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Wound Assessment and Dressing Selection

Wound Assessment and Dressing Selection. Noreen Campbell RN BScN MA IIWCC Lt CSW TCS Systems North Saanich, BC, Canada. Wound Healing Process. Maturation/Remodeling Day 21 - 2 years. Epithelialisation. Proliferation Day 4-21. Kane. Inflammation Day 1-4. Hemostasis immediate.

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Wound Assessment and Dressing Selection

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  1. Wound Assessment and Dressing Selection Noreen Campbell RN BScN MA IIWCC Lt CSW TCS Systems North Saanich, BC, Canada

  2. Wound Healing Process Maturation/Remodeling Day 21 - 2 years Epithelialisation Proliferation Day 4-21 Kane Inflammation Day 1-4 Hemostasis immediate

  3. Homeostasis – first 24 hours ‘Meat’

  4. Inflammation 1-4 days ‘Mess’

  5. Proliferation day 4 - 21 ‘Full’

  6. Fibrin, Collagen Bridge to Skin • Yellow, caramel like surface, pain • Granulation peeking, epithelial starting 6

  7. Epithelialization ‘Baby skin’

  8. Maturation/Remodeling up to 2 years • Normal • Hypertrophic • With incision • Keloid • Extends to normal tissue ‘stronger’ Well healed scar – always a scar…weaker tensile strength

  9. Potential for Healing Individual assessment Wound Care

  10. Tissue depth? Probe… 10

  11. Infection • Heat • Redness • Swollen • Pain • Not with neuropathy • Blood Sugars elevated Culture 11

  12. Infection: Assess Clean Wound • Wound Cleansing • Potable tap water • Saline • Boiled cooled water • Mild soap • Dove no dye or perfume Cochrane Review 2011 water for cleansing

  13. Wound Imperatives and Antimicrobials Canadian Diabestes Association Store – dodi.forbes@diabetes.ca

  14. Eschar: risk infection and delay healing Autoamputation? Stable Wet Drainage Marbling Breakdown • Black • Dry • Hard Debride Iodosorb + cast padding Inadine PHD

  15. Debride Unstable Eschar • Drainage • Fluctuance • Iodine produce will become paler with release of iodine

  16. 16

  17. MDT 4 days 17

  18. What type of debridement? 92yo anesthetic risk Trauma scooter accident Inner thigh 18

  19. Contact Dermatitis pattern Sensitivity Localized to wound and product Drainage Direction of pooling Differentiation: drainage or allergy?

  20. Blister: drain if risk expansion 20

  21. Edge: Undermined, rolled edge Packing – think ‘wicking’.

  22. Dressing: think ‘Band Aid’‘protect, absorb, hold layers’ There are no standards for stating performance of dressings (i.e. absorption). Standard for approval ONLY safety not efficacy.

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