Wound Dressings

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Finding the key to unlocking a non-healing chronic wound keeps us awake at night. Though we have, as bedside clinicians, learned much about the physiology and biochemistry of chronic wounds over the past decade, wound healing is not an exact science. Negative pressure wound therapy (NPWT) has become standard care for certain chronic wounds. Sometimes, however, wounds treated with this therapy do not progress as readily as we think that they should. This has led us to consider combining other wound care products with NPWT. This article will examine the rationale for using three products in combination with negative pressure.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

We just can’t resist New Year’s resolutions. This is the time of year when we reflect back on aspects of the year that is ending, and determine to do some things differently in the year that is dawning. If you are reading this, then you likely use negative pressure wound therapy (NPWT) in your clinical practice. If you use this valuable therapy to help your patients’ wounds to heal, then you are aware that NPWT comes with risks. Our friends in the legal profession certainly understand this. Look back at the FDA Safety Alert issued in February 2011 in response to increased injuries among patients receiving NPWT. The FDA concluded that many of the injuries and deaths were related to insufficient observation of wound dressings and lack of patient teaching.

Aletha Tippett MD's picture

By Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

How did you acquire your knowledge and skills around the application of NPWT dressings? Most of us learned by observing another clinician doing dressing applications, or from a manufacturer's representative. We likely just imitated what they did, largely winging it. In my work over the past few years, I have been surprised to learn that many excellent clinicians have gaps in technical ability. This article is intended to review principles of NPWT dressing application to increase the accuracy of your techniques. These tips are distilled from principles that are typical of manufacturer guidelines. It is always recommended that you read and follow the manufacturer’s guidelines for the product that you are using.

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By Beth Hawkins Bradley RN, MN, CWON

How often do you really consider the person that is attached to the wound you are treating? Do you take seriously those complaints, grunts, and grimaces that he sends your way when you remove drape and peel foam from a wound being treated with negative pressure? It isn’t pretty, but it is pretty important. I would love to hear what you think after you read and consider the content.

Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

Wounds treated with negative pressure wound therapy (NPWT) are not often straightforward. They occur in interesting places, have anything from slough to hardware visible in the bases, and have nooks and crannies that are not visible to the clinicians peering into the wound. A gentle probe is necessary during wound assessment to identify tunnels and undermined areas. I prefer to gently probe first with my gloved finger (I have small hands) because I can identify hidden structures and other oddities. Then I will use a swab to measure how far the tunnel or undermining extends. Once hidden dead spaces have been identified, clinicians can select the best strategy to bring them to closure. Herein are several techniques employed by clinicians to close undermined and tunneled areas.

Sue Hull's picture

By Sue Hull MSN, RN, CWOCN

Here is an idea you will love!

What do you do with a blister? You know the problem. You discover a blister. If you don’t do anything, it will probably unroof and be open and vulnerable by the next time you see it.

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Beth Hawkins Bradley's picture

By Beth Hawkins Bradley RN, MN, CWON

I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy (NPWT). As a clinician practicing in the outpatient and home care settings, it was not unusual for patients to have to take a "holiday" from negative pressure. Treatment was often put on hold for several days to allow skin to recover. Putting negative pressure on hold not only caused a potential delay in forward progress in the wound, but it also created the need for increased dressing change visits for the home care patient. While maceration is reported in wounds located anywhere on the body, it seems to be most prevalent on skin of the lower extremity.

Aletha Tippett MD's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

"Our food should be our medicine and our medicine should be our food."
-Hippocrates

This statement by Hippocrates rings true today as hospitals, rehabilitation centers and nursing homes strive to improve the quality of their meals. The day of “bland, cold, tasteless hospital food with limp vegetables and hard, dry meat” should be distant memory. When the meals and supplements served are not consumed, poor intake often results in weight loss and inadequate consumption of calories required for pressure ulcer prevention and healing.

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