8 Questions to Ask When Choosing a Wound Care Dressing

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Wound Dressing Supplies


I feel like I am spinning my wheels on this warm sunny day in Ohio. My passion for wound care continues to grow, but I have days like these every once in a while. I always say, "We don't know what we don't know, right?" So I keep chipping away to educate and mentor other health care professionals.

I observe clinicians innocently dumping loads of expensive product into wounds using them incorrectly. Many products have specific usage instructions just like medications. But for some reason, clinicians do not have this same perception. Wound care is much more than squeezing a dollop of ointment, or using embellished foams. Not all dressings are the same. They may look alike, but are not. There are many good reasons why certain dressings have specific usage instructions. Get in the habit of knowing what the dressing product category is, and how to use it. When using products correctly, you will see better clinical outcomes.

How to Select the Right Wound Care Dressing

To select the appropriate dressing for a given wound, ask yourself the following questions:

How is the wound being cleansed each dressing change?
Whether you are using normal saline or a non-cytotoxic wound cleanser, we must be consistent with wound cleansing for wound bed preparation.

Is the wound partial- or full-thickness, with or without tunneling and undermining?
Dead space of a wound must be packed, but not over packed. Will the dressing maintain its shape to keep direct contact with the wound bed? Will the dressing fray or come apart?

Is the wound dressing going to complement the type of wound?
Use dressings that conform, and/or are easy to apply and remove. Heel wounds are a good example. You may need to design or select a heel cup dressing to avoid bulkiness.

How much is the wound draining?
Use dressings that will keep the wound warm, and that absorb the amount of drainage you have assessed. There are many longer wear time dressings available such as foams, self-adaptive, and hydrocolloid dressings.

How big of a dressing should I use?
Most dressings are to be 1-2 inches larger than the wound. Protecting the periwound is as important as the wound. Prevent maceration to avoid further skin impairments.

Who is the payor source?
Unfortunately, we as clinicians need to follow dressing guidelines per payor source. Get familiar with the Medicare dressing guidelines as most payor sources follow this list.

Who will be changing the dressing?
The patient and/or their caregiver(s) should be able to demonstrate the dressing application. Educate your patients and caregivers.

How often should the dressing be changed?
If the wound is draining a scant amount, you can stretch the wear time. Research shows wounds heal faster when the wound bed is covered, keeping temperature consistent.

As an educator, I not only provide dressing category and usage information, but I also encourage the clinician to truly understand the technology behind the dressing, or the "how to" apply the product. We do not want our clinicians coming down with a big case of "Product Confusion"!

Other Considerations for Dressing Application

Once you have chosen the appropriate dressing for the wound you are treating, there are some other some other common dressing application specifics to look for or consider.

  • Dressing compatibility: Does the use of viscous materials block the absorptive properties of the dressing? Do the properties of the dressing interfere with or deactivate collagenase or antimicrobial products?
  • Ointment or cream thickness: Did you check for the correct dosage so as to ensure efficacy and prevent potential periwound maceration?
  • Wear time of medicated dressing: Are you changing the dressing often enough to ensure consistent mechanism of action, wicking or absorption?
  • Cleanser compatibility: Is the dressing compatible with the cleansers you are using on the wound (to avoid cytotoxicity or deactivation of certain bioactive products)?
  • Dressing size: If using a dressing larger than the wound, have you ensured that the periwound skin is protected from maceration? Can the dressing you chose be cut to fit the wound?
  • Packing dead space: Have you ensured that the dressing will be entirely retrievable from the dead space (woven so as not to leave fibers, counting individual pieces, leaving a tail)?
  • Clean wound bed: Have you ensured that any devitalized tissue that may block the mechanism of action of your dressing has been removed from the wound?

There are many resources out there to help you bolster your staff education. Sales representatives are always eager to help you educate your staff. Many are certified in wound care and offer free CEUs. Place ongoing education as being at the top of your dressing shelf. If there is a gap in quality of care, I can guarantee you that a gap in education is one of the culprits.


