent the dressing adhering to the surface of the wound, and is perforated to allow the passage of exudate from the wound into the body of the pad. <br />Indications<br />Melolin may be used on its own to dress dry sutured wounds, superficial cuts and abrasions, and other lightly exuding lesions. It may also be used as the primary wound contact layer for more heavily exuding wounds, if backed by a second absorbent dressing. <br />
  48. 48. Telfa: Type 2 Perforated Film Absorbent<br />Description<br />Telfa consists of a thin layer of absorbent cotton fibres, enclosed in a sleeve of poly(ethylene terephthalate) that is perforated in a regular pattern and sealed along two edges. The plastic film is present to prevent the dressing adhering to the surface of the wound, and is perforated to allow the passage of exudate from the wound into the body of the pad. <br />Indications<br />Telfa may be used on its own to dress dry sutured wounds, superficial cuts and abrasions, and other lightly exuding wounds. It may also be used as the primary wound contact layer for more heavily exuding wounds, if backed by a second absorbent dressing. <br />
  49. 49. Release: Type 3 Perforated Film Absorbent<br />Description<br />Release consists of a textured sleeve of EMA (ethylene-methyl acrylate) open at two ends, surrounding an absorbent core consisting of viscose fibres enclosed between two spreader layers of non-woven tissue. The sleeve, which provides a wound contact layer of low-adherence, is perforated to allow the passage of exudate into the body of the pad. <br />Indications<br />Release is indicated for the management of clean, light-moderately exuding superficial wounds including lacerations, abrasions and sutured wounds<br />
  50. 50. Skintact: Type 4 Perforated Film Absorbent<br />Skintact is a dual-sided, low-adherent perforated film dressings. Protective dressing for low to medium exudating wounds. Double sided for ease of use. Highly conformable. Sterile.<br />
  51. 51. Charcoal Dressings<br />Activated charcoal is used in several dressings to absorb noxious materials and so eliminate offensive odor from infected malodorous wounds.<br />
  52. 52. Modern Wound Management Products<br />Many of the wound management products which have been introduced in the last 20 years affect the wound healing process. Most are vapor permeable, enabling gaseous exchange but preventing dehydration of the wound surface.<br />
  53. 53. Vapor-Permeable Adhesive Films<br />The vapor-permeable properties of these films enable water vapor, but not liquid water, to pass through.<br />Vapor-permeable films are indicated for:<br /><ul><li> Lightly exuding shallow wounds, such as minor burns
  54. 54. Prevention and treatment of superficial pressure sores
  55. 55. Securing cannulae and catheters
  56. 56. Use as sterile drapes during surgery.</li></li></ul><li>Foams<br />Made of polyurethane or silicone to absorb liquid exudates from the wound.<br />Lyofoam®<br /><ul><li> Consists of a hydrophobic polyurethane foam sheet, one side of which has been heated under pressure to produce a smooth low-adherent hydrophilic surface.
  57. 57. Used for lightly to moderately exuding wounds when it needs to be secured by adhesive tape.
  58. 58. The liquid exudate is absorbed into its 0.5 mm thick hydrophilic layer.
  59. 59. Two types: Lyofoam A and Lyofoam C </li></li></ul><li>Foams<br />Made of polyurethane or silicone to absorb liquid exudates from the wound.<br />Kelo-cote®<br /><ul><li> Made in situ by stirring the silicone base with a catalyst for 15 seconds, then pouring into the wound. The foam sets in 3-4 minutes, expanding to about four times its original volume.
  60. 60. The hydrophilic foam absorbs the exudates from the wound surface.</li></li></ul><li>Foam Film Dressings<br />Foam Film Dressings are multilayered products consisting of:<br /><ul><li>an outer vapor-permeable polyurethane film
  61. 61. a central absorbent hydrophilic polyurethane foam or membrane
  62. 62. a low-adherent or adhesive layer.</li></ul>They are recommended for light to moderately exuding wounds such as leg ulcers and pressure sores (Type 1), variety of exuding wounds of limited depth, including leg ulcers, minor burns, and donor sites (Type 2 & 4) and, pressure sores and traumatic injuries (Type 3). <br />
  63. 63. Polysaccharide Beads<br />They are tiny spherical beads of glucose polymers (cardexomer or dextranomer). They are indicated for infected, medium to heavily exuding wounds especially leg ulcers.<br />Iodosorb® ointment is a sterile formulation of cadexomer iodine.  When applied to the wound, Iodosorb cleans it by absorbing fluids, removing exudate, pus and debris and forming a gel over the wound surface.  As the ointment swells, iodine is released, killing bacteria in the wound.<br />
  64. 64. Polysaccharide Beads<br />They are tiny spherical beads of glucose polymers (cardexomer or dextranomer). They are indicated for infected, medium to heavily exuding wounds especially leg ulcers.<br />Iodoflex®consists of individual applications of a cadexomer iodine paste consisting of a macrogol ointment base incorporating sterile, yellow-brown microspheres or beads 0.1- 0.3 mm in diameter. <br /><ul><li>The beads, which are formed from a three-dimensional network of cadexomer - a chemically modified starch, contain elemental iodine within their structure. The paste is presented between two layers of gauze fabric which act as carriers and facilitate application. </li></ul>The iodine content of the beads used to produce the paste is higher than that of standard Iodosorb, in order to produce a final concentration of iodine in the paste of 0.9% w/w. In the presence of aqueous solutions or wound fluid, the beads in the ointment take up liquid and swell, slowly releasing the iodine, which imparts antibacterial properties to the dressing.<br />
  65. 65. Polysaccharide Beads<br />They are tiny spherical beads of glucose polymers (cardexomer or dextranomer). They are indicated for infected, medium to heavily exuding wounds especially leg ulcers.<br />Beads should not be used on dry or lightly exudating wounds, as they may dry out and be difficult to remove.<br />Other available as alternative formulations:<br /><ul><li>Paste
  66. 66. Ointment
  67. 67. Paste enclosed in a nylon bag or gauze</li>

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