[Wound management, 12--Dressings for intravascular indwelling catheters: search for optimal nursing care--a never ending story?].
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Wound healing in venous leg ulcers is a highly complex, dynamic process that is influenced by a number of factors. The primary task of local therapy is to support this natural healing process. While a number of therapeutic agents are available, in most cases their efficacy has yet to be established in controlled prospective studies in the sense of evidence-based medicine. Thus, the physician is left with the task of drawing up individual therapy plans for each patient according to the state of the wound. Compression bandages or stockings form the mainstay of treatment, generally in combination with moist dressings for chronic wounds.
Painful split-skin-graft donor sites remain a common problem for patients. We undertook a prospective randomised trial to examine the comparative comfort and ease of care of two different donor-site dressings. One dressing is the alginate Kaltostat, the standard plastic-surgical dressing in the UK and abroad, and the other is the adhesive retention tape Mefix, a novel use of a readily available dressing. We randomised 50 patients requiring split-skin grafts to receive either alginate (Kaltostat) or retention (Mefix) donor-site dressings. Dressings were assessed by interview and questionnaire at 24, 72 h and 2 weeks, and by wound review at 2 weeks. Retention dressings were found to be more comfortable, required less nursing intervention and allowed patients easier mobility with a greater range of daily activities, especially washing, without compromising wound healing. We recommend adhesive retention dressings as cost-effective comfortable dressings, which readily conform to any donor site.
Many of the choices for managing split-thickness skin graft donor sites are satisfactory, but none is ideal. Epidermal regeneration in a donor site is readily available for clinical study. We have reviewed experimental studies of epidermal regeneration and applied those results to the clinical study of a new donor site dressing. This dressing is a vapor-permeable, transparent, polyurethane film with a polyvinyl ether adhesive. Used on 100 patients, it was found to be safe and effective in allowing rapid and painless healing. Although the dressing is occlusive and theoretically could promote infection in a contaminated wound, no infections were encountered. Comparison was made with 15 patients managed by other methods. No marked difference in healing time was noted clinically. The striking advantage of the new dressing was painless healing.
Toxic epidermal necrolysis results in skin sloughing that resembles a partial-thickness thermal injury. If the exposed dermis can be protected from infection and desiccation, regeneration can occur from the skin appendages. Biobrane, a synthetic wound dressing, has been used with good results on donor sites and outpatient partial-thickness burns in our institution. We report a case of a 12-year-old boy with toxic epidermal necrolysis, whose skin lesions were dressed with Biobrane temporary wound dressing. The Biobrane dressings prevented infection, decreased wound pain, and allowed uncomplicated healing in this patient.
A prospective and randomized trial that compares Jelonet (Smith & Nephew PLC, London, England) with a new hydrocolloid dressing, Dermasorb (Convatec Ltd., Clwyd, United Kingdom), is presented. The dressings were applied on contiguous donor sites in 21 patients that required skin grafting for burn wounds. Pain experienced with the dressing in situ was assessed on days 2, 4, 7, and on two subsequent occasions. During dressing changes, pain experienced was again assessed, bacteriologic swabs were taken, and the percentage of epithelialization was recorded. Questionnaires completed by investigators and patients were used to assess the perceived performances of both dressings. The results showed that Dermasorb is a less painful dressing than Jelonet, in which wounds heal faster. Dermasorb was preferred by both investigators and patients. No clinical or laboratory evidence of any differences of colonization or infection were found. All results were statistically significant. We would strongly recommend the use of Dermasorb as a split-thickness skin graft donor site dressing for a patient with burns.
With the numerous wound dressings now available, it is sometimes difficult to know which dressing is right for each different situation. This article examines the action of two products and highlights their appropriateness in varying circumstances.
Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased donor site complications. This method is ideally suited for the management of large defects. The dressing can be quickly and easily applied and there have been no significant complications.
An open comparative randomised study comparing the performance of hydrocolloid dressings (DuoDERM CGF) to saline gauze dressings in the treatment of pressure ulcers was done to evaluate the overall dressing performance, wound healing and cost effectiveness. Thirty-four subjects were enrolled at the University Hospital, Kuala Lumpur over a 643 days period. Inclusion criteria were Stage II or III pressure ulcers, at least 18 years of age and written informed consent. Only one pressure ulcer per subject was enrolled in the study. Patients with infected pressure ulcers, diabetes mellitus, an immuno-compromised status and known sensitivity to the study dressings were excluded. Subjects who met the enrollment criteria were randomised to one of the two dressing regimes. They were expected to participate in the study for a maximum of eight weeks or until the pressure ulcer healed, which ever occurred first. Overall subject age averaged 58 years and the mean duration of pressure ulcer existence was about 1 month. Twenty-one of the thirty-four ulcers enrolled were stage II and thirteen were stage III. The majority of the ulcers (88%) were located in the sacral area and seventeen subjects (50%) were incontinent. In the evaluation of dressing performance in terms of adherence to wound bed, exudate handling ability, overall comfort and pain during dressing removal; all favoured the hydrocolloid dressing by a statistically significant margin (p < 0.001). Subjects assigned the hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings. This was not statistically significant (p = 0.2318). In cost evaluation of the study products, there was no statistical significance in the total cost of wound management per subject. When only labour time and cost was evaluated, there was a statistically significant advantage towards hydrocolloid dressings.
