Hydrocolloids.
These dressings have been around for 30 years. They are generally a thin film that has a thick rubbery adhesive which , when contacting a moist wound, creates a gel against the wound surface.
Some hydrocolloids contain an alginate (seaweed base) to help with wound exudate absorption. Different hydrocolloids dressings come with many shapes for "difficult to attach" areas, and different thicknesses so the nurse can tailor the dressing to the amount of exudate. The hydrocolloids dressings often stick to the wound's healthy skin margin with a water resistant film type adhesive.
So how do they work?
Being water occlusive, they provide a moist healing environment and heat insulation. In episode one we discussed the need for a moist and warm wound bed.
These dressings also encourage a process called autolytic debridement. This is where the gel from the hydrocolloids attract moisture from the wound like a sponge, and in doing so, promote the release of protein and debris dissolving enzymes from tissues. These dressings clean the wound, not just cover it.
Pros
• Water resistant keeps bugs out.
• non stick to the moist painful wound surface, so gentle when being removed.
• non stick to the moist painful wound surface, so gentle when being removed.
• Easy peel and stick application that can be used under compression stockings or lymphoedema bandages.
• Can and should stay on for days. Many products report 3-7 days with the familiar mantra "leave it a week or till there's a leak"
Cons
• Never on infected wounds, and they are not great on heavily exuding wounds. Venous ulcers and some diabetic ulcers are notoriously oozy.
• extreme caution on diabetic feet!! Only safe if the wound is superficial with no signs of infection, there is low to moderate exudate, there are no signs or symptoms of ischemia, and dressings are changed frequently. This last point negates the value of a dressing that is designed to stay on for days.
Diabetic wounds crash in hours when they crash, and you want to be there when that starts. You don't want to pull off a dressing to find 2 weeks of healing undone overnight!
• unlike film dressings which are clear and transparent, hydrocolloids are opaque. So you can't watch the wound.
• notorious for dislodgement if wound is too wet, and they curl or roll at the edges, potentially trapping bacteria.
• some patients (and nurses) complain that they are a bit on the nose.
• can cause wet maceration to healthy skin (all those trapped enzymes in the Slough )
• May cause trauma/injury to fragile skin upon removal... That prednisone abused nana skin is so paper thin!
• hypergranulation can be a problem leading to scaring
• notorious for dislodgement if wound is too wet, and they curl or roll at the edges, potentially trapping bacteria.
• some patients (and nurses) complain that they are a bit on the nose.
• can cause wet maceration to healthy skin (all those trapped enzymes in the Slough )
• May cause trauma/injury to fragile skin upon removal... That prednisone abused nana skin is so paper thin!
• hypergranulation can be a problem leading to scaring
When to use
A hydrocolloid dressing is appropriate for these situations:
• necrotic or hard capped eschar covered wounds (lifts the dry nastiness)
• dry wounds
• partial- or full-thickness wound
• protection of intact skin ( but watch for maceration ) or a newly healed wound.
• necrotic or hard capped eschar covered wounds (lifts the dry nastiness)
• dry wounds
• partial- or full-thickness wound
• protection of intact skin ( but watch for maceration ) or a newly healed wound.
Frequency of dressing changes
• depending on the product specifications, dressings should be changed every 3 to 7 days. This of course depends also on exudate.
How to apply a hydrocolloid dressing .
Gloves on and remove the soiled dressing (noting the date it was applied) - contaminated bin is wise, irrespective of colonisation.
Deglove, hand wash, reglove
Clean the wound with warm normal saline or warm tap water.
There is no evidence that chlorhexidine or other antiseptics are safe, or necessary or helpful.
Use gauze to pat dry the foot edges of the wound margin where the adhesive should stick.
Apply liquid barrier film or moisture barrier to the periwound area.
For deep wounds, apply wound filler or packing materials as indicated/ordered ( a whole other post).
Deglove, hand wash, reglove
Clean the wound with warm normal saline or warm tap water.
There is no evidence that chlorhexidine or other antiseptics are safe, or necessary or helpful.
Use gauze to pat dry the foot edges of the wound margin where the adhesive should stick.
Apply liquid barrier film or moisture barrier to the periwound area.
For deep wounds, apply wound filler or packing materials as indicated/ordered ( a whole other post).
Warm it by holding it between your hands to increase molding and adhesive ability.
Remove the paper backing from the dressing.
Bend the dressing (sticky side out) and apply it from the center of the wound, smoothing it outwardly like putting contact on the kids books.
Hold the dressing in place for a few seconds, warming it with your hands to improve molding and adhesion.
The dressing should be at least 2cm larger than the wound.
Remove the paper backing from the dressing.
Bend the dressing (sticky side out) and apply it from the center of the wound, smoothing it outwardly like putting contact on the kids books.
Hold the dressing in place for a few seconds, warming it with your hands to improve molding and adhesion.
The dressing should be at least 2cm larger than the wound.
Our next instalment will take a look at hydrogels.
For ECT4Health information and courses
Www.ect4health.com.au
For ECT4Health information and courses
Www.ect4health.com.au
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