A skin and wound care program can fall apart like a house of cards if it does not have a solid foundation. For stability, that foundation should be built with clearly delineated processes for care delivery and documentation, staff education, and an advanced skin and wound care product formulary.

A great deal of attention is often focused on the product formulary because selecting effective topical products to manage a wound is an important step toward healing. A well thought-out product formulary can assist the staff in providing consistent wound care, reduce dressing changes, improve healing outcomes, and help demonstrate medical necessity to justify reimbursement.

New products are constantly being brought to the market, though, making it difficult for clinicians to ensure that their product formulary is as up-to-date as possible. Product Update 2002, therefore, is dedicated to helping clinicians familiarize themselves with some of the latest products and technologies available. Each entry in Product Update 2002 highlights a product's sizes, actions, indications, contraindications, and application and removal processes.

Information for Product Update 2002 was provided by the manufacturers, and it is not meant to be comprehensive. Clinicians are responsible for understanding a product's attributes; therefore, the package insert should be read prior to use of a product.

ARGENTUM MEDICAL, LLC

Figure. No caption available.

Category

Silver dressings

How supplied

Sheet (sterile): 4"x4", 4"x12", 10&"x12", 4"x 66", 6"x108"

Rope (sterile): 1"x24"

Wound pad (sterile): 2"x2", 3"x12", 4"x4", 3"x16", 3"x6", 8"x16", 6"x6"

Island dressings (with tape border, sterile): 2"x2", 4"x4", 3"x12", 3"x16"

Adhesive strip (sterile): 1"x3", adhesive strip with a 1"x1" Silverlon Pad

Action

The Silverlon wound dressings utilize flexible, minimally adhering, antimicrobial, silver-plated knit fabrics that are placed in direct contact with the wound surface. The knit fabric is composed of pure nylon base fiber that is uniformly and circumferentially covered with a thin coat of pure metallic silver of approximately 4/100,000 inch. The open knit pattern of the fabric permits oxygen and fluids to pass to and from the wound surface. The silver provides effective antimicrobial action and functions as an antimicrobial barrier. Silverlon Wound Contact Dressings (sheet) and Silverlon Wound Packing Strips (rope) utilize only the Silverlon silver-plated fabric. The Silverlon Wound Pad Dressings, Silverlon Adhesive Strips, and Silverlon Island Wound Dressings are multilayer dressings that utilize the Silverlon silver-plated fabric in direct contact with the wound surface, an absorbency pad, a film urethane (wound pad dressings), and a tape backing (Island Wound Dressings and Adhesive Strips).

Indications

To manage partial- and full-thickness wounds, partial-thickness burns, incisions, skin grafts, donor sites, lacerations, abrasions, and Stage I to IV dermal ulcers.

Contraindications

* Contraindicated for patients with known sensitivity to silver or nylon.

* Cleanse the wound with a wound cleanser and/or sterile water.

* Select the appropriate size dressing, based on the characteristics of the wound.

* Apply the silver surface of the dressing directly to the wound surface.

* The Silverlon Wound Dressings may overlap periwound skin.

* Either the shiny or dull surface of the Silverlon Contact Dressing may be placed against the wound surface.

* Apply the silver side of the Silverlon Pad Dressing against the wound surface.

* Apply nonmedicated wound contact layers between the Silverlon dressing and the wound surface if there is a possibility that the wound dressing may dry out.

* Silverlon Wound Dressings function optimally in a moist environment; this may require moistening the Silverlon dressing every 12 to 24 hours.

* Secure the dressing with an appropriate secondary dressing that will maintain moisture.

* Silverlon Wound Contact Dressings may be applied with the Vacuum Assisted Closure system (V.A.C.; KCI, Inc, San Antonio, TX).

Removal

* Change the dressing based on the amount of exudate present and the condition of the wound.

* Remove the secondary dressing, then remove the Silverlon dressing from the wound. Ensure that the dressing is moist before removing it from the wound. If the dressing is not moist, add sterile water so that the dressing does not stick to the wound surface.

* Discard the soiled dressings per facility policy.

COLOPLAST CORPORATION

Figure. No caption available.

Category

Foam

How supplied

Sheet: 9"x9"

Action

Biatain Adhesive Foam Dressings are highly absorbent, 3-dimensional (3-D) polymer dressings that provide an exudate handling system for wounds with light to heavy exudate. The Biatain Adhesive Foam Dressing has a hydrocolloid adhesive border and a central 3-D polymer absorbent pad with a waterproof, semipermeable film backing.

Indications

To manage low to highly exudating wounds, including pressure ulcers, chronic wounds, and skin tears, located in the sacral area.

