Wound pad
A dressing is placed on external wounds to prevent foreign bodies from entering the wound and to absorb blood and wound exudate . In addition, wound dressings can ensure a healing, moist, warm wound climate, reduce pain through the substances they contain, promote wound healing or have antimicrobial effects .
Types of dressings
There are wound dressings for dry and wet wound treatment as well as self-adhesive products and those that have to be covered with another dressing or fixed with a secondary dressing . The combination of a wound pad and adhesive tape is known as an adhesive plaster . The decision for a specific edition is based on the diagnosis, the specifications of the care facility, the economic requirements and the individual preferences of the patient.
Alginates
Alginates are used in wound care as compresses or tamponades . Made up of fine whitish fibers made from brown algae , they contain alginic acid , calcium and sometimes trace elements such as zinc and manganese . Upon contact with wound exudate, an ion exchange occurs between the calcium contained in the fiber and the sodium in the body's own exudate. This causes the alginate to swell and form a gel with high absorbency that can absorb significant amounts of exudate.
By absorbing excess wound exudate as well as tissue and other waste materials, the alginate cleans the wound and at the same time ensures a warm, moist wound environment that promotes healing. These products do not adhere by themselves and are therefore fixed to the wound with other coverings such as foils.
Foils
Semipermeable film covers allow oxygen and water vapor to be exchanged, but at the same time prevent germs and foreign substances from penetrating the wound. These products are made of polyurethane and are coated with hypoallergenic acrylate adhesives that only adhere to sufficiently dry skin. Although they allow a certain amount of wound exudate to evaporate, film coverings retain a sufficient amount and ensure a warm, moist wound environment that promotes wound healing.
Hydrogels
Hydrogel consists of 60-95% water and can be used both as a gel and in the form of compresses for wound care. The high proportion of water makes these products ideal for use on wounds that have only a small amount of exudate . By releasing moisture, hydrogels also promote the softening of dry scabs and undesirable deposits. With this effect, these materials support autolytic debridement , i.e. the cleaning of the wound by over-saturating it with moisture, which leads to the dissolution and detachment of adhering tissue residues or coverings.
The hydrogel compresses consist of three-dimensional structures made of polyacrylamide or polyurethane, in which water is bound. The hydrophilic basic structure is not itself water-soluble, which gives the hydrogel plates their strength. Despite the amount of water they contain, hydrogel compresses can absorb additional moisture. The absorption of wound exudate and waste materials causes the wound dressing to swell slowly and continuously.
Hydrocolloids
These products consist of a self-adhesive mass made of carboxymethyl cellulose , pectin or gelatine, which is applied to a carrier layer made of foam or thin polyurethane film. Hydrocolloid wound dressings release moisture to the wound and maintain a warm, moist wound climate. These are water-repellent pads with which the patient is able to shower. When it comes into contact with wound exudate, a yellowish gel develops that appears as a blister below the pad and can be mistaken for pus .
In the care of people with chronic wounds , allergic skin reactions have been observed with the use of hydrocolloids. The rosin contained in the products used was suspected to be the trigger .
Hydrofiber
Hydrofibers are used in the form of compresses or tamponades and consist of sodium carboxymethyl cellulose . Under the action of the body's own exudate, these products form a dimensionally stable gel that supports the autolytic cleaning of the wound. The gel formation reduces the occurrence of wound exudate, and waste and foreign substances are trapped in it. Hydrofibres do not adhere and must be fixed to the wound with absorbent compresses or foil.
In contrast to alginates, which have a similar effect, hydrofiber only expands in the vertical direction. If the hydrofiber pad overlaps the wound edge by up to three centimeters after application, it therefore keeps it free of wound exudate and reduces the risk of damage to the wound edge and the wound area through maceration of the tissue.
Hydropolymers
These are foam pads with a high absorption capacity that can absorb up to thirty times their own weight in liquid. On contact with wound exudate, these wound dressings swell towards the wound bed and thus fill the wound. Due to their absorption capacity in connection with the swelling effect, hydropolymers regulate wound moisture and stimulate wound healing.
Under pressure, these wound dressings release liquid again, which escapes in different directions and, if it occurs unnoticed, can endanger the immediate wound environment by softening. Many hydropolymers also do not absorb viscous wound exudate due to their fine-pored structure.
Compresses
The term compress is often used synonymously with the term wound dressing, because it is a classic material used in traditional dry wound care . Compresses have always been used in wound care and are made of cotton or wadding , previously also Scharpie , i.e. materials that primarily absorb fluid and thus keep the wound dry.
The possible uses of modern compresses, however, go far beyond the conventional covering and absorbent function and can be varied. There are compresses that are enriched with activated charcoal , which can bind and reduce wound odor. Other products have a hydrophobic coating, which binds hydrophobic germs and pathogens to the pad and removes them from the wound when the dressing is changed.
