Skill 19

Dressings

Hydrocolloid, Hydrogel, Foam, or Alginate

Hydrocolloid dressings are a formulation of elastomeric, adhesive, and gelling agents. They are indicated as primary dressings for minimally to moderately exudative partial- and full-thickness wounds. Hydrocolloids are used as secondary dressings over fillers such as hydrocolloid powders and pastes (Rolstad, Bryant, and Nix, 2011). International pressure ulcer guidelines recommend use of hydrocolloids for clean stage II and noninfected shallow stage III pressure ulcers in anatomic locations where the product does not roll or melt (National Pressure Ulcer Advisory Panel [NPUAP] and European Pressure Ulcer Advisory Panel [EPUAP], 2009).

Hydrogel dressings are glycerin- or water-based dressings designed to hydrate a wound (Rolstad, Bryant, and Nix, 2011). They are a good choice for painful wounds since they do not adhere to a wound base. In addition, international pressure ulcer guidelines recommend hydrogels for dry to minimally exudative pressure ulcers that are noninfected and granulating in anatomic locations that are not at risk for dressing migration (NPUAP and EPUAP, 2009). They absorb exudate and encourage healing by maintaining a moist wound healing environment. The gel dressings must be covered with a secondary dressing to hold them in place. Because of their “cooling” and soothing properties, they are also used with burns and to soothe radiation burns.

Polyurethane foam dressings are sheets of foamed polymers that contain small open cells capable of holding wound exudate away from a wound bed (Rolstad, Bryant, and Nix, 2011). Foam dressings are used as primary or secondary dressings to absorb moderate to heavy exudates. They are indicated to treat superficial or deep wounds, protect friable periwound skin, pad and protect high-trauma areas, and treat infected wounds following appropriate intervention and close monitoring of wound healing. International pressure ulcer guidelines recommend considering foam for use on exudative stage II and shallow stage III pressure ulcers (NPUAP and EPUAP, 2009). Foam dressings are not appropriate when there is wound tunneling because the dressing expands, which can enlarge the tunnels.

Alginate dressings create a moist environment and thus promote autolysis, granulation, and epithelialization (Rolstad, Bryant, and Nix, 2011). These dressings are appropriate for full-thickness wounds with moderate to high amounts of drainage. You can safely pack deep tracking wounds with calcium-sodium alginate preparation, which allows easy removal with little risk for retained dressing deep in the wound cavity.

Delegation Considerations

The skill of applying a hydrocolloid, hydrogel, foam, or alginate dressing cannot be delegated to nursing assistive personnel (NAP). The nurse directs the NAP about:

▪ Approach to assist in positioning patient during dressing application.

▪ What to observe (e.g., leakage of drainage, slippage of dressing) and report back to nurse.

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