Contraindications

* Contraindicated for use with hypochlorite solutions or hydrogen peroxide.

* Observe the following precautions:

- May be used on patients with systemic infections. Consult a health care professional if a wound infection develops.

- If an adverse reaction occurs, contact Coloplast.

- Remove Biatain Adhesive Foam Dressings before radiation therapy.

Application

* Rinse the wound with normal saline solution. Gently pat dry the skin around the wound.

* Contour the Biatain Adhesive Sacral Dressing to the sacral area.

* The Biatain Adhesive Foam Dressing may be used with a hydrogel to encourage natural debridement of necrotic tissue.

Removal

* Biatain Adhesive Foam Dressings may be left in place for up to 7 days, depending on the amount of exudate and the condition of the dressing. The frequency of dressing changes depends on the recommendation of a health care professional.

* Change the Biatain Adhesive Foam Dressing when clinically indicated or when the exudate approaches 1" (2.5 cm) from the edge of the dressing.

* Discard the used dressing per facility policy.

Biatain Heel Foam Dressing

Figure. No caption available.

Category

Foam

How supplied

Sheet: 7.5"x8"

Action

The Biatain Heel Foam Dressing provides a superior absorption and retention handling system for low to highly exudating wounds. This dressing has a hydrocolloid adhesive border and a central 3-D polymer absorbent pad with a waterproof, semipermeable film backing. Biatain Heel Foam Dressing fits 90% of all foot sizes.

Indications

To manage low to highly exudating wounds, including pressure ulcers, chronic wounds, and skin tears located on the heel.

Contraindications

* Contraindicated for use with hypochlorite solutions or hydrogen peroxide.

* Observe the following precautions:

- May be used on patients with systemic infections. Consult a health care professional if a wound infection develops.

- If an adverse reaction occurs, contact Coloplast.

- Remove Biatain Adhesive Foam Dressings before radiation therapy.

Application

* Warm the heel dressing between your hands to improve flexability and adherence.

* Remove the top layer of the cover.

* Imagine the Biatain Heel Dressing as an arrow. Fold the tail of the arrow at a 90[degrees] angle, then attach the arrowhead at the arch of the foot.

* Attach the arrow tail at the back of the heel/ankle.

* Remove the protective cover from one side of the dressing.

* Fold the foam side up and attach it to the foot, making sure that the foam parts touch or overlap. Smooth the dressing so that it conforms to the heel contours. Repeat application on the other side of the foot.

Removal

* Change the dressing if the foam is saturated, if the exudate is less than 1 cm to the edge of the dressing, or if the foam loosens from the adhesive.

* Discard the used dressing per facility policy.

CONVATEC

Division of ER Squibb and Sons, LLC

Figure. No caption available.

How supplied

Sheet: 2"x2", 4"x4", 6"x6", 8"x12"

Ribbon: 3/44"x18"

Action

AQUACEL Ag with Hydrofiber, silver-impregnated antimicrobial dressing, is a soft, sterile, nonwoven pad or ribbon dressing composed of sodium carboxymethylcellulose and 1.2% ionic silver that allows a maximum of 12 mg of silver for a 4"x4" dressing. The silver in the dressing kills wound bacteria held in the dressing, reduces the number of bacteria where the dressing conforms to the wound, and aids in creating an antimicrobial environment. This dressing absorbs high amounts of wound fluid and bacteria and creates a soft, cohesive gel that conforms to the wound surface, maintains a moist environment, and aids in the removal of nonviable tissue from the wound (autolytic debridement). A moist wound healing environment and control of wound bacteria supports the body's healing process and helps to reduce the risk of wound infection.

Indications

For over-the-counter use, AQUACEL Ag may be used for minor abrasions, lacerations, cuts, and scalds, and burns. Under the supervision of a health care professional, AQUACEL Ag may be used for the management of partial-thickness (second-degree) burns; diabetic foot ulcers, leg ulcers (venous stasis ulcers, arterial ulcers, and leg ulcers of mixed etiology); pressure ulcers (partial- and fullthickness); surgical wounds left to heal by secondary intention; traumatic wounds; wounds that are prone to bleeding, such as wounds that have been mechanically or surgically debrided; and oncology wounds with exudate, such as fungoids-cutaneous tumors, fungating carcinoma, cutaneous metastasis, Kaposi's sarcoma, and angiosarcoma. AQUACEL Ag may also be used on wounds as an effective barrier to bacterial penetration to help reduce infection. AQUACEL Ag may be used on minimally exuding, nonexuding, and dry wounds.

Contraindications

AQUACEL Ag should not be used on individuals who are sensitive to or who have had an allergic reaction to the dressing or its components.

