Comparing Alginate and Gelling Fiber Dressings

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By Holly Hovan MSN, APRN, CWOCN-AP

As wound care clinicians, we are aware that part of the process of consulting requires a comprehensive wound assessment, looking at wound characteristics, causative factors, and drainage. As I've previously mentioned, we've all heard the term, "a dry cell is a dead cell." However, not all wounds are dry.

We often have heavily exudating wounds for many different reasons. Though it is very important to identify the reason for the exudate, rule out and/or treat infection, and tailor a plan to meet the patient's needs, it is also important to treat the exudate. Wound exudate can be managed with many different modalities, both simple (like topical dressings) and advanced (like negative pressure wound therapy, or NPWT).

When managing exudates, commonly used dressing choices are alginates and gelling fiber dressings... However, I'm often asked: what really is the difference? In order to make a brief comparison of alginate dressings versus gelling fiber dressings, I've constructed a chart based on what I've learned at Cleveland Clinic's R.B. Turnbull, Jr., MD School of Wound, Ostomy, and Continence Nursing (WOC), through my own practice and experience, and from the WOCN Society's Wound Management Core Curriculum.

alginates_vs._gelling_fiber_dressings.png

References:
Doughty, D. B. & McNichol L. L. WOCN Society Core Curriculum, Wound Management (2016). Philadelphia, PA: Wolters Kluwer.

About the Author
Holly Hovan is a WOC nurse at the Cleveland Veterans Affairs Medical Center in long-term care/geriatrics. She has been practicing as a WOC nurse since 2013. Ms. Hovan has a passion for education, our veteran population, and empowering others to learn and succeed.

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.

Comments

Hello, I am a wound care nurse at my facility and In my recent training, we were taught to only change alginate dressing every 3 days or less with heavy exudate. My facility is working with a Physician whom specializes in wound care, I have noticed that he wants all dressing changes done daily, we use foam dressing and it is becoming costly. Just wondering why he might be wanting every one done daily. I know their is a difference and every wound and I really don't see the need in changing all of them daily as some I could see.

Frequency of change should be tailored to the volume of exudate managed by the dressing selected. An alginate and foam combo should be able to manage a moderately exudating wound with an every three day change. Adding light compression 15-20mmHG to hold the dressing in place will further manage the volume of exudate produced. Wounds need to be left undistrubed when not infected so the cellular signals and replicating/migrating cells can talk. Daily dressing changes should be reserved for infected and necrotic wounds where enzymatic debridement is being employed. Maggot therapy is a q72 hour change so this too validates the less is more mantra.

A healthy granulating wound bed can be changed less frequent- It's really all about the strike through/saturation levels.

If the wound sweats and is shallow then a contact layer and nonadhetant pad dressing changed twice a week is good or even a hydrocolloid alone.

If it is tearing then I would go with alginate or foam alone with a dry gauze secondary changed 2-3 times a week depending on thickness of exudate, thinner may require 3 times a week.

If it is drooling I would do alginate and foam three times a week and use a periwound barrier treatment with zinc oxide or an antifungal cream.

Skin prep is to protect the surrounding skin from medical adhesive related injury not great for periwound maceration.

Look at the wound source resource guide for HCPCs codes and it should help you determine how often a foam or alginate or hydrocolloid needs to be changed because reimbursement for dressings is calculated based on frequency of change.

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