Burn Dressing Application, Biological and Synthetic



Burn Dressing Application, Biological and Synthetic





Biological dressings provide a temporary protective covering for burn wounds and for clean granulation tissue. They also temporarily secure fresh skin grafts and protect graft donor sites. In common use are three organic materials—pigskin, cadaver skin, and amniotic membrane—and one synthetic material, Biobrane. (See Comparing biological and synthetic dressings, page 102.) Besides stimulating new skin growth, these dressings act like normal skin: They reduce heat loss, block infection, and minimize fluid, electrolyte, and protein losses.1




Comparing Biological and Synthetic Dressings






















Type Description and Uses Nursing Considerations
Cadaver (allograft)

  • Obtained at autopsy up to 24 hours after death
  • Applied in the operating room or at the bedside to debrided, untidy wounds
  • Available as fresh cryopreserved homografts in tissue banks nationwide
  • Provides protection, especially to granulation tissue after escharotomy
  • May be used in some patients as a test graft for autografting
  • Covers excised wounds immediately

  • Observe for exudate.
  • Watch for signs of rejection.
  • Keep in mind that the gauze dressing may be removed every 8 hours to observe the graft.
Pigskin (heterograft or xenograft)

  • Applied in the operating room or at the bedside
  • Comes fresh or frozen in rolls or sheets
  • Can cover and protect debrided, untidy wounds; mesh autografts; clean (eschar-free) partial-thickness burns; and exposed tendons

  • Reconstitute frozen form with normal saline solution 30 minutes before use.
  • Watch for signs of rejection.
  • Cover with gauze dressing or leave exposed to air, as ordered.
Amniotic membrane (homograft)

  • Available from the obstetric department
  • Must be sterile and come from an uncomplicated birth; serologic tests must be done
  • Bacteriostatic condition doesn’t require antimicrobials
  • May be used to protect partial-thickness burns or (temporarily) granulation tissue before autografting
  • Applied by the doctor to clean wounds only

  • Change the membrane every 48 hours.
  • Cover the membrane with a gauze dressing or leave it exposed, as ordered.
  • If you apply a gauze dressing, change it every 48 hours.
Biobrane (biosynthetic membrane)

  • Comes in sterile, prepackaged sheets in various sizes and in glove form for hand burns
  • Used to cover donor graft sites, superficial partial-thickness burns, debrided wounds awaiting autograft, and meshed autografts
  • Reduces pain
  • Applied by the nurse

  • Apply taut against the skin.
  • Leave the membrane in place until the underneath tissue is healed, typically 7 to 14 days.
  • Don’t use this dressing for preparing a granulation bed for subsequent autografting.
  • As the burn heals, Biobrane turns white and dry and lifts away.

Amniotic membrane or fresh cadaver skin is usually applied to the patient in the operating room, although it may be applied in a treatment room. Pigskin or Biobrane may be applied in either the operating room or a treatment room. Before applying a biological or synthetic dressing, the caregiver must clean and debride the wound. The frequency of dressing changes depends on the type of wound and the dressing’s specific function.




Equipment

Ordered analgesic ▪ cap ▪ mask ▪ two pairs of sterile gloves ▪ sterile or clean gown ▪ shoe covers ▪ biological or synthetic dressing ▪ normal saline solution ▪ sterile basin ▪ Xeroflo gauze ▪ sterile forceps ▪ sterile scissors ▪ sterile hemostats ▪ elastic netting.


Preparation of Equipment

Place the biological dressing in the sterile basin containing sterile normal saline solution (or open the Biobrane package). Using sterile technique, open the sterile dressing packages. Arrange the equipment on the dressing cart and keep the cart readily accessible. Make sure the treatment area has adequate light to allow accurate wound assessment and dressing placement.




Implementation

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Jul 21, 2016 | Posted by in NURSING | Comments Off on Burn Dressing Application, Biological and Synthetic

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