WOUND BLOG by Matthew Livingston RN » Wound Care Tool Kit

Wound Care Tool Kit: ORC Collagen

Matthew Livingston R.N. C.W.S. — Tue, 26 Apr 2011 23:01:10 +0000

Many wound care clinicians over the years have used Promogran and Prisma (ORC Collagen) as their treatment of choice for chronic wounds. What I first noticed with the use of ORC collagen (Prisma and Promogran) was that chronic wounds would often undergo a new wave of contraction and granulation. It was a product that I would pull out of my wound care tool kit for any long- standing wound.

As the years have rolled by many of the other wound care companies have jumped into the space seeking to capitalize on the chronic wound / collagen market. But is collagen the same as ORC collagen (Prisma & Promogran)? I learned first-hand that switching (from ORC collagen) to plain collagen can lead to disappointing results when different collagen products were added to our hospital formulary. In time I realized that plain collagen wasn’t providing the wound contraction and granulation formation that I would see with the ORC Collagen (To the point that I stopped using collagen altogether).

My question is has any one else observed this difference in quality?

Disclosure: The author of this article declares that he receives no financial reward for this posting from Systagenix (the manufacturer of ORC Collagen).

Wound Care Toolkit: Proteasemarker

Matthew Livingston R.N. C.W.S. — Tue, 26 Apr 2011 00:02:36 +0000

Take a look at Systagenix’s new educational offering www.proteasemarker.com . This site shows their commitment to sharing information with clinicians regarding chronic wounds (There are lots of resources at this site). Systagenix is also bringing a product to the US market at the beginning of the next year that should revolutionize how we assess our patients. Essentually, this product (after a swab of the wound) will quickly identify out of balance chemicals that lead to chronic wound states. Needless to say this will be a huge advantage over what has pretty much been guess-work.

Wound Care Tool Kit – Drawtex

Matthew Livingston R.N. C.W.S. — Wed, 20 Apr 2011 01:14:50 +0000

Drawtex (SteadMed) is a new find as a hydroconductive debridement agent. I was able to see an average reduction in slough of up to 75% in the eight patients I have tried it on so far. The assumed mode of action is through the dressings ability to forcefully remove drainage (up to 150cc/hr) and content from the wound into the dressing. The force of the fluid transferred into the hydroconductive dressing is able to cleave the denuded collagen that bonds the necrotic tissue from the healthy tissue. The advantage of hydroconductive debridement is that it is a top down debridement tool that can debride over a large surface area (versus the peripherial wound area such as side down debridement agents i.e. Santyl Collagenase).

Indications:

Drawtex works well with wounds with moderate to large drainage, Reoccurring slough, Adherent slough, Consolidated slough with is difficult to remove with curettage and as an alternative for patients who have pain with sharps debridement.

Author notes:

Drawtex is also useful for controlling Biofilm as noted in the (Randy Wilcott Poster which won first place at the SAWC Spring, 2011 Conference).

The dressing will not degrade in the wound and will continue to pull fluid from high draining cavities, so it is very useful with deep narrow or wide tunnels (Were alginates fail).

Hydroconductive Debridement a new Perspective in Wound Debridement

Matthew Livingston R.N. C.W.S. — Wed, 09 Mar 2011 03:31:31 +0000

I have long been looking for what to do once we lost Panafil and Accuzyme. Currently, many clinicians have been using Santyl as the default wound debridement agent. We know that Santyl has a place in the scope of debridement, but it in itself has limitations. Needless to say, I have found what we may have been looking for as a wound debridement agent. I recently had the opportunity to finish a case study with a product that provides what I have been looking for as a debridement agent. I will be submitted a poster on a Hydroconductive Debridement dressing called Drawtex (SteadMed) at the Spring 2011 SAWC . The numbers (in terms of reduction of avascular tissue) were very promising. This case study series included a average (with 8 cases) percentage reduction in the total slough and necrosis of 36% at week one, 52% at week two, and 72% at week three. Please note that no other types of debridement were utilized during this study. The study also noted an average percentage reduction in wound area of 15% at week one, 35% at week two, and 47% at week three.

Disclosure: the author receives no financial incentives from SteadMed.

Wound Care Tool Kit (Stoma Paste)

Matthew Livingston R.N. C.W.S. — Sat, 19 Dec 2009 21:05:38 +0000

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.

Wound Care Tool Kit – Acticoat flex.

Matthew Livingston R.N. C.W.S. — Thu, 03 Sep 2009 03:40:59 +0000

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.

Wound Care Tool Kit – Conformant 2 Wound Veil

Matthew Livingston R.N. C.W.S. — Mon, 10 Aug 2009 01:59:32 +0000

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.

Wound care Tool Kit – Xenaderm

Matthew Livingston R.N. C.W.S. — Tue, 10 Feb 2009 02:31:13 +0000

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.

Wound Care Tool Kit – Santyl Collagenase

Matthew Livingston R.N. C.W.S. — Mon, 09 Feb 2009 01:09:32 +0000

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

Wound Care Tool Kit, Mepitel

Matthew Livingston R.N. C.W.S. — Sat, 07 Feb 2009 21:42:54 +0000

Mepitel (Silicon Dressing)- MoInlycke Health Care

Description: Mepitel can be removed from the skin surface with minimum pain and without damaging delicate new tissue.

Indications: Mepitel is used in the management of wounds where adherence of a dressing to the underlying tissue represents a particular clinical problem. Typical applications include skin tears or abrasions, surgical excisions, second-degree burns, blistering conditions such as epidermolysis bullosa, lacerations, partial and full thickness skin grafts, bio-engineered skin and skin damage following radiotherapy or steroid therapy (Mölnlycke Health Care, 2008).

Authors notes:

1. Best option versus Adaptic, Xeroform, or other impregnated dressings including gauze as there is a possibility these dressings fibers will get tangled into newly formed granulation.

2. Very useful in protecting wound edges and reducing pain with NPWT during foam removal (Foam can entangle into granulation tissue).

3. Place over vital structures (bone, organs, etc..) before placing the NPWT foam in the wound bed.

4. Helps to retain moisture and stability on larger open or very fragle skin tears.

5. Helps retain moisture and stability with Apligraf and Dermagraft (after skin substitute is secured with steristrips)

6. A comparable product would be the Wound Veil by Smith and Nephew