≥ 92% of participants will know what to use to dress a wound.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥ 92% of participants will know what to use to dress a wound.
After completing this course, the participant will be able to:
The ideal dressing for wounds should promote the best environment in the wound bed to promote wound healing. In other words, it should maintain a moist wound bed, be thermally insulating, protective to the wound, free of particles that could remain in the wound or become foreign bodies in the wound, be vapor permeable, hypoallergenic, non-toxic, comfortable, and cost-effective. Also, if possible, the wound dressing should also be aesthetically acceptable to the patient/caregiver and promote the patient continuing as many daily living activities as possible (within the limits of their comorbid conditions) (Centers for Disease Control and Prevention [CDC], 2020a; CDC, 2020b; Joint Commission for Accreditation of Health Care Organizations [JHACO], 2017; Santana et al., 2018).
Some of the simplest substitutes for saline-moistened gauze (wet-to-dry) dressings are a hydrogel (gelling fibers) dressing, silicone sheet, or wound gel moistened/impregnated gauze. These types of dressings prevents the wound bed from drying out and is less painful (Shi et al., 2020). However, many evidence-supported wound dressings address various wounds’ specific needs. This section is a basic introduction to some common dressings with moderately strong evidence supporting their use. Please see Table 1 for a list of common wound dressings and suggestions for the frequency of dressing changes.
Data for the information in this section of the course were obtained from many primary sources (Alhajj et al., 2020; Del Amo et al., 2020; Bolton, 2019; Shi et al., 2020; Weller et al., 2020; Brumberg et al., 2021; Goldberg & Diegelmann, 2020; Sibbald et al., 2021; Yu et al., 2021) and summarized below. Also utilized were two textbooks specific to wound management (Baranoski & Ayello, 2020; Doughty & McNichol, 2015). In addition, the Agency for Healthcare Research & Quality (AHRQ) has evidence synthesis summaries and technical assessments published or currently in progress, such as a review of skin substitutes for chronic wounds (Snyder, 2020). With all current evidence guiding practice, it is recommended to continually re-evaluate the strength of the evidence as new evidence is generated.
The average health care provider or medical clinic should have at least a basic familiarity with the following products. Providers should probably have at least one of each type of dressing on hand/in stock:
Gauze comes in various forms, sizes, shapes, and layered products. The most common gauze products are sterile or aseptic (packaged individually, in packages of 2 or in bulk packages of 50 or 200 cotton gauze, woven, 8 or 12 layered, 4” x 4” or 2” x 2” sizes). Telfa is gauze, coated with a plastic film to help render it “non-adhesive.” Gauze also comes in larger bulk dressings such as ABD pads (originally known as Army Battlefield Dressings, but now are commonly referred to as “abdominal dressings”). Today, these dressings are commonly made with bulky absorbent layers of cotton batting and woven gauze in larger sizes such as 5” x 9” or 8” x 10.” Gauze dressings are also manufactured in woven gauze of one rolled length (roll gauze) in a variety of widths (such as 2” of 4” or 6” widths). Care should be taken when using certain roll gauze or woven gauze as a primary dressing in a wound bed. Some gauze products may leave behind small pieces of organic cotton material, becoming foreign bodies in the wound and perhaps facilitating bacteria’s growth or promoting hypergranulating tissue. Gauze may be used as primary and secondary dressings and may already be impregnated with other substances such as calamine, petrolatum, wound gels, silver, etc. Also, combination products may have layers of gauze combined with layers of other wound products such as charcoal, alginates, adhesive backings, or borders.
