Best management of exudate and maceration nursing in. Types of wound dressings currently used to promote optimal. In some cases, macerated skin can cause pain and exposes a layer of skin tissue. Exuderm satin hydrocolloid wound dressings medline at home. Avoidance and management of periwound maceration of the skin. Dykes and heggie 2003 found repeated application and removal of adhesive dressings can lead to damage to the skin s surface and can strip the stratum corneum. Dressings are classified in a number of ways depending on their function in the wound debridement, antibacterial, occlusive, absorbent, adherence, 60 type of material employed to produce the dressing e. This is a good habit to practice every time you use hydrogel as a treatment. The skin directly below the wound is at greatest risk of maceration owing to the gravitational effect of wound exudate drainage.
Pressure ulcers sacral ulcers are particularly at risk of maceration because of the presence of urinary andor faecal incontinence or the presence of skin folds in obese patients. How to treat a macerated wound and what does it look like. Macerated skin pictures, treatment, causes, symptoms. The hydrofiber dressing, similar to the sterile gauze pads, promotes healing and absorbs moisture. Hydrogel wound dressings are 80% to 99% waterorglycerinbased wound dressings that are available in sheets, gels, or impregnated gauzes. When a wound is too moist, the skin surrounding the wound, known as the periwound, can become macerated. The skin is soft and can easily break and exposes the deep layer of the tissue. Transparent film dressings provide a moist, healing environment. For example, it is important not to exceed the wear time beyond which the dressing. The causes and prevention of maceration of the skin journal of wound. Maceration of the skin around wounds is a common wound care. However, these dressings either lose integrity when saturated. Todays wound dressings can also help decrease or eliminate pain, reduce the need for dressing changes, and provide autolytic debridement.
If managed appropriately, wound exudate should begin to decrease as healing progresses. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more. Most transparent dressings dont absorb moisture and arent indicated for draining wounds. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound. Remove the backing, place over the wound or other dressing allowing fro a 2. Dec 16, 2016 the skin around the wound is soggy and soft. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound size. Even more, this wound dressing is nonadhesive, meaning minimal disruption to the wound and gentle, painfree removal. The skin under the bandage becomes wet from perspiration, seepage of fluids from wound. The skin also becomes soft, making it more susceptible to bacterial or fungal infections. Identifying, managing and preventing skin maceration.
Wound maceration is a condition which occurs in the surrounding skin of wound. Too much moisture can lead to periwound maceration and skin breakdown, while too little moisture can impede cellular activities and promote eschar formation, resulting in poor wound healing. Exudate and maceration in wound care nursing in practice. In common with all adhesive products, some cases of irritation andor maceration of the skin surrounding the wound have been reported. The skin under the bandage becomes wet from perspiration, seepage of fluids from wound and even urine in patients who are completely bed ridden. However, maceration is a complication of moist wound healing only if the dressing regimen is used inappropriately. The use of a superabsorbent dressing to manage periwound maceration and odor in chronic wounds introduction periwound maceration has been associated with slow healing of wounds. However, clinicians should ensure that the foam dressing is never overlapping wound margins and that its cut to fit the wound appropriately in order to minimize maceration. Because theyre flexible, these dressings can conform to.
Skin maceration is often associated with improper wound care. Fluid retention under the dressing may lead to periwound maceration. Health economic burden that wound impose on the national health service in the uk. Macerated skin is often associated with wounds, particularly wound dressings. The causes and prevention of maceration of the skin nursing. Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. Management of maceration is frequently attempted with the use of absorbent foams, alginates, and hydrogels. The type of dressing can affect odor as well as hygiene and the presence of nonviable tissue keast et al. Avoiding maceration from dressings occlusive therapy is often blamed for maceration andor infection. Bedding traps moisture next to the skin, and because the person lays immobile in bed for much of the day, the skin becomes macerated and prone to bed sores and infection. Because healing wounds all ooze fluid called exudate, the wound area may be moist. Remove any old bandages around the wound and inspect for signs of maceration. May 11, 2015 one way to minimize contact with wound drainage and prevent maceration of the periwound is to choose the appropriate dressing for wound conditions.
Remove the old bandage around the wound and look for signs of maceration such as decaying skin or foul odor which are the indications of an infection. Interventions to avoid maceration of the skin and wound bed. Skin that is macerated is vulnerable to breakdown, leading to a possible increase in wound. The role of dressings in the treatment of moisturerelated. This leg ulcer example shows how fluid is locked into the dressing. Some require an advanced knowledge of skin conditions and differential diagnosis while others are dependent on tricks of the trade for dressing changes and the understanding of different dressing. The causes and prevention of maceration of the skin journal of wound care. Adherence of dressing material to the wound bed and periwound skin can damage newly forming cells and cause distress to the patient. In addition, always follow the manufacturers instructions and make sure the you use products appropriate for the wound. This entry was posted on thursday, july 21st, 2016 at 3. Macerated skin is often associated with wounds, particularly wound dressings that are not regularly changed. Dry areas of the wound stay properly hydrated, fluid from exuding areas is absorbed and locked in, and periwound skin is protected from maceration.
