Advanced Dressings and Devices QPG...

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Medicine, Nursing and Health Sciences

Advanced Dressingsand Technology

Quality Pharmacy 2017

Associate Professor Geoff SussmanClayton Campus

Wound Dressings

• Dressings have developed over the past hundred years or so by people such as Joseph Gamgee and many of the original dressings used in the 1800’s are still in use today. There has however been considerable research and development in the field of wound dressings with the introduction of many new and exciting products.

Wound Dressings

It is very confusing at

Times to understand all

of the new dressings and

Which way to go with

your practices

Local Wound Management• Dressings don’t heal wounds

• Dressings for local environmental management of wound

• Moist Wound Healing

– Scab forms physical barrier to healing

– Exudate important

• contains growth factors & nutrients

• has antimicrobial properties

– Significantly increased rate of healing

– Decreased pain

– Autolytic debridement

Dressing selection• Dressing function drives selection

• PRIMARY DRIVER – Moisture balance (exudate management)

• Secondary considerations

– Facilitating autolytic debridement (for necrotic or sloughy tissue)

– Wound depth (e.g. need to fill a cavity)

– Bacterial management

– Wound-related pain & other patient comfort factors, including pain when applying & removing dressings

– Protection, insulation

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Passive DressingsGauze Swabs Replacements

These swab should replace plain Gauze swabs because

They do not shed fibres like gauze Are more absorbent than gauze Soft on the wound surface

Could be used as packing in combination with an amorphous hydrogel

Examples, Handy Spun bonded swabs

Multisorb non-woven swabs

Exudry/ Mesorb/Zetuvit

“modern” passive dressing

highly absorbent pad

non stick (shear) surface

secondary dressing over hydrocolloid paste, cadexomer iodine, alginate etc

Tulle GrasTulle Gras has minimal use in the areas of simple grazes and first degree burns, and has been used as an initial dressing over skin grafts.

The original tulles are made from open weave gauze and petroleum jelly. Because of the open weave granulation tissue grows through the open spaces and embeds the dressing into the wound causing Trauma on removal.

New Tulles

The newer tulles are tightly meshed in their weave and as such

Will not stick to the wound or allow granulation tissue to growth through

The openings as does paraffin gauze.

They are useful as a contact material with a secondary dressing over the top and also on excoriated peri-skin.

New Tulle Mepitel Non-fibreThis is a very unique dressing being composed of a protein not a fibre, It is coated with a silicone material and has the safetac adhesion system that sticks well but is easily removed without trauma.

Used in burns , skin tears and can remain in place for 10 to 14 days at a time

Mepitel OneOne sided Safetac wound contact layer.

Transparent Mepitel One is an exciting new development in the quest to minimise interruptions to healing. An innovative one-sided Safetac wound contact layer, Mepitel One lets you give the healing process the time it needs as it can be left in place for up to 14 days–avoiding the need for dressing removal can help minimise patient pain and unnecessary disturbance to the healing process. Mepitel One offers high transparency allowing you to instantly assess healing progress without removing the contact layer.

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Urgotul/ Hydrotul/Physiotulle

incorporates a fine suspension of Sodium Carboxy methylcellulose. When the product is applied to the wound the exudate in taken up by the NaCMC and forms a gel on the surface of the wound providing a moist environment.

Acelity have taken over the wound care products from Johnson and Johnson but will still be distributed by J & J a new silicone contact layer is Adaptic Touch

New Brands in Australia

New Skin Closure SystemA Combination of strips and super glue

Non-absorbing Dressings(for nil to low exudate)

Film dressings (inc island dressings)

-waterproof

-gas/vapour permeable

-flexible

-protects from shear, friction, chemicals, microbes

-transparent

-spread tension forces

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Film/Island Films/Impregnated Absorbing Dressings(for Low to medium exudate)

Films with Acrylic Pad

- absorbent pad

- moist interface

- not need secondary dressing

- Transparent

Absorbing Dressings(for Low to medium exudate)Tegaderm Acrylic Pad Dressing

Absorbing DressingsTegaderm Acrylic Pad Dressing

Used on Donor Sites

Complete barrier protection

Allows wound visualisation

Rapid absorbsion of exudate and transpiration of excess

Sealed from theatre to discharge

Cheaper and more effective than Hydrocolloids

Latticed Allevyn

REACTIC Film controls moisture

Non adherent contact layer = comfort

Opsite Post Op Visable

Cover in O.R. next day

OPOV captures exudate, transpires and maintains the barrier, reducing risk of SSI

