Journal of Community Nursing - page 70

70 JCN
2013,Vol 27, No 4
WOUND CARE
Figure 3.
How much fluid would a 10x22cm dressing absorb before it should be changed?
50mls
1
1
13
6
10mls
75mls
100mls
200mls
Figure 5.
What other issues do wet wounds present?
Increased wound size/
excoriation to periwound
Odour
Maceration
Patient comfort
Infection
Leakage
Body image
Patient wellbeing
Pain
Delayed healing
0
2
4
6
8
10
12
14
Dressing becomes
too heavy
To check on
condition of
wound
Patient comfort
Strikethrough
to outer bandage
Level of exudate
0
2
4
6
8
10
12
Figure 4.
What is the most common reason for changing a dressing before it has reached
full capacity?
if exudate occurs as a result of
uncontrolled oedema, venous disease
or infection, these must be the
primary goal of management.
The importance of treating the
underlying condition as well as the
symptoms is reflected in
Figure 4,
where nine clinicians wanted to
check a wound before the dressing’s
capacity was reached, an important
consideration if the wound is infected.
Experienced nurses should use their
clinical judgement and understand
that leaving a dressing in place until it
has reached maximum capacity could
result in additional discomfort for the
patient. Similarly, diabetic podiatrists
and tissue viability nurses should
review an infected wound more
frequently than if the patient was
infection-free.
The clinicians’responses in this
evaluation also reflect the literature on
the increased risk of infection where
there is strikethrough and leakage,
with its concomitant malodour,
maceration and poor patient
experience (Graham, 2004; Jones
et al, 2008). As outlined in
Figure 5
,
clinicians were concerned about the
potential for macerated skin, which
has a white‘soggy’appearance (caused
by over-hydration of the surface
keratinocytes) and can break down
easily, resulting in increased wound
dimensions (Dowsett, 2008).
While there are claims that some
superabsorbents are able to hold
large quantities of exudate (i.e. more
than 100mls), in the authors’clinical
experience, from a patient perspective
such a dressing, once at maximum
capacity, would become bulky, heavy
and uncomfortable and risk dragging
the primary dressing from the wound,
particularly if the wound was on
the leg. This was clearly a concern
for clinicians in this evaluation, who
largely agreed that the dressings
would become too heavy and
uncomfortable. As discussed earlier,
there are also concerns regarding
the potential impact on compression
therapy profiles.
A plethora of wound care
dressings are available within a
variety of categories, including
foams, hydrogels, hyrdocolloids
0
2
4
6
8
10
12
14
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