Precautions and Observations

* Caution: Sterility is guaranteed unless the pouch is damaged or opened prior to use. Single use only.

* During the body's normal healing process, nonviable tissue is removed from the wound (autolytic debridement), which could initially make the wound appear larger. If the wound continues to grow larger after the first few dressing changes, consult a health care professional. The wound should be inspected during dressing changes. Consult a health care professional if any the following are seen: (a) signs of infection (increased pain, increased redness, wound drainage), (b) bleeding, (c) a change in wound color and/or odor, (d) irritation (increased redness or inflammation), (e) maceration (skin whitening), (f) hypergranulation (excessive tissue formation), (g) sensitivity (allergic reaction), or (h) no signs of healing.

* Because AQUACEL Ag provides a moist environment that supports the growth of new blood vessels, the elicited newly formed blood vessels may occasionally produce bloodstained wound fluid.

* AQUACEL Ag is not compatible with oil-based products, such as petrolatum.

Application

* When used in partial-thickness (second-degree) burns, adherence of the dressing over joints could interfere with movement. However, in clinical trials of AQUACEL Ag on partial-thickness (second-degree) burns, this was not shown to have any effect on the range of motion after healing was complete.

* Appropriate supportive measures should be taken where indicated-for example, use of graduated compression in the management of venous leg ulcers, pressure-relief measures in the management of pressure ulcers, systemic antibiotics and frequent monitoring in the treatment of wound infection, and control of blood glucose for diabetic ulcers.

* Leg ulcers; diabetic ulcers; pressure ulcers; partial-thickness (second-degree) burns; or surgical, oncology, or traumatic wounds left to heal by secondary intention should be treated under the supervision of a health care professional.

* Secondary dressings should be used.

* This wound dressing should not be used with other wound care products other than those listed in the package insert without first consulting a health care professional.

* For oncology wounds, a highly absorbent secondary dressing may be required.

* In cavity wounds, the ribbon dressing may be used to pack the wound. For fistulae and wounds with sinus tracts, employ appropriate techniques during the insertion and removal of the dressing.

* In partial-thickness (second-degree) burns, consider alternate (surgical) procedures if the wound has not reepithelialized after 14 days.

* AQUACEL Ag is not intended for use as a surgical sponge.

* Before applying the dressing, cleanse the wound area with an appropriate wound cleanser.

* AQUACEL Ag should overlap 1 cm (1/2") on the skin surrounding the wound.

* When using AQUACEL Ag ribbon in cavity wounds, leave at least 2.5 cm (1") outside the wound for easy retrieval.

* AQUACEL Ag should be used with a secondary cover dressing. Apply AQUACEL Ag to the wound and cover with a moisture-retentive dressing, foam dressing, gauze, or other appropriate dressing. Refer to the package insert for complete instructions for use.

* Place AQUACEL Ag in the wound, then wet with sterile saline only over the wound area. The vertical absorption properties of AQUACEL Ag will help maintain the moist area over the wound and reduce the risk of maceration.

* Cover the dressing with a moisture-retentive dressing to avoid drying out the dressing and subsequent dressing adherence to the wound.

Removal

* All wounds should be frequently inspected.

* Remove AQUACEL Ag when clinically indicated (ie, leakage, excessive bleeding, or increased pain) or after a maximum of 7 days.

* If the dressing is difficult to remove, it should be soaked with water or sterile saline until it is easily removed.

* Please see package insert for full instructions, including the spectrum of activity and burn indication use.

HEALTHPOINT AND COOK BIOTECH

HEALTHPOINT, Ltd (distributor)

Figure. No caption available.

How supplied

Sheet (sterile): 3"x3.5" fenestrated, 3"x7" fenestrated, 7"x10" fenestrated, 7"x20" fenestrated, 7"x10" meshed, 7"x20" meshed

Storage Information

This device should be stored in a clean, dry location at room temperature.

Action

The small intestinal submucosa (SIS) technology, on which Oasis is based, is a new biomaterial that provides a supportive environment to allow a patient's body to rebuild and repair damaged tissue. SIS is extracted from the submucosal layer of porcine small intestine. The submucosa, found between the mucosal and muscular layers, provides strength to the intestine through a complex organization of structural and functional proteins and molecules that forms a 3-dimensional matrix. Extracted in a manner that removes all cells but leaves the complex matrix intact, the result is a naturally derived, extracellular matrix material that combines remarkable strength and flexible handling.

Indications

To manage partial- and full-thickness skin loss injuries, such as pressure, venous, and chronic vascular ulcers; diabetic ulcers; surgical and trauma wounds; partial-thickness burns (second-degree burns); abrasions; and autograft donor sites.