OPOV – excellent exudate handling

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Duodenal ulcer surgery

Day 2 Day 3

Removal of the dressing after 3 days from the operation

Absorbing Dressings(for low exudate)

Hydrocolloids

-flexible, waterproof

-provide physical barrier

-gel with exudate

-debriding

-no secondary dressing

-thin available (transparent)

Hydrocolloids

Absorbing Dressings (for medium to high exudate)

Foams-highly absorbent

-non-particulate

-insulating

-moist interface

-cushioning

-1,2 or 3 layer

-non-stick

-cavity foams

-may need secondary dressing

Foams

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Lyofoam Max

This is a new polyurethane

absorbent foam with a

waterproof film backing

which has a high vapour

permeability

Soft Silicone Foam Dressing

Mepilex ( Safetac) MőlnlyckeThis is a new style of dressing composed of a multiple layer foam dressing The

Surface of the foam has a soft silicone surface adhesive for non-traumatic removal.Available in several forms –Transfer and thin Mepilex Border is not a simple foam

It is a multi-layer dressing

Dressings for fragile skinSilicone Coated Dressings

Soft Silicone Foam Dressing

Allevyn Gentle & Border S & N

This is an Allevyn Foam dressing with a

Surface of soft silicone.The surface adhesive

is non-traumatic removal.

Available in several forms including

Absorbing DressingsMepilex Transfer

This is a new style of dressing composed of a

thin single layer foam dressing allowing

exudate to pass into and through the dressing

protecting the wound and the peri-skin from

maceration. The Surface of the foam has a soft

silicone surface adhesive for non-traumatic

removal. Very useful for large wet wounds

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Absorbing Dressings

1. Exudate masking layer

a. Acts as a ‘masking layer’; dressing may be left in place longer therefore reducing

the frequency of change, the cost of treatment and wastage.

b. Acts as a bump guard to provide protection for patients from knocks and bumps.

c. Change indicator allowing patients to take control of dressing changes and minimise wastage.

2. Unique quadrilobe shape

a. Designed to fit to the contours of the human body.

b. Wide border for secure adhesion.

3. Hyper-absorber lock away core

a. Solidifies exudate, allowing an increased volume of exudate containment.

b. Solidifying the exudate reduces the odour transmission.

c. Prevents exudate from washout back to the wound bed on removal.

4. Silicone wound contact layer

a. Provides gentle adhesive for minimal pain and discomfort on removal.

b. Elliptical holes reduces the surface tension of exudate allowing for faster exudate absorption

5. Hydrocellular foam

a. Controlled absorption through the structure of the dressing

b. Small and large hydrophilic cells rapidly absorb exudate into the inner areas of the foam

6. Patented REACTIC top breathable film

a. Maintains an optimal wound environment, preventing the dressing from becoming saturated or the wound from drying out.

Allevyn Life in UseAbsorbing Dressings

(for medium to high exudate)

Hydroactive dressings- highly absorbent

polymer dressing

-waterproof

-expandable

-non-residual

-semi-permeable

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Hydroactive Dressing in Use

Biatain® Silicone

Biatain Silicone’s unique 3-part opening allows you to open and apply the dressing to a wound without your fingers or latex gloves ever coming into contact with the dressing or the wound. This greatly minimizes the risk of infection and avoids the waste of dressings

Absorbing Dressings(for medium to high exudate)

Alginates

-seaweed derived

-form gel with exudate

-moist interface

-highly absorbent

-easily removed

-haemostatic (Some)

-need secondary dressing

Alginates

Kaltostat

Absorbing (moderate to high exudate) Hydrofibre

• Synthetic fibrous mat

• forms a firm gel in contact with exudate

• highly absorbent

• no lateral wicking protects peri-skin

• requires secondary dressing

• available in sheet or rope

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Aquacel Foam

Aquacel Foam Structure Aquacel Foam

Moisture Donating Dressings(for dry or sloughy wounds)

Hydrogels (sheet or amorphous)

-to re-hydrate slough and eschar

-autolytic debridement

-pain relief

-cavity wounds

-remove with saline

-needs secondary dressing

Hydrogels Amorphous

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Hydrogels SheetsSorbact

Features and Benefits of the Sorbact®-methodSelective binding of microorganisms

• Only bind pathogenic microorganisms

Instant action

• Binds bacteria and fungus within 15-30 seconds

High binding capacity

• Continues to bind, does not become saturated.

