Temple University School of Podiatric Medicine Journal Review Club
Article Title: Using the Entropic Wound Cycle as the Basic for Making Effective Treatment Choices
Authors: Mcguire, J, Sebag JA, Solnik, J
By Terri Kolenich, RN, CWCA, AAPWCA
I travel to several states educating wound care providers and nurses in the long-term care setting. Many of the questions I get are the same whether I'm on the east or west coast. The one question that I encounter the most often during wound rounds or an education session is: "How do I know which treatment to use for this wound?"
My general response to this frequently asked question is: Treat the wound according to the characteristics of the wound bed. This simple answer often leads to more questions. What does that really mean? What wound bed characteristics am I looking for? Which wound treatment will address those characteristics? What treatments can I use together, and are there treatments I should not combine?
Signs and symptoms of infection, devitalized tissue, drainage amount, composition of the wound bed and depth are all things to consider when deciding what treatment product to use. There are many wound treatment products on the market, and more being developed every day. Effective wound care is not about the latest and greatest product you can use. Effective and appropriate wound care is about the ongoing daily monitoring, assessment and management of the entire wound patient.
"Focusing on the whole patient and not just the 'hole' in the patient is essential"1
Signs and symptoms of infection must be addressed in order to promote wound healing. Treatment options that contain silver are just one of many ways to manage a wound bed that presents as infected. Other wound product treatment options include methylene-blue foam, antimicrobial barrier dressings, medical honey dressings, and cadexomer iodine dressings. The product used to cleanse the wound can also help manage infection in the wound bed. A physician must manage antibiotic therapy.
Devitalized tissue in the wound bed will also delay or prevent healing. In an ideal scenario, with all systems working, the human body will get rid of this devitalized tissue on its own. This process is called autolytic debridement. There are many products that will help the body to promote autolytic debridement of devitalized tissue. Another treatment option to aid in the removal of devitalized tissue is an enzymatic debriding agent. The only enzymatic debriding product on the market is called Santyl. It is important to use SANTYL correctly to ensure the product is able to work effectively. Most silver products and wound cleansers will deactivate the collagenase in SANTYL.
A wound with a large amount of drainage and depth may require absorbent packing. It is important to loosely pack the empty space of a wound to promote healing. Negative pressure wound therapy is an option for wounds with these characteristics as well. The composition of the wound bed is an important consideration when choosing a treatment. Wounds with devitalized tissue covering the wound bed may not benefit from negative pressure wound therapy.
We have all had that battle with the annoying little multi-folded package inserts placed inside the box of wound dressings. It's the paper that blocks us from putting an unopened, unused, still sealed in the package treatment back in the box it came from. You may have tossed this resource in the trash without even realizing its value and usefulness. Those annoying little package inserts in every box of every different dressing are enough to make a wound nurse crazy! That is... only if you do not see how valuable they are to your wound care practice. Package inserts are the gold standard resource of useful information for every person in wound care. It is a good idea to keep one package insert from each product easily accessible, perhaps in a binder.
The products you use in your wound practice will have a customer service phone number somewhere on the packaging. Calling this number will connect you with a product representative in your area. These product reps are usually very happy to provide education on their wound products.
1. Hampton S, Collins F. Holistic wound assessment. In: Hampton S, Collins F, eds. Tissue Viability. London: Whurr Publications; 2004: 40-75.
About the Author
Terri Kolenich, RN, CWCA, AAPWCA is the clinical liaison at Select Medical Specialty Hospitals. Terri has extensive experience in long term care as a Wound Care Nurse and Program Manager. She is passionate about wound care education and has over nine years experience assessing, managing, and documenting wounds. Terri is also well versed in MDS 3.0. Her knowledge coupled with her skill as a public speaker, make her an effective wound care educator.
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.