Skin Deep
December 2012/January 2013
An Advanced Tissue newsletter written by Janis Harrison,
Harrison RN,
RN BSN,
BSN CWOCN,
CWOCN CFCN of Harrison WOC Services L.L.C.,
L L C CCC WoundRight®
Q: I’m new to wound care. Can you give me more information on calcium alginate dressings and when I should use them? A: Many times using a foam dressing is just not enough to control the large amounts of exudate (drainage) we see with
large wounds, tunneling deep wounds, or infected wounds. Calcium alginates come in sheet form and ropes. They work
well to pack tunneling or deep wounds, as long as there is room for expansion. Never pack a wound tightly with any type
of dressing. Calcium Alginates are made of absorbent spun fibers of brown seaweed or from a fiber gelling dressing
called carboxymethylcellulose. They act in an ion exchange to absorb the exudate and form a gel substance that
conforms to the shape of the wound. This is a hydrophilic action (fluid absorption). Alginate dressings are not occlusive
or adhesive. Because alginate dressings become damp from the drainage they are able to keep the wound bed moist
aiding in autolysis, granulation, and epithelialization.
Calcium
C
l i Alginates
Al i t andd fib
fiber gelling
lli ddressings
i
are considered
id d th
the primary
i
ddressing
i andd coveredd bby a secondary
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They are changed as often as daily or may be left in place as long as they are not over-saturated or dry. The time the
dressing remains on the wound, depends on the secondary dressing chosen for absorption control. It is not considered
good practice to place an alginate or fiber gelling under a transparent dressing as there is no added absorption to this
type of secondary dressing. Alginates are used to absorb and it is against best practice to use it in conjunction with a
hydrogel. If the wound is too dry, it will desiccate the wound to add the alginate and decrease the growth of epithelial
tissue The fibers of the Alginate are biocompatible with the wound so attempting to aggressively irrigate or trying to
tissue.
remove all of the dressing fibers is not necessary. It is important that the alginate touch the wound bed in order for good
granulation to take place. Reference: Bryant, RA, Nix, DP: Acute and Chronic Wounds: Current Management Concepts. 4th Ed. Mosby 2012.
Vocabulary Word – Strikethrough Drainage
Rule of Thumb:
This is the drainage noted in the secondary dressing by looking at g
y
g y
g
it from the outside. If the drainage that you see at the top of the secondary dressing is larger than the margins of the wound then the dressing should be changed. If the dressing is being wrapped to secure it then you will need to remove the outer wrap to check for the strikethrough drainage. It is helpful to mark the size of the wound on your dressing with a permanent marker for the next staff nurse to assess the dressing easily.
If the wound is drying out too much with the
dressings you have chosen:
•Decrease the absorption of the dressing
combination by changing the primary dressing or
removing it all together.
•Decrease frequency of dressing changes.
changes
•An alternative dressing type should be chosen.
This newsletter was written by Janis Harrison, RN,
BSN, CWOCN, CFCN of Harrison WOC Services L.L.C.,
CCC WoundRight® of Thurston, NE. If you have a
question for Ms. Harrison please email
[email protected].
If it is too wet, dry it up.
If it is too dry moisten it.
If the wound is still too moist and exudate is
striking through:
•Add a hydrophilic (Absorptive) dressing to the
wound bed.
•Increase the frequency of dressing changes.
•An alternate dressing type should be chosen.
For more information about Advanced Tissue, please call 866‐217‐9900 or go to advtis.com