Whereas wet-to-dry dressings are moistened with saline and allowed to dry out (therefore not recommended for routine wound care), wound gels are a good alternative that effectively maintains a moist wound bed. The clinician may moisten the gauze with a wound gel or use a pre-packaged gel impregnated gauze. Typically, this only needs to be changed once a day instead of 2-3 times per day. Wound gel dressing changes would be less painful than wet-to-dry. Wound gels come in amorphous gels (in tubes) or sheets of flexible semisolid gel. Wound gels are commonly made of organic polymers that maintain moisture in the wound bed and swell with water or wound drainage. Also, wound gel may contain silicone, water, glycerin, polyethylene oxide, alginate, or collagen. These wound gels’ common brand names include (this is not meant to be all-inclusive):
Some gel sheets, such as Vigilon®, come with polyethylene film covers on each side that should be removed before placing gel sheets on the wound (this will allow more vapor permeability). Gel products may absorb up to 5 times their body weight in wound drainage yet will not dry out or dissolve. Typically, the gel product is placed in the wound bed and covered with a secondary dressing to secure it in place (such as gauze or foam). These products are typically changed daily, though gel sheets on certain wounds such as superficial wounds and skin tears may be left on for one week if the skin tear is clean (non-infected) with a well-approximated flap that is not heavily exudating. Wound gel sheets that come with adhesive borders may typically be changed three times per week. Wound gels are appropriate for full-thickness, shallow or deep wounds with scant to small or varying drainage amounts. The wound bed may sometimes dry out. Silicone gel sheets may also help prevent or treat wound scarring (keloid/hypertrophic tissue) up to one year after wound closure.
Care should be taken to manage moisture so that excessive moisture cannot seep over the surrounding wound edges, causing maceration. Skin barrier wipes or creams may help protect periwound skin from adhesives (barrier wipes) or excessive moisture (barrier creams such as zinc oxide or dimethicone). These are applied at each dressing change.
Another simple dressing to use is impregnated gauze. Pre-packaged impregnated gauze products are typically impregnated with petrolatum, hydrogel, Bismuth Tribromophenate, hypertonic sodium chloride, zinc, or crystalline iodine compound (iodoform), or oil emulsions, to name a few. These dressings’ common brand names include (this is not meant to be all-inclusive):
The most basic and inexpensive petrolatum impregnated gauze may average $40 or less per box of 50. These dressings conform and may be a good choice when filling tunnels or tracking as long as one piece and not multiple pieces are packed loosely into the tunnel. These dressings provide a non-drying and moisture-retaining wound interface. They conform to the wound bed and may help protect periwound skin if shallow abrasions may be placed on the wound overlapping the edges. Usually, these dressings are changed daily and covered with a secondary dressing such as gauze pads or roll gauze, foam, bandage, or wraps.
Hydrocolloid dressings are typically opaque, self-adherent “patch” type dressings made of sodium carboxymethylcellulose, pectin, and gelatin mixed with polymers and adhesives. They also have a semipermeable film or foam sheet covering, making them generally waterproof. However, waterproofing does not mean it can be submerged in a bathtub or pool. These dressings are flexible wafers of differing sizes, thicknesses, and shapes (some may be cut to the desired size and shape). They can conform to many areas of the body. These dressings’ common brand names include (this is not meant to be all-inclusive):
When exposed to exudate (wound drainage), the polysaccharides & other polymers absorb water and swell but remain in the adhesive matrix. Some have marks to indicate when the wound drainage exceeds the dressing’s limit, and it is time to change. If cut to size, most should be cut larger than the wound. These dressings are typically changed every 2-5 days. Applying a skin barrier wipe to the periwound skin is best before applying the hydrocolloid.
Alginates are super absorbent fibers typically composed of calcium alginate manufactured from brown seaweed that becomes gel-like when exposed to sodium-rich wound exudates. It resembles angle hair and is manufactured from brown seaweed. They may absorb up to 20 times their weight in wound exudates. This makes them a good choice for highly exudating wounds. However, they are not recommended for dry or only slightly moist wound beds, as they will not remain a gel without the presence of moisture from the wound bed. Thus, they may dehydrate the wound bed or allow the wound bed to dry out. Alginates may be available as sheets or pads and ropes and are known for some hemostatic properties, making them a good choice for a wound bed that may ooze a small amount of blood after sharp debridement. Also, some alginates may have silver incorporated into the fibers as an antimicrobial agent. Alginates typically require a secondary cover dressing such as gauze or an ABD pad and are changed daily or as necessary to manage wound exudates.