The causes and prevention of maceration of the skin. Management of wounds with dressings ensure the underlying disease etiology is known or there is an understanding of the disease processes understanding the underlying disease etiology and comorbid conditions helps define dressings and the plan of care be familiar with dressings. These dressings are available in a variety of sizes and shapes. In addition to the pain and discomfort it causes, maceration can also slow wound healing and make skin more vulnerable to infection. The surface that comes in contact with the wound is nonadherent and allows for traumafree removal. Wound management for patients living with venous insufficiency often involves multiple complexities. Available in a range of sizes, shapes and fluid handling capacities, we have the solutions needed to help you manage wounds with confidence. Thus, the dressing dynamically balances the evolving moist wound environment and provides hydration or absorption depending on the instantaneous needs of wound and periwound skin. Sep 12, 2017 the macerated skin can very readily be infected with fungi and bacteria. Martyn butcher, rgn, diphsw, certmhs, is tissue viability clinical nurse specialist, plymouth hospitals nhs trust maceration of the skin around wounds is a common wound care problem. Prevent maceration of surrounding skin by controlling wound exudates with absorbent dressing, such as, foams or hydrocolloid dressings are important to prevent further damage of the. Martyn butcher, rgn, diphsw, certmhs, is tissue viability clinical nurse specialist, plymouth hospitals nhs trust. Although the wound surface must be kept moist, the dressing must be capable of absorbing any excess exudate, otherwise periwound skin maceration, irritation, soreness or unpleasant odour.
It should be noted that inappropriate use or too frequent dressing changes, particularly in patients with fragile skin, can result in skin. When applied to the skin or wound, they feel cool and. The macerated skin can very readily be infected with fungi and bacteria. Change dressings at appropriate intervals to avoid pooling of exudates. Pairing advanced wound care therapy with npwt todays. However, some of the newer transparent films have absorption properties. Optilock nonadhesive super absorbent wound dressings. At best it can cause patient discomfort and irritation, at worst it can lead to ulceration and the extension of damage into previously unaffected tissues. Areas of macerated skin turn a white or grayish color, and usually line the edges of the wound.
How to prevent periwound maceration with vac therapy. Jan 22, 2018 skin maceration is often associated with improper wound care. By laurie swezey rn, bsn, cwocn, cws, faccws a wound that is too moist can be as detrimental to wound healing as a wound that is too dry. Skin and periwound care part 2 wound care certification. Hydrogels can only absorb a minimal amount of fluid. A macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. The moist environment that heals the wound is provided by dressing the wound. Remove the old bandage around the wound and look for signs of maceration such as decaying skin. Pressure ulcers pressure ulcers of the sacrum are vulnerable due to the presence of urine and feces that may cause maceration.
Nov 28, 2015 originally nylon derived film dressings were not used for highly exudating wounds due to their limited absorption capacity and caused maceration of the wound and the healthy tissues around the wound. Decaying skin, putrefaction, or foul odors are signs of an infection that should be evaluated and treated by a medical professional. These are nonabsorbent and waxcoated, making them both airtight. Use barrier products to protect from adhesives and moisture.
Maceration of the skin surrounding a wound may occur if a dressing with a low absorptive capacity is used on a heavily exuding wound. A wound dressing must be able to manage the rate and amount of exudate from the wound without drying it out or causing maceration of the surrounding skin. What you need to know about transparent film dressings. Managing wound exudate and controlling maceration are key to wound healing. These variations require providers to consider a spectrum of strategies. The use of npwt is further bolstered when its coupled with certain advanced wound care dressings that, when used together, have further quickened healing rates and improved the patient care experience. Healthy skin has normal flesh color, and a healthy wound bed looks beefyred. The nurse irrigates the wound until there is a clear flow of solution to remove any debris from the wound. The skin around the wound gets macerated when the bandage is kept too tight for many hours. While these skin changes may be partly due to maceration, which predisposes the affected area to traumatic injury which may also be caused by some types of adhesive dressings, a second and potentially more important factor is the presence within chronic wound fluid of proteolytic enzymes.
