FROM THE EXPERTS...

Get quick tips that you can use in daily practice from Advances in Skin & Wound Care's Clinical Associate Editor, Elizabeth Ayello, PhD, RN, APRN,BC, CWOCN, FAPWCA, FAAN, and Editorial Advisory Board member R. Gary Sibbald, BSc, MD, FRCPC (Med) (Derm), FAPWCA, Med.

This month's clinical practice tip is on skin barriers for wound margins. Keep this handy for an easy reminder.

LOWE® Skin Barriers for Wound Margins: 20-Second Enablers for Practice*

Wound exudate can be classified in 2 ways:

  • Type (color and consistency)
    • Serous or clear color that represents serum or transudate
    • Sanguineous for blood
    • Purulent for pus made up of inflammatory cells and tissue debris that can result from infection or an inflammatory process
    Exudate may exist as a single form or in combinations (eg, serosanguineous).

  • Amount
    • None
    • Small: There is only a detectable discharge when the dressing is removed, less than 33%.
    • Moderate: Discharge covers less than 67% of dressing surface.
    • Large: Discharge covers more than 67% of the surface.

Exudate may indicate that the cause of the wound has not been treated (eg, edema due to venous insufficiency); congestive heart failure is present (look for bilateral involvement and extension above the knee); low albumen (malnutrition, or kidney or liver disease); or infection (check for symptoms or signs).

Periwound skin needs protection from exudate. This can be accomplished by using absorbent dressings over the wound and protecting the periwound skin. You can choose from 4 ways to protect the external skin of a wound. Try using this memory jogger to remember them:
LOWE® (from Old English, meaning to approve of, prompt, or to humble oneself)

   TYPE  ADVANTAGES  DISADVANTAGES
L
 Liquid film
 forming acrylate
no sting
skin preparation, etc

Transparent surface that resists removal
Low incidence of reactions
Some skin sealants may evaporate and dry out
Lack of availability on some institutional formularies
O
 Ointments
Petrolatum
Zinc oxide

 

 
Relatively cheap and easy to apply
Petrolatum liquefies with heat
Zinc oxide ointment does not allow visualization of underlying wound margin
Ointment vehicle may interfere with the action of ionized silver
W
 Windowed dressing
Framing of wound margin with protective adhesive
hydrocolloid
film,
acrylate,
silicone, etc
 
Provides a good seal around the wound edge
Some products facilitate visibility of the wound margins
Reactions to the adhesive can occur
If seal is compromised moisture may accumulate under the dressing
E
 External collection  devices

 
  External pouching may help in locations where an external seal is difficult (eg, perirectal area)
Devices need to be monitored for external seal
Note: These devices do not replace a search for the cause of the excessive exudate and the need to correct the cause.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Copyright 2006, Ayello and Sibbald. All rights reserved.