Hydrofiber dressings are non-wicking, primary absorptive dressings made of sodium carboxymethyl-cellulose fibers that absorb wound drainage and turn into a gel sheet. They may also keep the wound bed moist if the wound is dry (you would moisten them with saline or water). Hydrofibers act somewhat like alginate but will not promote hemostasis like alginates. Some hydrofiber dressings include 1.2% silver as an antimicrobial component (usually delineated by the silver element symbol “AG” in the hydrofiber name). They are appropriate for full-thickness wounds with minimal to moderate amounts of drainage. They are typically changed once every 1 to 3 days and require a secondary cover dressing.
Foam dressings are typically both absorptive and protective. They may be selected to provide conforming padding. If needed, they may be combined with other products (such as alginates or hydrofibers). Foams may be used as packing material in large wounds to fill dead space. Not all foam dressings are appropriate for infected wounds. Check manufacturer guidelines if an infection is an issue. Some foam dressings are impregnated with silver or other antimicrobial material (such as Methylene Blue and Gentian Violet or polyhexamethylene biguanide/PHMB) or coated with a silicone interface.
Silver ions may be incorporated in wound gels, woven fabric dressings, foam, rope, alginates, or hydrofiber dressings. Most silver fabric dressings are not very absorbent. They are used primarily to deliver silver ions to the wound bed for the silver’s antimicrobial effects. However, silver alginates, hydrofibers, foams, or composite dressings are absorbent. Silver ions are activated by wound exudates or water; some silver products (Acticoat® three days or seven days) should not be moistened with sodium chloride (saline). Most ionic silver products should not be mixed with hydrogen peroxide or sodium hypochlorite (Dakin’s® or DiDaksol®) solutions because the ions will inactivate each other. Ionic silver products should not be combined with iodine products for the same reason. Silver dressings may need secondary dressings to hold them in place or provide extra absorption. Depending on the product, they may be changed daily up to every seven days.
A 10% povidone-iodine solution provides about 1% of available iodine and is commonly used as an antimicrobial. It should not be used in typical chronic wound care due to its cytotoxic properties (but may be used short-term if infection warrants it or “paints” stable dry, intact eschar). However, a cadexomer iodine is available, which has antimicrobial properties while remaining non-cytotoxic to the wound bed. Cadexomer iodine is available in a wound gel (thick paste) or impregnated on a flexible pad, which is typically applied to the wound bed with a secondary dressing on top and left in the wound bed for three days, or until the color changes from an orange-brown to a grey-brown. They are used for antimicrobial effects. They are effective against most bacteria, including pseudomonas, staphylococcus aureus, streptococcus, and fungus. Some literature suggests that caution should be exercised when using a slow-release iodine product in patients with thyroid disease due to iodine’s potential systemic uptake.
Compression dressings or bandage wraps are primarily used for lower extremity venous insufficiency (Gupta et al., 2017). Compression garments are also appropriate for extremities affected by lymphedema (such as mixed etiology lower extremity edema, and after cancer surgeries such as mastectomies with axillary lymph node removal) or burns (National Institutes of Health National Cancer Institute [NIH], 2020). Short-stretch compression is typically used for lymphedema (not ace bandages). Long-stretch compression (multilayer wraps and ace-type bandages) is typical for venous leg wounds. It is essential to verify arterial perfusion to the affected limb before applying compression. Compression may be applied in 2 to 4 layers. A therapeutic layer such as zinc oxide or calamine impregnated strips is applied first, an absorbent layer next, possibly a bandage layer or Coban® layer on top. These dressings may be applied every few days to weekly, depending upon the amount of wound exudate. Once edema is under control and wounds healed, the patient should wear life-long compression stockings (apply daily first thing in the morning before ambulating and remove at night just before retiring to bed).
Composite dressings, or layered dressings, are combination dressings of various sizes made up of two or more different materials to address the unique needs of certain wounds. These dressings tend to be layered with a contact layer (non-adhesive), an absorbent layer, and possibly an antimicrobial layer or odor-absorbing layer (such as charcoal). They also may have an adhesive border to secure them to the wound site.
