FROM THE EXPERTS...

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

This month’s clinical practice tip is on selecting a wound dressing. Keep this handy for an easy reminder.

NICE^© for dressing decision making: 20-second enablers for practice*

With thousands of dressings available, clinicians must be able to select the best dressing for each particular wound. Ask yourself these questions about the wound to help determine the dressing that will be NICE^© to use:

• Is there any Necrotic tissue that needs to be debrided?
  Make sure the wound has the ability to heal. If it does not, then moist interactive dressings and active surgical debridement to bleeding tissue are contraindicated.
• Is the wound Infected or inflamed?
  Clinicians often look for more than 1 sign or symptom before diagnosing infection.
• Do the specific wound Characteristics, such as location, need to be considered as special needs (eg, around the anus where a waterproof adhesive dressing may be preferred)? Is pain an issue?
• Is there any Exudate?
  If so, determine why and how much, as well as the color and consistency.

Exudate may indicate that the cause of the wound has not been treated (such as edema because of venous insufficiency), congestive heart failure (look for bilateral involvement and extension above the knee), low albumen (malnutrition, kidney, or liver disease), or infection (check for symptoms or signs). Protect the periwound skin from exudate by using absorbent dressings. Select a dressing by answering the 4 questions above. Try using this memory jogger to help remember them:

NICE^© to pick the right dressing

	QUESTION	KEY INFORMATION TO KNOW	CAUTION
N	Necrotic tissue Slough, eschar	Wet-to-dry dressings are a nonselective method of mechanical debridement. Autolytic debridement of tissue is best accomplished with hydrogels, hydrocolloids, and alginate dressings. With dressing-stimulated autolytic debridement, watch for secondary infection and remove unwanted slough with dressing change.	Dressings are a slower method of debridement compared with sharp/ surgical methods. Use of wet-to-dry dressings as a debridement method is limited (see CMS Tag F-314 in the United States). Some dressings cannot be used or caution is urged in necrotic wounds. Check with the manufacturer for any contraindications for use.   Removal of nonviable tissue is a critical step in preparing the wound bed for healing.
I	Infection/inflammation	Consider use of antimicrobial dressings (eg, silver or iodine). Infected wounds may require more frequent dressing changes.	Not all dressings can be used in infected wounds. Check with the manufacturer to ensure a specific brand is indicated for infection use.
C	Characteristics of the   wound Painful Location	Select and reassess a dressing based on location of the wound; use conformable dressings for hard-to-fit areas. Use waterproof dressings if incontinence is an issue. Consider the patient’s wound pain and select dressings that may promote comfort and pain reduction.	Change dressings when soiled from feces or urine. Different dressings can remain in place for different lengths of time. Check with the manufacturer for recommended frequency of dressing changes. Avoid dressings that may increase or contribute to wound pain, and consider systemic pain management strategies.
E	Exudate	Match the absorbency of the dressing (none, low, moderate, heavy) to amount of exudate from the wound. Assess the surrounding skin to evaluate for maceration.	Surrounding skin needs to be protected from wound drainage. Refer to the enabler LOWE© from last month’s issue.   Search for the cause of the excessive exudate and the need to correct the cause. Exudate may be an indicator of infection.