20.5 Wound Dressings

Wound dressings should be selected based on the type of the wound, the cause of the wound, and the characteristics of the wound. A specially trained wound care nurse should be consulted, when possible, for appropriate selection of dressings for chronic wounds. See Table 20.5 for commonly used wound dressings and associated nursing considerations.[1] See additional information about many types of wound dressings in Appendix B – Wound Dressings, including indications and instructions for use.

Table 20.5 Wound Dressings[2]

Type of Dressing Description Nursing Considerations
Sterile gauze

(see Figure 20.22[3])

Kerlix

(see Figure 20.23[4])

 

 Can be used as a primary dressing or moistened wound packing.
  • Least expensive option.
  • Dressings must be changed frequently (at least daily).
  • If unmoistened, the gauze can adhere to the wound base causing injury to granulation tissue.
Nonadherent dressings, nonadherent gauze, or petroleum impregnated gauze

 

Nonadherent dressing

(see Figure 20.24[5])

Petroleum impregnated gauze

(see Figure 20.25[6])

 

 Applied over open wounds and covered with a secondary dressing. Nontraumatic to skin and wound base. May be applied over skin tears.
  • Change dressing every 24-28 hours to prevent drying and adherence to the wound bed.
Transparent films

(see Figure 20.26[7])

 

 Can be used on wounds with minimal or no exudate to retain moisture. Commonly used to secure other dressing materials such as foam.
  • Do not use on skin tears or fragile skin.
  • Surrounding skin can macerate if the wound has more than minimal drainage.
Hydrocolloids

(see Figure 20.27[8])

 

 Used as an occlusive dressing to prevent contaminants, promote a moist wound environment, and cause autolytic debridement. Thicker hydrocolloids absorb moderate amounts of drainage.
  • Avoid in infected wounds.
  • Commonly used for pressure injuries.
  • Odor may be present on removal due to composition.
  • Change dressing every 3 – 5 days.
Hydrogels

 

 Creates a moist wound environment in wounds with little or no exudate. If in gel form, apply directly to the wound and cover with secondary dressing.
  • Can be soothing for painful wounds.
  • Typically changed daily.
  • Take care to only cover the wound and not the surrounding skin to avoid maceration.
Silicone-based dressings

 

 Nonadherent dressing used on moderately to highly exudative wounds. Nontraumatic to wound bed and promotes a moist wound environment.
  • Can be used for all types of wounds, including skin tears.
  • Sacral and heel-shaped silicone dressings can be used to prevent pressure injuries.
Foam

(see Figure 20.28[9])

 Nonadherent and absorptive.
  • Can be used as a primary dressing.
  • Can be used under compression dressings for venous ulcers to manage exudate.
Alginate/hydrofibers

(see Figure 20.29[10])

 Nonadherent and highly absorptive for highly exudative wounds. Used for wound packing in full-thickness wounds such as Stage 3 or 4 pressure injuries.
  • Usually changed every 24-48 hours; left in place based on the saturation of wound drainage.
  • Can be used as a primary dressing for exudative wounds like venous ulcers and covered with a secondary dressing such as foam or silicone.
  • Do not use in dry wounds because it may injure the wound bed.

 

Photo showing a sterile gauze and packaging
Figure 20.22 Sterile Gauze

 

Photo showing Kerlix bandage roll and packaging
Figure 20.23 Kerlix

 

Phot showing Non-Adherent Dressing and packaging
Figure 20.24 Nonadherent Dressing

 

Photo showing petroleum gauze and packaging
Figure 20.25 Petroleum Gauze

 

Photo showing hydrocolloid and packaging
Figure 20.26 Transparent Film

 

Photo of hydrocolloid dressing and packaging
Figure 20.27 Hydrocolloid

 

Photo showing foam dressing and packaging
Figure 20.28 Foam Dressing

 

Photo showing alginate dressing and packaging
Figure 20.29 Alginate Dressing

Types of Tape

There are several types of tape that can be used to secure dressings. The most commonly used types of tape are medical transpore, micropore paper, cloth, and waterproof tape.

  • Medical transpore tape (often referred to as “medi-pore”) is inexpensive, durable, and very sticky. It has tiny holes in it that allow air to reach the skin underneath and sweat and body fluid to pass through it without causing it to come off. However, it leaves residue and can damage sensitive skin.
  • Micropore paper tape is gentle on skin and doesn’t leave residue, but it is not waterproof and doesn’t work well on irregular areas. It allows air to reach the skin underneath.
  • Cloth tape sticks well, allows air to reach the skin, and does not leave a residue. It has high strength so it can be used to secure a splint. However, it is not flexible or waterproof and can be difficult to tear.
  • Waterproof tape is more expensive, but it is flexible and doesn’t leave residue. It sticks well to skin but does not stick well to hair. It is waterproof when applied to dry skin.
Read Inside First Aid’s webpage about different types of medical tape:
5 Different Types of Medical Tapes and How to Use Them.

Wound Vacs

The term wound vac refers to a device used with special foam dressings and suctioning to remove fluid and decrease air pressure around a wound to assist in healing. During a wound vac procedure, the nurse applies a special foam dressing over an open wound and seals it with a thin film layer. The film has an opening that rubber tubing fits through to connect to a vacuum pump. Once connected, the vacuum pump removes fluid from the wound while also helping to pull the edges of the wound together. A person with a wound vac typically wears the device 24 hours a day while the wound is healing.[11] See Figure 20.30[12] for an image of a wound vac foam dressing attached to suctioning by a wound vac device. Figure 20.31[13] demonstrates the progression of a wound healing with a wound vac from image A to D.

 

Photo showing wound vac and application on patient
Figure 20.30 Wound Vac

 

Photo showing progression of healing with a wound vac in four images
Figure 20.31 Progression of Healing with a Wound Vac
  1. Cox, J. (2019). Wound care 101. Nursing, 49(10). https://doi.org/10.1097/01.nurse.0000580632.58318.08 ↵
  2. Cox, J. (2019). Wound care 101. Nursing, 49(10). https://doi.org/10.1097/01.nurse.0000580632.58318.08 ↵
  3. “Sterile 4x4 Dressing and Package 3I3A0330.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  4. “Kerlix with Package 3I3A0365.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  5. “Nonadherent Dressing and Packaging 3I3A0203.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  6. “Vaseline Gauze Package -1 3I3A0296.jpg” and “Vaseline Gauze Dressing 3I3A0299” by Deanna Hoyord, Chippewa Valley Technical College are licensed under CC BY 4.0 ↵
  7. “Transparent Film.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  8. “Hydrocolloid.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  9. “Foam Dressing 3I3A0406.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  10. “Alginate Dressing 3I3A0396.jpg” by Deanna Hoyord, Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
  11. Yetman, D. (2020, March 23). What you need to know about vacuum-assisted wound closure (VAC). Healthline. https://www.healthline.com/health/wound-vac#how-it-works ↵
  12. “KCI Wound Vac01.jpg” and “KCI Wound Vac02.jpg” by Noles1984 at English Wikipedia are in the Public Domain. ↵
  13. “0100-6991-rcbc-44-01-00081-gf1.gif” by unknown is licensed under CC BY 4.0. Access for free at https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912017000100081#f1 ↵
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