Natural process

• No risk of resistance

• No known side effects

• No negative environmental effects

The Sorbact®-method

Bacteria and fungus bind to surfaces via hydrophobic interaction.

When two hydrophobic particles comes in direct contact the bind together with the binding force of the surrounding water molecules=Hydrophobic interaction

Water molecules

Hydrophobic particle

•Staph. aureus

•Psuedomonas

•E. coli

•Streptococcus

•Candida albicans

Hydrophobic properties

Hydrophobicity of microorganisms

94 %

Enterococci 94%

90 %

Staph. aureus 90%

85 %

E. Coli 85% 84 %

Candida albicans 84%

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• All wounds regardless of etiology, exudate level and wound condition.

• Fungal infections: skin folds and in between toes.

• Microbial prophylaxis on acute, chronic, traumatic and post surgical wounds.

Areas of use

ACUTE WOUNDS & BURNS

HARD TO HEALWOUNDS

FUNGAL SKIN INFECTIONS

NPWT WOUND FILLER

Sorbact® areas of use

Infected WoundsCritically colonized

Hard to heal wounds Prevention

Fungal infection in skin folds Athletes foot

Bacteria and fungus bound to Sorbact® surface What makes Sorbact® so special?

Pathogenic microorganisms bind to the Sorbact surface and become inactivated.

The bound microorganisms are removedwhen the dressing is changed.

Sorbact uses the same binding process that bacteria and fungus use to bind to surfaces, hydrophobic interaction.

Sorbact applied directly on the wound surface.

Frequency of dressing changes

Recommended frequency of dressing changes

- Infected wounds: Initially once daily

- Collonized/Critically

colonized wounds: According to exudate level every 2 – 3 days

The frequency will be decreased according to wound status improvement

- ”Clean” wounds: 2 times/week or when needed

SILVER CONTAINING DRESSINGS

Silver has been used for many years in

particular in the treatment of burns as a Silver

Sulphadiazine Cream. This cream has also

been applied to some wounds.

The difficulty is the a cream is formulated to be

applied to intact skin. When applied to a wound

it encourages the development of

muscilagenous slough.

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In recent year a range of dressings that contain or

combine Silver into their structure have been

released. They include

High Density Polyethylene dressings

Foam Dressing

Alginate Dressing

Hydroactive Dressing

Hydrofibre Dressing

Tulle Dressing


The level of silver contained in the various

dressings varies greatly.

The mode of action also varies some as some

release the silver into the wound and some

partly release the silver and hold some in the

dressing

Some do not release the silver hold the silver within

the dressing

Silver Dressings

The ACTICOAT◊ family are a unique range of antimicrobial barrier

dressings for use over partial, full thickness and acute wounds.

Unique Patented Silver technology: SILCRYST Nanocrystalline

Silver Antimicrobial protection

Effective barrier to over 150 wound pathogens¹

Faster kill rates, longer wear times

Silver DressingsActicoat Absorbent

Highly absorbent alginate with

Nanocrystalline Silver Antimicrobial barrier

ACTICOAT◊ Moisture Control (with SILCRYST™ Nanocrystals) is an absorbent 3-layer dressing consisting of the following: A nanocrystalline silver-coated polyurethane layer, a white polyurethane foam layer and a blue waterproof polyurethane film layer. ACTICOAT◊ Moisture Control provides an effective barrier to bacterial penetration. In the presence of exudate the dressing will help maintain a moist wound

environment. ACTICOAT◊ Moisture Control may be left in place over a wound for up to 7 days.

Acticoat Flex 3 and 7

Acticoat Flex consists of a single layer of knitted polyester to ensure ultimate flexibility and comfort during wear time for the patient.

Highly conformable and flexible

One–way stretch improves patient mobility

Open–weave allows fluid and exudate migration

Pre-moisten the dressing for acute and low

exuding wounds

Acticoat Flex 3 and 7

Soft and Conformable

Acticoat Flex is a knitted polyester weave which conforms to anatomical areas to maximise dressing contact with the wound. The dressing moves with the patient to facilitate a comfortable duration of wear1 and low wound adherence helps to minimise trauma on removal.