About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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This is such an excellent, succinct article that I hate to criticize it, but it is important to emphasize the need to read the Instructions for Use, and I would like to add that dressing "categories" (e.g., foam, hydrogel, alginate) are simply tools for reimbursement coding which do not always reflect the essence of the dressing. For example, some honey dressings may be listed as alginates, but their absorption is not the main attribute clinicians find attractive in choosing them. Polymeric membrane dressings (PMDs) are so different from all other dressing types that they are listed as a unique category in many countries, but in the USA they are still categorized as foams. Because PMDs contain a continuous built-in wound cleansing system, using them as one would use an ordinary foam dressing can lead to less than ideal results. Therefore, it is particularly important to read the Instructions for Use for these multifunctional dressings.

Activated by the moisture remaining on the wound bed after the initial thorough wound cleansing, PMDs slowly release glycerol and a tissue-friendly surfactant into the woundbed. The surfactant breaks the chemical bonds adhering the slough and other contaminants to the wound bed. The glycerol pulls fluid from the body into the wound bed, floating the now non-adherent slough. A superabsorbent, locked into the PMD, pulls the excess watery portion of the fluid into the dressing, along with the slough and other contaminants. Excess moisture evaporates through the self-adjusting outer membrane barrier. Moisture is added to dry areas of the wound while excess fluid is absorbed, resulting in an ideal moisture level across all areas of the wound. The continuous wound cleansing system also flushes out chronic wound fluid and concentrates fresh, nutrient-filled fluid in the wound bed to speed healing.

However, the Instructions for Use warn that, because of this system, for the first few days of PMD use one should expect a dramatic increase in wound fluid. Assuming that PMDs are like conventional foam dressings and ignoring this admonition can result in poor outcomes if the PMDs are permitted to become oversaturated. Dressings should be changed when indicated by an area of the backing as large as the wound becoming a darker color. The Instructions for Use also state that wounds managed with PMDs should not be cleansed routinely at dressing changes. If your protocol requires wound cleansing at dressing changes, document that you are fulfilling that duty by applying a new PMD; additional manual cleansing cools the wound bed, removes nutrients, and can damage fragile new granulation tissue. Because routine cleansing is not required and the PMD's backing clearly indicates when the dressing should be changed, it is easy to teach family members to change the dressings between healthcare provider visits.

Hi Cheryl,. I have been reading your articles here for a while and they are always thought provoking and insightful to me. As a "novice" in the wound care world I feel like I am in the "Wild West" when it comes to wounds. How can I know if the wound would respond better to application of a collagen product like Endoform, or would it be better to use an amniotic graft instead? This is one a several questions I ask myself everyday.....

I would live to speak with you sometime and hope our paths will cross soon.

Mark Hinkes, DPM

Hello Dr. Hinkes,
Thank you very much for your reply to my blog.. ;) There are many clinicians and healthcare professionals who feel they are in the "Wild West". ;) We all learn something new every day! To answer your question, I always encourage physicians to think of product selection as more of "wound bed preparation." For example, if your patient's full thickness wound is clean, but has not had much progress in the last 3-4 weeks, you probably want to try and use a dressing from the antimicrobial or bacteriostatic family. These dressings can be used for 2 weeks to help eradicate biofilm formation. I would also suggest you perform sharp debridement if you feel it is indicated. This way you are "preparing" the wound bed for your amniotic graft you have been waiting so anxiously to apply. ;) Biofilms are hungry little guys. Remember they will use the amniotic graft for a food source. You asked about the Collagen dressings. There are gels, powders, and dressings. Collagens are great to give that "clean" wound a boost.
I have an easy way I teach physicians and clinicians to select products. I divide ALL wound types into three categories. Intact, partial thickness, and full thickness. If you are interested, I could email you a copy.

I was in the "Wild West" at one time too, that is why I have tried to break wound care education into the simplest form. My email is Nurse4wounds@aol.com. Keep on healing ! Thanks Dr. Hinkes ;)

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