BACKGROUND: Before a meta-analysis by Hoffman et al was published, polyurethane dressings were used at insertion sites for peripheral i.v. catheters at our institution. On the basis of the results of the meta-analysis, we began to use gauze dressings. The change from polyurethane dressings to gauze dressings limited direct observation of the i.v. insertion site, and i.v. catheters were anecdotally reported not to be anchored as securely as before. OBJECTIVES: The purpose of this study was to compare the effects of the use of transparent polyurethane dressings and gauze dressings at insertion sites for peripheral i.v. catheters on the frequency of phlebitis, infiltration, and catheter dislodgment by patients. METHODS: Two hundred twenty-nine patients were randomized to receive either gauze (n = 121) or transparent polyurethane (n = 108) dressings, and observations were recorded. RESULTS: The frequency of catheter dislodgment by the patient was significantly higher (P < .05) in patients with the gauze dressing (15%) than in patients with the transparent polyurethane dressing (6%). A trend toward lower frequencies of phlebitis (1.8% vs 3.3%) and infiltration (17.6% vs 20.7%) was noted in the patients with the transparent polyurethane dressings. DISCUSSION: The clinical advantages of the transparent polyurethane dressings lie in the ease of direct visualization of the i.v. insertion site and the securement of the i.v. catheter. CONCLUSION: At our institution, given the decreased disruption of the i.v. therapy with the transparent polyurethane dressings and the lack of differences in the rates of phlebitis or infiltration with the two types of dressings, we prefer to use transparent polyurethane rather than gauze dressings at insertion sites for peripheral i.v. catheters.
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This study compares the cost per case of treating wounds with conventional gauze dressings or with silastic foam elastomer dressings and concludes that the foam dressing is less costly both in terms of materials and of labour time.
Eleven European burns centres in five countries (Belgium, England, Germany, Italy, Switzerland) participated in a prospective, randomized clinical trial comparing a new wound dressing Inerpan with conventional dressings such as petroleum jelly gauze, petroleum jelly gauze with antibiotics and silver sulphadiazine cream. The indication was partial skin thickness burns and 62 patients were included. In each patient, two similar lesions (with respect to depth and surface area) were compared, one being treated with Inerpan, the other one with a control dressing. The following parameters were studied: healing time, quality of healing, intensity of pain, local tolerance and frequency of dressing changes. Analysis of the results showed that Inerpan-treated sites healed faster than conventional ones, and were associated with a highly significant reduction of pain. The frequency of dressing changes was greatly reduced and the local tolerance was good.
Vacuum-assisted wound closure is established in acute wound treatment and assists granulation tissue as well as promotion of graft survival in critical localisation. A new vacuum-assisted wound closure device is launched for the treatment of heel wounds (V.A.C. GranuFoam Heel Dressing). First experience with this heel contour shaped dressing is presented in a case of primary surgical care of a high risk melanoma. The initial defect after excision, measuring 8 x 6 x 3.5 cm, granulated by V.A.C. treatment in 5 weeks to skin surface niveau and was successfully covered with a full thickness skin graft. The V.A.C. Heel Dressing is easy to apply, reduces vacuum leakage und increases patients' comfort and treatment safety in comparison to "classic" vacuum dressings.
The use of adhesive preparations to reinforce surgical tapes and to secure dressings to the skin is standard practice. BioBrane is a biosynthetic membrane for use in dressing clean, well-debrided wounds, particularly partial-thickness burns and skin graft donor sites. The close and undisturbed contact of this material with the wound surface is important during the first 2 days after its application to achieve adherence. This has prompted a study to test the relative anchoring strength of four methods of securing the dressing to the normal skin around the wound: 1/2-inch (1.27-cm) Steri-Strips only; Mastisol, a mastic compound, with and without 1/2-inch Steri-Strips; and compound tincture of benzoin, USP, in combination with 1/2-inch Steri-Strips. The results obtained with a tension of 1.1 pounds/square inch (0.5 kg/6.5 cm2) were not conclusive as to the superiority of any one method. However, with a tension of 2.2 pounds/square inch (1 kg/6.5 cm2), the combination of mastic compound and 1/2-inch Steri-Strips provided the strongest adhesion. This type of application should also prove useful when other types of surgical dressings must be anchored in place.
The clinical benefits of using the VENTEX Wound Dressing System (VWDS) (The Kendall Co.) in the management of donor site wounds were evaluated in this pilot study involving 10 informed and consenting patients. The study was a prospective, randomized, controlled study in which one donor site wound was managed with VWDS, and the other donor site wound on the same patient was managed by our standard of care, which involved the use of Xeroform gauze (The Kendall Co.). Each donor site wound was independently assessed daily for pain, rate of reepithelialization, adverse reactions, and ease of dressing use while patients were hospitalized. Quality of scar was assessed during regularly scheduled follow-up visits. The use of VWDS eliminated donor site pain and accelerated reepithelialization compared with Xeroform gauze. There were no adverse reactions associated with the use of VWDS. In contrast, there were two cases of suspected infection at the donor sites treated with Xeroform gauze. The VWDS was more complicated to apply and use compared with Xeroform gauze. There were no differences observed in scar quality of donor sites treated with these dressings.