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Acticoat PostOp

Acticoat Post-Op is a surgical wound dressing that utilises the dynamic antimicrobial properties of nanocrystalline silver.

Acticoat Post-Op provides sustained protection by maintaining its antimicrobial effectiveness for up to 7 days

Acticoat Post-Op features an absorbent polyurethane foam pad that wicks away excess fluid while the waterproof adhesive-coated polyurethane film layer secures the dressing firmly and allows the patient to shower.

ACTICOAT™ Post-OpPart of an integrated infection management strategy

™ Trademark of Smith & Nephew

ACTICOAT™ Post-OpPart of an integrated infection management strategy

An adhesive‐coated waterproof

polyurethane film layer

Absorbent polyurethane foam pad to wick away

excess fluid

Nanocrystalline silver‐coated wound contact layer for

proven bactericidal activity

™ Trademark of Smith & Nephew

Allevyn Foam Dressing

impregnated with Silver

Sulphadiazine.

It releases silver over

7days

Silver Dressings

ALLEVYN Ag Gentle & Ag Gentle Border

Antimicrobial Hydrocellular Foam Dressing with Soft or Silicone Gel Adhesive for Low to Moderately Exuding Wounds

Pricing comparable to ALLEVYN Ag

All products in box of 10

Enhanced Silver Sulphadiazine

ALLEVYN Ag contains silver sulphadiazine (SSD) particles embedded within the structure of its foam layer

SSD was chosen due to its long history of safe and effective use in the management of bacterial colonisation and Infection.

SSD provides broadspectrum, quick acting antimicrobial activity and targets bacteria at multiple sites, reducing the risk of resistance.

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Enhanced Silver Sulphadiazine

ALLEVYN Ag was developed to combine the benefits of SSD with the following improvements:

– Sustained release of Ag+ over the 7 day wear time of the dressing.– Release of Ag+ at an efficacious and bactericidal level.– The Ag+ releases in contact with wound fluid, ALLEVYN Ag does not

require pre-moistening to activate.– Unlike other SSD preparations ALLEVYN Ag does not form a

psuedo-eschar.

How it works

Step 1

Exudate containing bacteria is absorbed into the ALLEVYN Ag

dressing

Step 2

Exudate fills the foam cell structure foam

Step 3

Exudate dissociates the silver ion from the cellular structure and is released into the

wound bed.

Step 4

The silver ions kill the bacteria in the dressing

and the wound.

SeaSorb®-Ag alginate dressing with silver is a unique mix of high G (guluronic acid) and highly absorbent carboxymethylcellulose (CMC) with the addition of an ionic silver complex, which releases silver ions in the presence of wound exudate. As exudate is absorbed, the dressing forms a soft, cohesive gel that intimately conforms to the wound surface.

SILVER DRESSINGS

Soft and flexible foam-like,

dressings are prepared with hydro-activated silver, which is released into the wound during wear.

BIATAIN Ag

Silver Dressings

Mepilex Ag combines the unique features of Safetac technology with the bacteria reducing power of silver. Mepilex Ag goes to work quickly, inactivating wound pathogens within 30 minutes and for up to 7 days. At dressing removal, Mepilex Ag does not stick to the wound or strip surrounding skin, minimising patient pain and wound trauma. Now available as a Border dressing

Mepilex Ag Border

Mepilex Ag Silver Foam with SafeTac

Silicone adhesion now comes as a border version

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Silver Dressings

AQUACEL® Ag dressing incorporating unique Hydrofiber® Technology with 1.2% (w/w) silver combines the favourable gelling

characteristics of Hydrofiber® Technology with the broad-spectrum antimicrobial properties of ionic silver (Ag+).

Aquacel and Aquacel AgNew Forms with added stitchbonding

AQUACEL® Dressing incorporating unique Hydrofiber® Technology is a sterile, white, fibrous dressing derived from 100% sodium carboxymethylcellulose. It is a primary, versatile dressing indicated for use on moderately and highly exuding chronic and acute wounds. Now available in ribbon form, with stitchbonding for added strength

Over 20 times stronger

More than 1.3 times less shrinkage

Aquacel and Aquacel Ag New FormsWhen using AQUACEL® Ag rope dressing in deep cavity wounds, leave

at least 2.5cm (about 1 inch) outside the wound for easy retrieval.