This can be a tricky balance between maintaining just the right amount of moisture in the wound bed too dry and the wound bed becomes desiccated, too wet and maceration soon follows. Describe wound edges approximated, rolled, calloused describe periwound skin indurated, erythematous, macerated. This skin condition is also linked to wounds, more so the wound dressings which are not changed often enough. This article discusses the efficacy of these treatment modalities and offers product recommendations for the wound care clinic. If the dressing is highly absorptive then more frequent dressing. Manages drainage 1 to help maintain a moist wound healing environment. Skin and periwound care part 1 wound care certification. Diabetic foot ulcers plantar ulcers are particularly vulnerable to maceration. Maceration is a largely underrecognized problem and one of the causes of delayed wound healing. However, periwound can become compromised and negatively affect the healing progress of the wound. There are two distinct kinds of wound dressings used in preventing and treating macerated skin. By beth hawkins bradley rn, mn, cwon i am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy npwt.
These are sterile gauze pads and bandages that absorb extra moisture. Best management of exudate and maceration nursing in practice. If there is too little exudate retained in a wound, the dressings will start to adhere to the wound bed, causing pain and damage to the granulation tissue. They create a moist wound healing environment by letting the moisture in but keep the bacteria and other. Jul 27, 2017 a macerated wound is an injury accompanied by soft, white, deteriorating skin around the site of the original injury. Skin damage can be reduced by pushing the skin away from the tape while pulling the adhesive from the skin. Pairing advanced wound care therapy with npwt todays wound. I am frequently asked for solutions relating to maceration to periwound skin in wounds being treated with negative pressure wound therapy. Factors that may damage vulnerable periwound skin include tissue maceration, traumatic insult due, for example, to wound dressing adherence and wound related dermatological disease. Optilock is a super absorbent polymer core dressing.
Triad hydrophilic wound dressing offers a unique approach to wound management and wound treatment. The use of a superabsorbent dressing to manage periwound. It may be caused by keeping the skin under the water for a long time bathing, swimming or preventing the escape of moisture from the skin, such as wearing a bandage for too long or wearing nonbreathable materials. Mild cases of maceration are often reversed by simply exposing the affected skin area to air. Triad is a sterile coating that can be applied directly onto the wound or peri wound skin.
Achieving the right moisture balance can be a challenge. Maceration occurs when too much moisture is trapped between the wound and its bandagesometimes the exudate seepage of biological waste from the wound escapes and gets trapped under the bandage, and sometimes the wound. Treatment for macerated skin usually depends on the main cause and severity of maceration. Thus, moisture levels must be reduced and monitored. If the dressing is highly absorptive then more frequent dressing changes may be needed, in addition to investigation and management of the cause of the exudate such as infection. Treatment was often put on hold for several days to allow. Preventing maceration associated with npwt dressings. Choosing the right dressing depends on your wound assessment and characteristics of the wound bed. Maceration is often a contributing factor for slow wound healing. It was first described by jeanmartin charcot in 1877.
If there is too much exudate in a wound, the surrounding skin becomes macerated and starts to break down under attack from the released enzymes, leaving a worse wound than when you started. But, these dressings are highly elastic and flexible, and can conform to any shape and do not require additional tapping. Foam wound dressings are usually made up of semipermeable polyurethane with small, open cells that are capable of holding fluids. This results in maceration of the skin and wound bed. A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds. Skin maceration is a term used to describe the oversaturation of the skin due to prolonged exposure to moisture. At times, this macerated skin leads to soreness and pain and reveals the underlying tissue layers. But since they contain high waterglycerin content they are able to donate moisture to dry wounds. Proper care taken while dressing the wound reduces the risk of maceration of skin around the wound. It takes in a remarkable amount of wound fluid, even under compression, and locks it away to help prevent maceration. If there is too little exudate retained in a wound, the dressings will start to adhere to the wound.
In addition, be sure to apply a moisture barrier, like skin prep, around the wound edges to prevent maceration. Proper dressings and proper technique when performing dressing changes reduces the risk of developing macerated skin at the edge of the wound. Maceration of the skin around wounds is a common wound care problem. The causes and prevention of maceration of the skin journal. Preventing maceration associated with negative pressure wound therapy dressings skin protectant products to prevent periwound maceration. As a clinician practicing in the outpatient and home care settings, it was not unusual for patients to have to take a holiday from negative pressure. It is important to treat the condition especially in elderly and immobile patients, or else there is associated risk of infection. Alternative dressing techniques for small, deep wounds. Given these challenges, these authors present a novel technique to address this issue and reduce the risk of periwound maceration. It can be applied anywhere on the body and adheres to wet skin, while keeping the wound. The optimal wound dressing keeps the wound moist and absorbs exudate, locking it inside the dressing to prevent maceration. In relation to wound management, the authors advocate the removal of moisture away from the wound or skin, either through superabsorbent dressings, or by allowing the excess moisture to evaporate through semipermeable dressings to reduce maceration.
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