Tissue-engineered skin substitutes, matrix dressings, electrical stimulation, collagen products, platelet-rich dressings, and negative pressure wound therapy are some advanced wound therapies that are becoming more commonly used. As technology advances, additional novel therapies are being developed (Brumberg et al., 2021; Yu et al., 2021), including bioactive dressings, surfactant gels (Salisbury & Percival, 2018), nanomaterials (Stoica et al., 2020), and dressings which not only treat the wound but also monitor the wound and provide real-time information to clinicians on a phone application (NextGov, 2020). Staying up to date with advancing technologies in treating wounds is a challenge for nurses and other healthcare providers but attending wound conferences and reviewing online CEU courses is a great place to start.
The following wound product (basics) table below is not comprehensive and newer products are continuously being added in each category all the time. Also review wound treatment algorithms and guidelines to assist the clinician in selecting evidence-based wound treatment approaches determined by individualized wound assessments and treatment plans (Sibbald et al., 2021; Wounds Canada, 2017):
|Type of Product (Typical average cost: $=Lower cost $$$= Higher cost)||Some Examples (not all-inclusive) *Brands/Names||Types of Wounds||Action|
|Petrolatum or Hydrogel Impregnated gauze ($)||Vaseline® Gauze, Adaptic®, Xeroform®; Skintegrity®, Elta®, Restore®, DermaGauze®, Curafil®, Curad® Petrolatum Gauze||Shallow and dry wounds; abrasions, skin tears, etc||Provides non-drying and moisture-retaining wound interface, conforms to the wound bed. Petrolatum impregnated products may help protect periwound skin if shallow abrasions with wound exudate. These impregnated gauze dressings (primary dressing) typically require a secondary dressing to secure them. These primary dressings generally are changed daily, though they may be left in place over well-approximated, non-infected skin tears up to 1 week.|
|Wound Gels/Hydrogels ($-$$)||SAF-Gel®, Vigilon®, Elastogel®, Curasol®, Solugel®, Intrasite® Gel, Purulon® Gel, DuoDERM® gel, Stimulen® collagen gel, Carrasyn® Curagel®, Nu-Gel®, Restore®, XCell®, (Hypergel® is a hypertonic saline gel)||Dry to minimally draining wounds; partial and full-thickness depth, 2nd-degree burns, exposed tendons||Organic polymers maintain moisture in the wound bed and swell with water/drainage (some can absorb up to >5x their weight in exudate). These gels typically will not dry out or dissolve. It may be changed daily, though some gel sheets such as skin tears may be left on for one week if there is a well-approximated flap. Some gel sheets (particularly glycerin or silicone) may also be used over scars to reduce hyperkeratosis (keloid formation).|
|Hydrocolloids ($-$$)||Restore®, DuoDERM®, DuoDERM® CGF, Tegasorb®, Comfeel®, Granuflex®, 3M® Tegaderm hydrocolloid thin||Partial and full-thickness wounds; minimal to moderate drainage||A flexible wafer of differing sizes, thicknesses, and shapes (some may be cut to desired size and shape); forms an impermeable barrier (most are waterproof); self-adhesive; may contain gelatin, pectin, and carboxy-methylcellulose together with other polymers and adhesives. When exposed to exudate (wound drainage), the polysaccharides & other polymers absorb water and swell but remain in the adhesive matrix. It may be changed every 3-5 days.|
|Transparent films ($-$$)||Op-Site®, 3M® Tegaderm, PolySkin®, Suresite®, Blisterfilm®, Argomed® and Argomed® plus TPU films, Mefilm®, Uniflex®, AcuDerm®||Partial-thickness or shallow wounds with minimal to small drainage amounts||Most are polyurethane films; provide moisture retention and may provide skin protection. May also assist with autolytic debridement. Most are oxygen or vapor permeable (not 100% occlusive). Sometimes used to “waterproof” a wound.|