Pack wounds only up to 80%, as AQUACEL® Ag rope dressing will

expand to fill the wound space as it absorbs exudate.

AQUACEL® Ag rope dressing with strengthening fiber is designed to provide a painfree removal and to come out without breaking. Gauze dressings can adhere to wounds, possibly causing pain and trauma upon removal.

Silver Tulle Dressing

Atrauman Ag is an ointment impregnated silver containing wound contact layer. It prevents secondary dressings from sticking to wounds, provides skin care for the wound edges and is antibacterially effective when bacteria come into direct contact with the dressing.

Silvercel

Antimicrobial Alginate Dressing is a

sterile, non-woven pad composed

of high tensile strength alginate,

carboxymethylcellulose (CMC) and

Silver coated fibers. SILVERCEL

Antimicrobial Alginate Dressing

contains elemental silver (8%) as a

sustained release formulation.

Biatain® Ibu Non-adhesive

Biatain Ibu is the first dressing to combine moist wound healing with an active pain reliever. In addition to the advantages of the soft and flexible foam, this dressing releases ibuprofen evenly into the wound. This may help to ease pain from the wound during wear and when changing the dressing.

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Cochrane Systematic Review

Two trials evaluating interventions for persistent venous leg ulcer pain were identified for this review update. Both studies evaluated ibuprofen slow release foam dressings; one comparing it with local best practice and the other with an identical foam comparator. The primary end point for both studies was "pain relief achieved". When compared with a foam dressing alone, there was no evidence of a statistically significant effect of the ibuprofen foam dressing in terms of achieving some pain relief the first evening after treatment. There was no difference in healing rates but slightly more adverse events with ibuprofen dressings than with a similar foam dressing without ibuprofen.

Hypergranulation ?

Hypertonic Salt Dressings These dressings are recommended for use on

chronic infected wounds. They often need changing more frequently, 1-3 times per day, and the companies suggest re-evaluation of usage after 7 days.

They are also used to treat Hypergranulation tissue.

“fluff up when used in cavities or use multiple layers on surface wounds for greater wicking features.

Hypertonic Salt Dressings

There are two types available from manufacturers.

MESALT (Mőlynlcke) a non-woven pad impregnated with hypertonic salt 20% , dry.

CURASALT (Tyco) an open weave gauze impregnated with 20% hypertonic salt solution, wet.

Non-toxic

High osmotic gradient

Miscellaneous Dressings (for Hypergranulation)

Hypertonic Saline in use Adhesive Tapes [ Skin Friendly]

Hypafix Fixamull

MediporeAdhesive Tapes Removal

[ Skin Friendly]

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MEASURES TO ENSURE SKIN TONEPeri-skin Protection

The peri-skin can be protected from damage from adhesive removal or excoriation by the application of Barrier Films These products are Polymer film solution when applied to the Petri skin will dry leaving an invisible film protecting the skin.The film will last for about 72 hours

Keratin Matrix ProductsKeratin is the key structural material making up the

outermost layer of our skin. In addition to its vital role

as a physical structure, research into keratin function

at some of the world's leading medical universities

has identified the crucial biological role that keratin

proteins play in the wound healing process.

Keraplast’s Replicine keratin technology has

captured, for the first time, the native form and

function of keratin proteins.

Keratin Matrix ProductsThe amino acids in keratins are linked in a particular sequence.

Within keratin materials, such as hair and skin, these

sequences coil together like small bundles of rope, to build

strong protein networks. The particular amino acids in the coil

link, like teeth in a zipper, to lock the structure in place.

Keramatrix

Keramatrix is a robust keratin matrix designed

for medium exudate wounds, or for use as an

interface with negative pressure wound therapy.

As the wound heals the keramatrix is absorbed

into the wound area and does not need to be

removed at dressing change.

Keramatrix

Keramatrix

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Keragel & Keragel T

Keragel is a keratin-rich gel designed for chronic dry

wounds, acute wounds and skin disorders. Keragel

provides moisture to a dry wound as well as a keratin

environment to encourage cell growth, leading to an

excellent healing outcome.

Keragel T is formulated for convenient application to

delicate skin, keragel T is used in the management of

the skin disorder epidermolysis bullosa (EB).

