Journal of Community Nursing - page 67

JCN
2013,Vol 27, No 4
67
WOUND CARE
Figure 1.
Soggy and macerated skin.
Figure 2.
Excoriated skin (reproduced with kind
permission of Steve Thomas:
.
worldwidewounds.com/2008/march/
Thomas/Maceration-and-the-role-of-
dressings.html).
handle fluid. Appropriate dressing
selection impacts on the wound
healing process and, importantly,
patient comfort and quality of life of
the patient (Romanelli et al, 2010).
Patient comfort and acceptability
are important factors when
determining the success of a
treatment regimen and in optimising
patient wellbeing (International
Consensus, 2012). Clinicians have
a responsibility to their patients to
manage wound exudate effectively,
and reduce the occurrence of harm
(Department of Health [DH], 2009).
SUPERABSORBENT DRESSINGS
Superabsorbent dressings, a new
generation in wound care technology,
are made of superabsorbent polymers
(SAP). They have been developed
to help clinicians manage and treat
heavily exuding wounds, as they have
a greater absorption capacity than
traditional foam dressings.
Superabsorbents have the ability
to trap unwanted components of
exudate, such as bacteria, proteases
and inflammatory mediators, within
the core of the dressing (Wiegand
et al, 2011), thereby reducing
MMPs (Eming et al, 2008). They are
also designed to reduce potential
leakage and the risk of maceration,
which in turn, reduces dressing
change frequency. In addition, they
protect the periwound skin from the
corrosive effects of exudate (Langoen
and Lawton, 2009).
In the authors’ clinical
experience, before the introduction
of superabsorbent dressings,
managing exudate was a huge
challenge for both clinicians and
patients. Often the only solution
was to increase the frequency of
dressing changes and/or apply
a thicker (presumably more
absorbent) version of the selected
dressing. However, these solutions
were not ideal and had their own
inherent flaws — in many cases,
the fluid-handling capacity of the
dressings was poor and caused
strikethrough, which could result
in anxiety for the patient and social
isolation (Jones et al, 2008).
Accompanying these problems
was the cost of extra nursing time —
arguably the most expensive aspect
of wound management (Drew et
al, 2007) — combined with the risk
of trauma through more frequent
dressing changes. Dressing change
is often the most common trigger for
pain in chronic wounds (Meaume et
al, 2004), and Gardner (2012) notes
that in situations where exudate is
poorly managed, patients can quickly
loose confidence in the treatment
regimen, which affects concordance.
Appropriate use of superabsorbent
dressings reduces the need for
frequent dressing changes and
reassures patients that their
wounds will not become saturated,
unsightly, or result in problems to the
surrounding skin. It is also incumbent
on clinicians to be mindful of cost
to the organisation — as mentioned
above, dressings and nursing time are
two of the greatest costs associated
with wound care (Drew et al, 2007).
Wound care itself is estimated to
cost the NHS £2.3–£3.1bn each year,
representing up to 4% of total NHS
expenditure (Posnett and Franks, 2008;
Dowsett and Shorney, 2010).
However, as there is a paucity
of research data available on
superabsorbents, some unanswered
questions remain. For example,
Steinlechner et al (2008) suggest
that the polymer network structure
of superabsorbents allows them to
permanently retain liquid in their
core, even under compression therapy.
What this does not tell clinicians,
however, is the potential alteration to
the sub-bandage pressure as a result
of the dressing swelling significantly
in size as it absorbs the exudate.
Similarly, another unanswered
question in the literature is whether
the dressing may become a wounding
agent due to the risk of high pressure
on a vulnerable area?
The British National Formulary
(Joint Formulary Committee, 2011)
classifies several dressings as
superabsorbents or soft polymer
dressings with an absorbent core. The
most commonly used ones are listed
in
Table 1,
together with the cost,
absorption and retention rates.
EVALUATION OF
SUPERABSORBENT DRESSINGS
The primary objective of the
evaluation detailed here was to gain
a greater understanding of clinicians’
requirements and expectations
of superabsorbents.
METHOD
In the authors’ region, clinicians who
regularly treat wounds were asked
to complete a short questionnaire
on their expectations and use of
superabsorbent dressings in the
management of exuding wounds of
varying aetiologies (
Table 2
).
The clinicians were presented
with five 10x22cm KerraMax
®
Care
(Crawford Healthcare, Knutsford)
dressings. The dressings were filled
with warm tap water using a syringe
in volumes of 10ml, 50ml, 100ml,
and 200ml, while one dressing
was left empty. The clinicians were
encouraged to handle and feel
each dressing and then asked their
opinions on the following criteria:
Fluid capacity before
dressing change
Most common reason for
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