Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 39

CLINICAL PRACTICE GUIDELINE

Table 3. Selection of Wound Care Dressing
Dressing Category
and Definition

Indications

Advantages

Disadvantages

Considerations, Usage,
and Precautions

PA S S IVE WOUND CARE PRODUCTS/ THERAPI ES

Hydrogel
Water- or glycerin-based
amorphous gels
delivered from a tube or
impregnated into strip
packing materials,
gauzes, or sheet
dressings.
It donates moisture /
fluid into the wound.
Absorptive capacity
varies.

* Primary dressing
(amorphous and
impregnated gauzes)
or as primary or
secondary dressings
(sheets)
* Partial- and fullthickness wounds
* Deep wounds
* Dry to minimal
exudate
* Used in combination
with other dressing
materials

* Promotes autolytic
debridement
* Conformable to
wound space
* Fills in dead space
* Rehydrates the wound
bed
* Soothing and reduces
pain
* Amorphous form can
be used when
infection is present

* Not recommended for
wounds with heavy
exudate
* Dehydrates easily if
not covered
* Requires secondary
dressing
* May be difficult to
secure
* May cause maceration
of periwound skin or
candidiasis from
inappropriate usage

* Sheets without
adhesive border or
wound fillers are
changed up to once
per day
* Apply skin protective
wipe to periwound
skin to prevent
maceration
* Sheets with adhesive
covers are changed up
to 3 times per week

Foams
Semi-permeable
hydrophilic foam.
Available in varying
thicknesses, absorptive
capacity, and adhesive
properties.
Available in pads, sheets,
wafers, rolls, pillows,
surfactant impregnated
or with an odor
absorbent charcoal layer.

* Primary dressing
for absorption and
insulation
* Secondary dressing for
wounds with packing
and provide additional
absorption and to
absorb drainage
around tubes
* Partial- and fullthickness wounds
* Minimal to heavy
exudate
* Infected wounds
* Used in combination
with other dressing
materials such as films,
alginates, pastes, and
powders

* Non adherent and
protects periwound
skin
* Conformable to body
contours
* Insulates wounds and
provides padding
* Repels contaminants
* Easy to apply and
remove

* Not recommended for
desiccated wounds or
those with sinuses
unless packing is
added
* Cavity dressing pillows
should not be cut
* Nonadherent foam
requires secondary
dressing, tape, or net
to hold in place
* Poor conformability to
deep wounds

* Select a dressing
approximately 2-3 cm
larger than the wound
* Dressing change may
be up to 3 times per
week
* Usual dressing change
for foam wound fillers
is up to once per day

Gauze
Woven or non-woven
material that may
include cotton, rayon,
and / or polyester.
Available sterile or nonsterile. May be used wet,
moist, dry, or
impregnated with
petrolatum, antiseptics,
or other agents (see
below). Comes in
varying weaves with
different size interstices.

* Partial- and fullthickness wounds
* Infected wounds and
those with
combination exudate
or necrotic tissue
* Exudative wounds
* Wounds with cavities
or dead space,
tunneling, or sinus
tracts

* Loosely filling large
wounds
* May use in
combination with
other wound products
such ashydrogelgels

* Adheres to wound
tissue for nonselective
debridement
* May lint or shred
if cut
* Labor intensive
approach
* Wound may desiccate

* Fluff gauze and
avoid pressure or tight
packing
* Monitor for
desiccation or
saturation
* Dressing interval
depends upon level
of saturation

Impregnated Gauze
Woven sponges that
are impregnated with
chemical compounds
and agents (hypertonic
or NS, petrolatum, zinc,
iodoform) to deliver
antimicrobial,
medication, nutrients
and
moisture

* Partial- and fullthickness wounds
* Infected wounds and
those with
combination exudate
or necrotic tissue
* Exudative wounds
* Wounds with cavities
or dead space,
tunneling, or sinus
tracts

* Dressing dependent:
Petrolatum makes
gauze nonadherent;
hypertonic dry
sponges provide
absorption, and
antimicrobials
decrease bioburden

* Dressing dependent

* Loose packing
* Monitor for exudate
to avoid maceration
* Choose appropriate
size and ingredients
for dressing

39
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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