Keragel & Keragel T

Keragel & Keragel TPost CABGS Wound

Treatment period June – August 2013

Newer Antiseptics Prontosan

Prontosan is a solution containing Polyhexanide a Biguanid antiseptic related to Chlorhexidine and Undecylenamidopropyl Betaine a surfactant

There are a number of good studies published on the company website and in the literature

Polyhexamethylene biguanide (PHMB)

PHMB was recognised as possessing superior antimicrobial effect to other cationic biocides, but it could only be poorly defined chemically. Early attempts to rationalize the PHMB mixtures were unsuccessful and precluded their use in pharmaceutical products Nevertheless, PHMB was marketed as a broad-spectrum antimicrobial agent in a number of diverse applications.

Polyhexamethylene biguanide (PHMB)

As with the biguanides, PHMB was shown to bind rapidly to the envelope of both Gram-positive and Gram-negative bacteria and in doing so displaces the otherwise stabilising presence of Ca2+. This binding is to the cytoplasmic membrane itself, and also to lipopolysaccharide and peptidoglycan components of the cells wall.

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Undecylenamidopropyl Betaine

A very mild, active surfactant with a dual water and oil solubility. A highly pure betaine based on undecylenic acid, developed for special demands of the personal care industry.

This betaine is exceptionally mild.

The action is to reduce surface tension and allow wound contaminants to lift.

Flaminal

Flaminal is available as two hydrogels with a high alginate content which are promoted for

the reduction of bacterial growth in wounds

Flaminal

Richard White Wounds UK, 2006,Vol 2, No 3

Flaminal

Flaminal® hydrogels are based upon gelled alginate and not on other polymers

Flaminal® hydrogels use the enzymes glucose oxidase and lactoperoxidase to control the bioburden in a similar way to honey.


Flaminal

Flaminal® contains lactoperoxidase which is an enzyme extracted from milk and acts as an important natural antimicrobial (Banks et al, 1986). It has been shown to be bacteriostatic

against Gram-positive organisms and

exhibits pH-dependent bactericidal action against Gram-negative organisms in the presence of hydrogen peroxide and thiocyanate.


1. Glucose oxidase forms peroxide2. Lactoperoxidase transforms it into ROS3. Lactoperoxidase at bacterial wall4. ROS destroy bacterial cell wall

De Smet K, Van den Plas D, Sollie P. Pre‐clinical evaluation of a new antimicrobial enzyme system for the control of wound bioburden. Submitted for publication, JWC

1

2

3

4

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Challenge test with Staph. aureus

Staphylococcus aureus

1000 0 0

267000

0

50000

100000

150000

200000

250000

300000

0 1 3 6

time (hour)

nu

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Sollie P. Evaluation of alginate gels with antimicrobial enzyme system technology for leg ulcer healing. Wounds UK Glasgow 2007

Flaminal

From the available laboratory and clinical evidence it is clear that the Flaminal® products are safe and effective both clinically and microbiologically though some studies have shown MRSA is not always cleared.


How to Chose a Basic Range of Products for your Workplace

Can use existing guides

– AWMA Inventory of Wound/Skin Care products & devices– Therapeutic Guidelines dressing classifications

Consider

– Know your stock– Develop a formulary – not allow other products without process

in place– Limit range of products– Know resources for product identification – can suggest

alternatives based on function– Participate in ordering/ stock decisions– Get support (information & training) from manufacturer

aus

Medicine, Nursing and Health SciencesA.C.® Therapy™ d

Basic principles of V.A.C.® Therapy™

Vacuum Assisted Closure™

(V.A.C.®) is a non-invasive, active wound-closure system that uses

controlled, localised negative pressure to promote healing in acute and chronic wounds.

WOUND

V.A.C.®

DRESSING

DRAPE

T.R.A.C. PAD®

Indications for V.A.C.® Therapy™

Chronic wounds• Diabetic ulcers

• Pressure ulcers

• Venous stasis ulcers

Acute wounds

• Traumatic wounds

• Partial-thickness burns

• Grafts, meshed grafts (pre- and post-surgery)

• Flaps: fresh and compromised

Subacute wounds

• Dehiscent surgical incisions

Please refer to the KCI Clinical Guidelines for further information regarding indications, contraindications and precautions for V.A.C.® Therapy™.

