Wound Care Tool Kit (Stoma Paste)

December 19, 2009 — Matthew Livingston R.N. C.W.S.

Stoma Paste is a very useful tool when trying to provide a uniform surface for the placement of wound VAC drape over uneven surfaces. Uneven surfaces include skin folds, incision line deformations, or anatomical irregularities related to surgery or trauma. There are many brands of stoma paste available, but I have had good luck with Convatec and Hollister Brands. I recommend using the following process to prevent the paste from doing what it does best – sticking to everything.

1. Prewarm the past in a tray of warm water for a few minutes to make the paste less thick

2. Squeeze a little paste out on the clean side of the opened VAC kit package (let it sit for about a minute).

3. Pour a little water or normal saline into an appropriate container.

4. Dip into the water with a wood depressor or the back of the 10 blade scalpel (that you are using to cut the VAC foam)

5. Take up the stoma paste with the moist utensil surface and place it into the uneven surface. Leaving the top of the stoma paste even with the corresponding topside tissue. If you need to add more paste remember to re-moisten the utensil or else it will stick fast to the applicator.

6. Smooth out the paste between the inserted stoma paste with the corresponding topsided tissue by re-wetting the utensil and gently moving across it surface.

7. Wait a few minutes for the paste to firm and then apply the VAC drape over it. If you don’t wait for the stoma paste to firm up the VAC suction could pull it in, which could loose the seal.

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Wound Care Tool Kit – Acticoat flex.

September 2, 2009 — Matthew Livingston R.N. C.W.S.

The new Acticoat flex dressing (Smith and Nephew) is a flexible low adherent polyester layer coated with nanocrystalline silver. Nanocrystalline silver provides a high kill rate against microbes and serves as an effective barrier against microbial contamination.

Indications: include grafts, surgical sites, venous, pressure and diabetic wounds.

Authors take:

1. Very flexible material with a little stretch that allows full contact with wound surface.

2. Works as antimicrobial layer under NPWT or VAC foam dressing allowing fluid transfer from wound base through to the foam.

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Wound Care Tool Kit – Conformant 2 Wound Veil

August 9, 2009 — Matthew Livingston R.N. C.W.S.

Description
The Conformant 2 wound Veil consists of high-density polyethylenenon which is non-adherent, permeable, and flexible.

Indications
The veil is useful for partial and full thickness wounds, grafts or donor-sites. It also an appropriate cover for Apligrafs and Dermagrafts

Authors Take
Much like Mepitel this non-adherent product protects the wound bed during the removal of the secondary dressing. It also an appropriate barrier to protect the wound bed during removal of the VAC or S&N NPWT Therapy foam. The advantage of this product over Mepitel (which I have used for years) is that the the Conformant 2 comes in large sheets 12×12. It is also very easy to work with versus Mepitel (which seems to stick to everything and is hard to reposition on the wound bed).

Warning – The Conformant 2 Wound Veil is somewhat transparent which allows for some monitoring of a wound or graft. But it also blends well into granulating tissue. So make sure that you document your placement of the veil for the next person who changes the dressing.

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Wound care Tool Kit – Xenaderm

February 9, 2009 — Matthew Livingston R.N. C.W.S.

Xenaderm (Ointment) – Healthpoint
Description: Xenaderm is a vasodilator that promotes healing with a non-petrolatum base that provides a fluid repealing barrier.
Indications: Xenaderm is appropriate for partial thickness wounds, perineal wounds, and radiation skin reactions (Healthpoint, 2008).
Authors notes:
1. Xenaderm is particulary useful for difficult to dress incontinence-related skin injuries.
2. Xenaderm may cause rashes in a limited population of patients.
3. Keep the Xenaderm ointment on the wound bed (as much as possible) and don’t use as a barrier cream. Xenaderm placed on normal skin will often cause a reddened inflammatory response, that will subside in a few days with discontinuation of the product.

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Wound Care Tool Kit – Santyl Collagenase

February 8, 2009 — Matthew Livingston R.N. C.W.S.

Santyl Collagenase (Enzymatic Ointment) – Healthpoint
Description: Santyl Collagenase digests collagen in necrotic tissue and contributes towards the formation of granulation tissue and subsequent epithelization
Indications: debridement for chronic dermal ulcers including pressure ulcers, venous ulcers, arterial ulcers, diabetic foot ulcers, and severely burned areas (Healthpoint, 2007).
Authors notes:
1. Can be used in a wound bed that has a combination of non-viable tissue along with granulation tissue and epithelization.
2. May work better with a moist dressing on top.
3. Can be used with NPWT (as we did with accuzyme)
4. Can be used alternatively with silvadine

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