|Hydrofiber ($$-$$$) – with and without silver||Aquacel®, Aquacel® AG (with silver)||Mostly shallow; partial to full- thickness; minimal to moderate drainage||Non-wicking, absorptive dressing made of sodium carboxymethyl-cellulose fibers that absorbs wound drainage and becomes a gel sheet. They may also keep the wound bed moist if the wound is dry (moisten with saline or water). Act somewhat like alginate but will not promote hemostasis like alginates. Typically changed every 1-3 days.|
|Non-adherent polyurethane foam or silicone interfaced foam; ($$)||Optifoam®, Mepilex®, Mepilex® Border, Mepilex® Transfer®, Allevyn®, PolyMem®, Lyofoam®, Hydrasorb®||Shallow wounds to those with some depth; partial to full- thickness; minimal to heavy drainage||Absorptive & protective- provides conforming padding and may be used in combination with other products (such as alginates or hydrofibers) if needed; Some have self-adhesive borders. Foams with a silicone contact layer may help reduce hypertrophic (keloid) scarring. Some have multiple layers (polyurethane foam+ polyacrylate fibers + waterproof film in Mepilex). Typically changed every 1-3 days.|
|Calcium Alginate ($$)||CalciCare®, AlgiSite® M, Maxsorb®, Algicell®, SeaSorb®, Restore® Calcium Alginate||Moderate to heavily draining wounds with no necrotic tissue||Highly absorptive fiber (rope or pad) product made from brown seaweed. May absorb up to 20 times their weight. It turns to gel when moistened with wound drainage. Change daily. May promote hemostasis.|
|Foams ($$)||Optifoam®, Mepilex®, Hydrasorb®||Deeper, full-thickness; moderate to heavy drainage||Absorptive and protective- provides conforming padding and may be used in combination with other products (such as alginates or hydrofibers) if needed. Foam may be used as packing material in large wounds to fill dead space.|
|Impregnated Foams ($$$)||Hydrofera® Blue||For exudating wounds. Can be used in pressure ulcers, venous ulcers, arterial ulcers, donor sites, abrasions, lacerations, superficial burns, etc||Absorptive and bacteriostatic wound dressing made of Polyvinyl alcohol sponge, methylene blue, and Gentian violet. It may help prevent infection or manage bioburden in the wound. It also binds endotoxins, which may aid in patient comfort (may be helpful in pyoderma cases). Contraindicated for 3rd-degree burns. It may also be used with enzymatic debriders. First dressing change at 24 hours. After that, it may be changed every 72 hours – however, do not allow the wound bed to dry out.|
|Silicone ($$)||Mepitel®, Elastogel®, etc.||Dry to exudating wounds or delicate wound beds (exposed tendons, etc.); or over newly closed wounds with a high risk of scarring||Some are fenestrated (have holes in them, such as Mepitel) and may be applied directly to the wound bed under negative pressure wound therapy or as a nonstick primary dressing. Some are thicker and used over shallow or newly closed wounds to prevent hypertrophic (keloid) scarring. It may be changed every 2-7 days.|
|Roll Gauze ($)||Roll Gauze||Deeper, full-thickness; moderate to heavy drainage||Absorptive and may be used to fill dead space; may also be used in combination with other products (such as alginates or hydrofibers) if needed; Kerlix not recommended due to loose fibers|
|Antimicrobial silver-impregnated woven fabric ($$$)||Acticoat® Burn (3-day or 7-day), flex, surgical site dressings||Not for very dry wounds||Not very absorbent - used primarily to deliver silver ions to wound bed for antimicrobial effects. Silver ions are activated by wound exudates or water; some silver products should not be moistened with sodium chloride (saline) or sodium hypochlorite (Dakin’s or DiDaksol) solutions because the ions will inactivate each other. Silver products should not be combined with iodine products.|
|Other silver products ($$-$$$)||Silver wound gels; silver gel sheets (Silvasorb®), silver alginate; silver Hydrofiber, silver foam, etc.||Application varies by type of base product||Use silver gels as you would other wound gels, use silver alginates as you would other alginates, silver foams as you would other foam dressings, except silver products should typically be used as primary dressings and not secondary dressings (so the wound bed receives the benefits of the silver antimicrobial).|