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Contraindications for V.A.C.® Therapy™

Malignancy in the wound (may be used for QOL)

Untreated osteomyelitis within the wound

Necrotic tissue with eschar present (debride first)

Non-enteric and unexplored fistulae

Exposed blood vessels or organs (ensure cover with tissue or protective barrier)


Precautions for V.A.C.® Therapy™ Active bleeding

Difficult wound haemostasis

Anticoagulant therapy

Greater care with weakened, irradiated or sutured blood vessels or organs

Bone fragments/sharp edges

Enteric fistulas


Recommended operating protocols

Continuous therapy is recommended:• in the initial 48 hours of therapy1

• if significant discomfort occurs in intermittent mode

• if large volumes of exudate continue after initial 48 hours

• if there is difficulty maintaining seal

• when using V.A.C.® White Foam™

• if the wound requires constant contraction

Intermittent therapy• Following an initial 48 hours of continuous therapy

• Where fastest granulation tissue growth required

• 5-minutes-on, 2-minutes-off recommended1. Argenta LC et al. Ann Plast Surg 1997; 38: 563–76.

When to discontinue V.A.C.® Therapy™

When the goals of therapy have been met:

– V.A.C.® Therapy™ is predominantly used to prepare a wound for surgery, e.g. prepare a wound bed for graft or flap

– V.A.C.® Therapy™ may also take a wound to full closure

When the wound shows no progress for 1–2 weeks

When to change V.A.C.® dressings Every 12–24 hours for infected wounds

Every 48 hours for non-infected wounds

For meshed grafts and dermal substitutes please refer to the KCI Clinical Guidelines

V.A.C.® WhiteFoam™ Indications

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Initial wound

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New Negative Pressure Devices

There at least two new machines

Launched on the Australian Market

1. Smith & Nephew

2. Huntleigh Health Care

RENASYS EZInstitutional Model

‐Simple and easy to use

‐Selectable Vacuum Range 40‐200mmHg

‐250 & 800ml canister option, using existing filter set

‐Greater than 40 battery life with 6 hour recharge

‐Light weight

‐Patient Lock Out

Alarms

• Low battery, Low vacuum, Excessive Leak

• High vacuum, Occlusion ,Canister Overflow

RENASYS GO

New Negative Pressure DevicesSmith & Nephew

This Device uses

Moist Antibacterial

Gauze as the filler

RENASYS GO Portable deviceShoulder strap ‐300ml integral canister‐20hr battery life with 4 hr recharge

‐ LCD display ‐Easy operation ‐Light weight (1.2 KGS) Frosted Canister with

view window Designed for portable market Carry bag

Alarms

• Low battery

• Low vacuum

• Excessive Leak

• High vacuum

• Occlusion

• Canister full

New RENASYS‐Foam with Port Kit

Application benefits

• Simple application

• Large opening, reducing the risk of blockage at the wound site

• Adhesive integrated up to the suction opening, enhances the seal and reduces the risk of the drape being drawn into the tubing

Simple, quick application

Attach the RENASYS Port Tubing to the Canister Tubing and activate the device

What is PICO™?

PICO is a new simplified NPWT device that differs significantly from previous NPWT devices in two critical aspects:

• The device is constructed to operate without an exudate canister

• The device is light weight, single patient use and disposable after 7 days

The concept is to radically simplify NPWT for wounds at the lower end of the current NPWT acuity scale by providing a simple, easy to use, patient‐friendly device

The pump can run for up to 7 days on 2 AA lithium batteries (replaceable) and is set at ‐80 mmHg

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How does PICO™ work?

The PICO™ dressing is constructed from 4 layers:

1. A high MVTR upper film

2. Absorbent layer

3. Airlock layer

4. Silicone adhesive

wound contact layer

SEM image of a cross section of PICO dressing

Pressure is evenly transmitted by the airlock layer which doesn’t collapse under negative pressure

The perforated silicone adhesive wound contact layer allows transmission of negative pressure to the wound bed and allows fluid to pass through it

The PICO™ Dressing continued..

Exudate and bacteria are retained in the dressing and away from the wound bed to keep the peri-wound area healthy

Dressing manages fluid associated with small-medium sized NPWT wounds

Up to 7 days wear time, depending on exudate, minimises required interventions by nursing staff/carers

Conformable and non bulky to allow patient freedom of movement following surgery and at home

Dressing is showerproof and can be disconnected from the pump to enable showering.

