DRESSING CHOICE
›
10
WOUND CARE TODAY
2015,Vol 2, No 1
TIME, Schultz et al (2003) described a
framework that provides a structured
approach to wound assessment. This
approach can help the nurse select
the correct dressing to optimise the
wound environment.
The TIME framework consists
of four basic concepts that nurses
should consider when attempting
dressing selection and treatment (see
Box 1) (Schultz et al, 2003; European
Wound Management Association
[EWMA], 2004)
›
T:
tissue, non-viable or deficient
›
I:
infection or inflammation
›
M:
moisture imbalance
›
E:
edge of the wound — non-
advancing or undermined.
DRESSING TYPES
Alginates
Properties
Alginates are made from brown
seaweed and are considered highly
absorbent and biodegradable. On
contact with sodium-rich exudate, an
exchange of sodium and calcium ions
occurs leading to the alginate forming
a gel.
The action of the various alginate
dressings differs slightly according
to the amounts of calcium/sodium
salts within the product, which
mean that some have a faster gelling
action and form a softer gel; whereas
others form a firmer gel that can
be removed from the wound in
one piece. Some alginates have
haemostatic (stopping the flow of
blood) properties due to the level of
calcium ions that are released.
When to use
Alginates are generally recommended
for use in moderate-to-highly
exuding wounds and are also suitable
for cavity wounds, however they will
require a secondary dressing. They
come in flat sheets and ribbons, and
some are silver-impregnated and may
be used on infected wounds.
Considerations
Alginates are not recommended for
dry or necrotic wounds as they may
adhere to the wound bed, causing
trauma and pain on removal
(Vuolo, 2009).
Examples include: Sorbsan
®
(Aspen Medical); Kaltostat
®
(ConvaTec).
Foams
Properties
Foams are available either as
polyurethane or silicone dressings.
They are recommended for low-
to-moderately exuding wounds,
however the ability to manage
exudate will depend on the moisture
vapour transfer rate (MVTR) (a
measure of the passage of water
vapour through a substance) of the
dressing and performance does vary
between brands.
When to use
Foams are suitable for granulating
wounds with low-to-moderate
exudate. They can also be used
as a secondary dressing. Foams
generally conform well to the
body shape and create an ideal
moist wound environment. The
silicone formulation of the foam
is recommended for fragile skin,
however it is slightly more expensive
than the polyurethane equivalent,
which should be taken into
consideration when selecting foam
dressings. Foams are available as
cavity dressings and some are silver-
impregnated for use on infected
wounds.
Considerations
Caution should be used when using
adhesive foam dressings, as they
may cause skin-stripping. Using a
foam dressing on a wound that is
too wet, may cause maceration or
erythema (White et al, 2012). Foams
are not recommended for necrotic
wounds unless they are to be used
in conjunction with a debriding
agent. Not all foams are suitable
for use under compression and the
manufacturer’s recommendations
should always be checked before use.
Examples include: Allevyn
®
(Smith and Nephew); Mepilex
®
(Mölnlycke Health Care); Activheal
®
(Advanced Medical Solutions).
Hydrocolloids
Properties
Hydrocolloids are made from
carboxymethyl cellulose and
comprise self-adhesive conformable
wafers, which are occlusive (air-
and water-tight) or semi-occlusive.
Hydrocolloids turn into a gel when
absorbing exudate and this creates
an ideal moist environment, which in
turn promotes autolytic debridement.
When to use
Hydrocolloids are suitable for low-
to-moderately exuding wounds. They
can be used to debride slough and
necrosis, and are also suitable for
use on shallow granulating wounds.
There may be a slight odour present
when the dressing is removed.
Considerations
Hydrocolloids may cause maceration
if the wound is too moist. They can
also cause stripping if used on fragile
skin. Due to the occlusive property of
these dressings, hydrocolloids should
be used with caution on infected
wounds.
Examples include: Comfeel
®
(Coloplast); Duoderm
®
(ConvaTec);
Granuflex
®
(ConvaTec).
Hydrogels
Properties
Hydrogels have a high water
content — sometimes as much as
96% — and are mainly composed of
starch compounds or carboxymethyl
cellulose. They have excellent
biocompatibility (where a synthetic or
›
Practice point
Properties of the ideal dressing
(Morgan, 1999):
›
Bacteria-resistant
›
Permits gaseous exchange
›
Maintains a moist wound
environment
›
Non-adherent
›
Fibre- and toxin-free
›
Hypoallergenic
›
Maintain haemostasis and
optimum temperature
›
Is acceptable to patients
›
Cost-effective.