|Compression ($$-$$$)||Profore®, Profore® lite, Unna® Boots (with zinc oxide or calamine impregnated contact layer) or multilayer (2-4 layer) wraps, ace wraps||For lower extremity venous wounds||Long-stretch compression (multilayer wraps and ace bandage) is the typical treatment of choice for venous insufficiency and venous leg wounds. Verify arterial perfusion to the affected limb first!|
|Silver Nitrate sticks ($$)||Silver Nitrate||For minor active bleeding or hypergranulating tissue in the wound bed or at wound edges||Applied directly to rolled wound edges, hypergranulating tissue in wound bed; chemically cauterizes acute bleeding (must be used by a healthcare provider who can perform chemical cauterization within their scope of practice).|
|Collagenase ointment ($$)||Santyl ointment||Wounds with necrotic tissue in the wound bed||Only FDA approved active enzymatic ointment to help remove necrotic tissue from the wound bed|
|Antifungal skin products ($)||2% miconazole nitrate in powder, spray, cream, lotion, or ointment. Aloe Vesta Antifungal®; Monistat 1®, Neosporin AF®, Baza Antifungal®; Carrington® Antifungal; Fungoid®; Lotrimin® AF, etc.||Skin with a fungal rash||For fungal rash affecting the skin around the wound. Typically apply a small amount, gently rubbing it into the skin, so it is no longer visible. The powder may be applied with a light dusting, then gently massage onto affected skin (and may blot with skin barrier liquid to seal in if excessive moisture is present or under ostomy appliance).|
|Hypertonic dressings and Antimicrobial dressings (not all-inclusive) ($$-$$$)||Manuka® honey-based dressings||To assist in debridement and prevent or treat minor infections in “sloughy” wounds with moderate amount of exudate||Broad-spectrum antimicrobial activity. Aids in autolytic debridement of wounds by creating an osmotic effect. Promotes growth of tissues for wound repair; also helps suppress excess inflammation. Typically, these dressings are changed every other day.|
|Hypertonic saline impregnated gauze ($$)||Hypertonic saline impregnated gauze (Mesalt®); Hypergel is a hypertonic wound gel||To assist in debridement and prevent or treat minor infections in “sloughy” wounds with moderate to large amounts of exudate||Creates a hypertonic environment (unfavorable to bacterial growth and creates an osmotic effect) to gently draw exudate, debris, and edema from the wound bed. It comes in tightly woven fabric ribbons or fabric squares. Apply to wound bed and cover with secondary dressing. Change Mesalt and Hypergel products daily or more often as dictated by the amount of wound exudate.|
|Iodine dressings ($$$)||Cadexomer® Iodine gel; Cadexomer® Iodine dressing pads (Iodosorb gel® or Iodoflex® pads)||To prevent infection or treat infection in a wound (broad-spectrum antimicrobial including meticillin-resistant Staphylococcus aureus and suspected polymicrobial biofilm)||Cadexomer Iodine gel and pads have a hydrophilic property allowing absorption of up to 7 times its weight in exudate. Cadexomer Iodine contains 0.9% iodine but in a non-cytotoxic formulation. This still should not be used on anyone with an allergy to iodine. Read the label for other cautions. Cadexomer iodine gel and dressings will transition from brown to yellow/grey when the iodine has been depleted, indicating time to change the dressing. Also, change dressing when it is saturated with wound fluid and all the iodine has been released (as indicated by color change). Typically, these dressings should be changed 2-3 times a week, as needed. Do not mix iodine products with ionic silver products!|
|Antimicrobial gauze dressing ($$)||Polyhexamethylene® Biguanide (PHMB)||To prevent wound infection (such as in surgical wounds) or treat minor wound infection||Antimicrobial Gauze Dressing Impregnated with 0.2% Polyhexamethylene Biguanide (PHMB). Used in exudative wounds. Change up to every 3 days (PHMB is active for 3 days). If PHMB gauze adheres to the wound bed, moisten with saline before removing. PHMB is also now available in a hydrophilic PHMB polyurethane foam pad and may soon be available as a PHMB hydrogel.|
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.