The PICO™ Pump

Delivers -80mmHg of continuous negative pressure

7-day life allows minimal intervention from the healthcare provider, conserving time and resources

Battery powered: replaceable in case this is required during the duration of wear

One button for simple operation. The pump is not turned off by pressing the button. This pauses it for an hour and then the pump will resume operation. Thus clinicians can be confident that the patients will receive appropriate therapy

Small enough to fit in a pocket for total portability and. This improves quality of life and therefore increases the likelihood of patient concordance

The PICO™ Pump

3 lights to communicate status

OK – Continuously flashes green to Indicate correct application of therapy.

LEAK – Flashes amber to indicate a air leak that requires attention. Patients will also feel pump running.

BATTERY – Flashes amber to indicate the batteries require changing.

The inherent quietness of the pump helps patient confidence - no loud alarm will occur if they wish to go out and therefore improves concordance with the therapy

A PICO branded bag also available to provide an easy way for the patient to carry the pump.

28th February 2011Presentation title 143

The PICO™ Pump Clinical Case

22/08/2014 25/08/2014

30/07/2014 13/08/2014

Non Healing Leg Ulcer JG Tx Iodosorb / Allevyn 30/8 to 22/8 PICO 22/8 to 25/8/

28th February 2011Presentation title 144

The PICO™ Pump Clinical Case

22/08/2014 25/08/2014

30/07/2014 13/08/2014

Non Hea ling Leg U lce r JG Tx U rgoclean / Com pression 12/9 to 26/10 Zn Pst/M ep ilex /Com p 26/10 to1/11/

Then M ep ilex Bo rder/Com p

19/9/14 14/10/14

26/10/14

1/11/14

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Huntleigh Health Care


Huntleigh Health Care

This Device uses

Moist Antibacterial

Gauze as the filler

New NPWT Device

SNaP® Wound Care System (Spiracur Inc, Sunnyvale, USA), an ultraportable NPWT system for ambulatory and active patients. This system is easy to use, accessible, and may allow earlier discharge from hospital, helping to reduce costs and improve quality of life.

Piaggesi A, Ivins N, Gibbons G, Fong K. SNaP� Wound Care System Made Easy. Wounds International 2012;3(1)

New NPWT Device

Piaggesi A, Ivins N, Gibbons G, Fong K. SNaP® Wound Care System Made Easy. Wounds International 2012;3(1)

Because there is no electrical pump, operation of the SNaP System is completely silent, and it is small enough to be worn

on a patient’s leg, arm, or belt and hidden under everyday clothing.

New NPWT Device

Piaggesi A, Ivins N, Gibbons G, Fong K. SNaP® Wound Care System Made Easy. Wounds International 2012;3(1)

Other Treatment of Diabetic Wounds

David G Armstrong,Lawrence A Lavery,

for the Diabetic Foot Study Consortium

Negative pressure wound therapy after partial diabetic foot

amputation: a multicentre, randomised controlled trial

Demonstrated NPWT delivered by the VAC Therapy

System seems to be a safe and effective treatment for

complex diabetic foot wounds, and could lead to a higher

proportion of healed wounds, faster healing rates, and

potentially fewer re-amputations than standard care.

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Hyperbaric Oxygen

Oxygen is a required element for wound healing

Hyperbaric oxygen is defined as “the inhalation

of 100-percent oxygen while the entire patient is

enclosed within a chamber at pressures of at least 1.4

atmospheres absolute or greater.”

Hyperbaric oxygen has been used to treat

decompression illness, intravascular air embolism, and

carbon monoxide poisoning. In recent years it has

Been used to treat gas gangrene, osteomyelitis, soft

tissue radionecrosis and skin ulcers.


Large HBO Chamber


Large HBO Chamber Hyperbaric Oxygen

Hyperbaric OxygenHyperbaric Oxygen

There have been some success as a

treatment in chronic non-healing wounds,

however it is still not clear as to the true role

this method plays.

There are a number of different types of

chambers from the full walk in type, single

Body chambers and limb chambers. The cost

of such units vary from $200,000 to many

million dollars for a full size chamber..

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Conclusion

“You must be the change you want to see in the world”

(Mahatma Ghandi)

Advanced Dressings and Devices QPG...

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