In a recent survey, we asked our WoundSource Editorial Advisory Board members what outdated wound care practices they continue to see in the field. Depending on what health care setting clinicians work in, there are specific guidelines, policies, and procedures that may impact standard of care....
By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
The sheer number of dressings available makes choosing the correct dressing for clients a difficult proposition. Clinicians today have a much wider variety of products to choose from, which can lead to confusion and, sometimes, the wrong type of dressing for a particular wound. Knowing the types of dressings available, their uses and when not to use a particular dressing may be one of the most difficult decisions in wound care management.
Although there are hundreds of dressings to choose from, all dressings fall into a few select categories. Dressings within a particular category can then be chosen according to availability and familiarity. Let’s examine some of the wound dressing categories and when they should be used:
Gauze dressings are made of woven or non-woven materials and come in a wide variety of shapes and sizes. Use on: infected wounds, wounds which require packing, wounds that are draining, wounds requiring very frequent dressing changes.
Pros: usually readily available; may be cheaper than other dressing types; can be used on virtually any type of wound.
Cons: must be changed frequently, which may add to overall cost; may adhere to the wound bed; must often be combined with another dressing type; often not effective for moist wound healing.
Transparent film dressings allow oxygen to penetrate through the dressing to the wound, while simultaneously allowing moisture vapor to be released. These dressings are generally composed of a polyurethane material. Use on: partial-thickness wounds, donor sites, minor burns, stage I and stage II pressure ulcers.
Pros: conforms to the wound well, can stay in place for up to one week; aids in autolytic debridement; prevents friction against the wound bed; does not need to be removed to visualize the wound; keeps the wound bed dry and prevents bacterial contamination of the wound.
Cons: may stick to some wounds, not suitable for heavily draining wounds, may promote periwound maceration due to its occlusive nature.
Foam dressings are less apt to stick to delicate wound beds, are non-occlusive and are composed of a film coated gel or a polyurethane material which is hydrophilic in nature. Use on: pressure ulcers, minor burns, skin grafts, diabetic ulcers, donor sites, venous ulcers.
Pros: comfortable, won’t adhere to the wound bed, and highly absorbent; allow for less frequent dressing changes, depending on the amount of wound exudate; come in many shapes and sizes.
Cons: may require a secondary dressing to hold the foam in place; if not changed often enough may promote periwound maceration; cannot be used on wounds with eschar or wounds that are not draining; some foams may not be suitable for certain wounds, such as those that are infected or are tunneling.
Hydrocolloid dressings are very absorbent and contain colloidal particles such as methylcellulose, gelatin or pectin that swell into a gel-like mass when they come in contact with exudate. They have a strong adhesive backing. Use on: burns, pressure ulcers, venous ulcers.
Pros: encourage autolytic debridement; provide insulation to the wound bed; waterproof and impermeable to bacteria, urine or stool; provide moderate absorption of exudate
Cons: leave a residue present in the wound bed which may be mistaken for infection; may roll over certain body areas that are prone to friction; cannot be used in the presence of infection.
Alginate dressings contain salts derived from certain species of brown seaweed. They may be woven or nonwoven and form a hydrophilic gel when they come in contact with exudate from the wound. Use on: venous ulcers, wounds with tunneling, wounds with heavy exudate.
Pros: highly absorbent; may be used on wounds that have infection present; are non-adherent; encourage autolytic debridement.
Cons: always require a secondary dressing, may cause desiccation of the wound bed, as well as drying exposed tendon, capsule or bone (should not be used in these cases).
Composite, or combination dressings may be used as the primary dressing or as a secondary dressing. These dressings may be made from any combination of dressing types, but are merely a combination of a moisture retentive dressing and a gauze dressing. Use on: a wide variety of wounds, depending on the dressing.
Pros: widely available; simple for clinicians to use.
Cons: may be more expensive and difficult to store; less choice/flexibility in indications for use.
Other dressings available on the market include dressings containing silver or other antimicrobials, charcoal dressings and biosynthetic dressings.
It is likely that as your experience with wounds grows, you will find success using a small variety of wound care products of different types that are readily available to you. You may occasionally need to use other dressings for special situations or wounds recalcitrant to healing. It is important to understand how dressings from each category affect the wound bed and which wounds you should not be using particular dressings on. In short, know your dressing categories and become familiar with a few dressing types from each category to create your own collection of go-to dressings to suit most wounds.
Baranoski, S. (2008). Wound and skin care: Choosing a wound dressing part 1. Nursing 2008; 38 (1). p. 60-61.
Myer, B. (2008). Wound Management: Principles and Practice. (2nd Edition). Pearson Prentice Hall. Upper Saddle River, New Jersey. p. 128-140.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
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.