Some foam pads or grids are also referred to as compresses.
PU foam pads
These wound dressings are made of polyurethane and can absorb and store exudate through capillary force without losing their shape. To prevent new capillaries from sprouting into the wound pad , the side that rests directly on the wound is thermally smoothed or covered with a perforated film. Foam pads can absorb an amount of exudate that exceeds twenty times its own weight and ensure a warm, moist wound environment.
These products can be structured very differently. Some foam compresses must be held in place with a secondary bandage, while others have an adhesive edge. There are also foam pads with special shapes that are designed to be attached to hard-to-care areas such as the heel . Some foam pads are enriched with nanocrystalline or ionic silver or polyhexanide . Such antimicrobials these products are effective against pathogens and germs and play an important role in the antisepsis of infected or infections for wounds.
Suction rinsing body
For so-called "wet therapy", wound dressings are used whose core consists of a super-absorbent polymer that is enriched with Ringer's solution . The wound dressing constantly releases moisture to the wound and in return absorbs wound exudate . In this way, absorbent rinsing bodies for wet therapy ensure the moist wound environment and at the same time reduce the bacterial load within the wound. These wound dressings can remain on the wound for several days, depending on the product up to 72 hours.
Wound dressings in the first aid kit
Suitable wound dressings are low in germs , ideally sterile and non- fluffy . These conditions are met by the dressing materials contained in the first- aid kit , provided the individual packaging is undamaged. Alternatively, fresh, ironed, smooth linen or cotton towels can be used. Paper tissues or the like are completely unsuitable .
Notes and individual references
- ↑ K. Protz: Modern wound care , Elsevier Verlag, Munich 2016, ISBN 978-3-437-27885-3 , p. 50
- ↑ Anette Vasel-Biergans, Wiltrud Probst: "wound care for nursing A Playbook." , Scientific Publishing Company Stuttgart, 2nd revised edition, Stuttgart 2011, ISBN 978-3-8047-2798-4 , pp 130-131
- ↑ Anette Vasel-Biergans, Wiltrud Probst: "Wound care for care. A practical book" , Wissenschaftliche Verlagsgesellschaft Stuttgart, 2nd revised edition, Stuttgart 2011, ISBN 978-3-8047-2798-4 , pp. 118–119
- ↑ A. Vasel-Biergans: Wound pads for the smock pocket, Volume 1 , Wissenschaftliche Verlagsanstalt Stuttgart, Stuttgart 2018, ISBN 978-3-8047-3307-7 (print) page 323
- ↑ C. Erfurt-Berge: "Contact sensitization in patients with chronic wounds" in Pflegezeitschrift, Kohlhammer, Stuttgart 2016, vol. 69, issue 6, ISSN 0945-1129 , pp. 342-345
- ↑ K. Protz: Modern wound care , Elsevier Verlag, Munich 2016, ISBN 978-3-437-27885-3 , p. 50
- ↑ Application standard PU foam and hydropolymer bandages of the Wundzentrum Hamburg, accessed on September 13, 2018
- ↑ T. Proschek: "New therapies for challenging wound situations" , nursing journal Springer Medizin Verlag, Berlin, Volume 70, Issue 8 2017, ISSN 0945-1129 , pp. 34–37
- ↑ A. Vasel-Biergans: Wound pads for the smock pocket, Volume 1 , Wissenschaftliche Verlagsanstalt Stuttgart, Stuttgart 2018, ISBN 978-3-8047-3307-7 (print) page 441
- ^ JD Rembe, C. Fromm-Dornieden, J. Böhm, EK Stürmer: "The influence of human wound exudate on the anti-bacterial effectiveness of various antiseptic polyurethane foam pads " in Wundmanagement, mhp-Verlag, Wiesbaden, 12th year 5/2018 , ISSN 1864-1121 , pages 268-274
literature
- Kerstin Protz: Modern wound care, practical knowledge, standards and documentation, 8th revised edition . Elsevier Verlag, Munich 2016.
- Anette Vasel-Biergans: wound pads for the smock pocket, 4th revised edition in 2 volumes . Scientific Publishing House Stuttgart, Stuttgart 2018.
- Bernd von Hallern: Compendium wound treatment . Mode of action and indications of wound treatment products. Publishing house for medical publications, Bremerhaven 2018.
- Hans Lippert : Wound Atlas . Compendium of complex wound treatment. Georg Thieme Verlag, Stuttgart 2006, p. 68 ff . ( Google Books ).
- Sebastian Dickhaut: Life! GU's house book . Gräfe and Unzer, Munich 2005, p. 167 ( Google Books ).
- Thomas Cissarek: Vascular Medicine: Therapy and Practice . ABW Wissenschaftsverlag, Berlin 2009, p. 163 ff . ( Google Books ).