Contraindications

* This device is derived from a porcine source and should not be used in patients with known sensitivity to porcine material.

* This device is not indicated for use in full-thickness burns (third-degree burns).

* Do not resterilize.

* Discard all open and unused portions of Oasis.

* The device is sterile if the package is dry, unopened, and undamaged. Do not use if the package seal is broken.

* The device must be used prior to the expiration date.

* Discard the device if mishandling has caused possible damage or contamination.

* Oasis should not be applied until excess exudate, bleeding, acute swelling, or infection is controlled.

Potential Complications

The following complications are possible:

* infection

* chronic inflammation (initial application of wound dressings may be associated with transient, mild, localized inflammation)

* allergic reaction

* excessive redness, pain, swelling, or blistering.

* Cleanse and prepare the wound bed using standard methods to ensure the wound is free from debris and necrotic tissue. The wound may be surgically debrided to ensure the wound's edges contain viable tissue.

* Position the cut, dry Oasis sheet on the wound surface so that it overlaps all wound edges. If the wound is larger than a single sheet, multiple sheets may be used. While holding Oasis in place, gently pour sterile saline or another isotonic solution over Oasis to rehydrate. Alternately, Oasis may be rehydrated in a bowl of sterile saline for at least 1 minute before it is placed on the wound.

* Place the edge of the sheet in contact with the intact tissue surrounding the wound. Smooth Oasis into place to ensure the sheet is in contact with the underlying wound bed.

* Use a nonadherent, secondary dressing over Oasis to keep the device in place and to maintain a moist environment.

* Oasis wound matrix should be reapplied to the wound if more than 50% of the wound matrix is incorporated into the wound bed. During secondary dressing changes, a caramel-colored gel may be seen on the wound. This is common and is a result of Oasis being combined with body fluids. The gel should be rinsed away with gentle irrigation. Then place additional Oasis to cover the wound. Never forcibly remove Oasis from the wound bed. This could disturb budding epithelial cells on the wound's periphery.

* Two to 3 days after application, check the wound and reapply Oasis as necessary.

* Check the wound approximately 5 to 7 days after application and reapply Oasis as necessary.

* Check the wound at least weekly and reapply Oasis as necessary.

* Continue the use of Oasis until the wound has completely epithelialized.

Removal

* Oasis should not be removed from the wound bed during dressing changes. As healing occurs, sections of Oasis may gradually peel and only then may be removed during dressing changes. Do not forcibly remove sections of Oasis that may adhere to the wound.

* During each secondary dressing change, make sure Oasis is covering the wound surface. Place additional Oasis in any area where it is no longer covering the wound.

HEALTHPOINT, LTD

Figure. No caption available.

How supplied

Tube: 60 grams

Action

Xenaderm contains 3 active ingredients: balsam of Peru, castor oil, and trypsin. Balsam of Peru is an effective capillary bed stimulant used to increase circulation in the wound site. Castor oil is used to improve epithelialization by reducing premature epithelial desiccation and cornification. It can also act as a protective covering and may help reduce pain. Trypsin provides proteolytic cleansing action by removing any dead protein matter that may impede healing.

Indications

To promote healing of pressure ulcers, varicose ulcers, and dehiscent wounds.

Contraindications

Warnings

* Do not apply to fresh arterial clots.

* Avoid contact with eyes.

* Keep out of reach of children.

* Use only as directed.

* When Xenaderm is applied to a sensitve area, a temporary stinging sensation may be noted.

Application

* Apply a thin film of Xenaderm a minimum of twice daily or as often as necessary.

* A wound treated with Xenaderm may be left unbandaged or an appropriate dressing may be applied.

Removal

* To remove Xenaderm, wash with appropriate cleanser.

JOHNSON & JOHNSON WOUND MANAGEMENT, A DIVISION OF ETHICON, INC

Figure. No caption available.

Category

Alginate

How supplied

Wafer: 2"x2", 4"x4", 4"x8"

Rope: 1"x12"

Action

NU-DERM Alginate Wound Dressing is a sterile, nonwoven pad consisting of high G (guluronic acid) alginate and carboxymethylcellullose (CMC) fiber. The wound dressing is designed to be fast gelling to allow removal intact.

Indications

To manage moderately to heavily exuding chronic wounds and to control bleeding in superfical acute wounds. Chronic wounds include pressure ulcers, leg ulcers, venous stasis ulcers, diabetic ulcers, and arterial ulcers. Superficial acute wounds include abrasions, lacerations, donor sites, and postoperative wounds.

Contraindications

* NU-DERM Alginate Wound Dressing is not indicated for use on full-thickness burns (third-degree burns) or surgical implantations.

* NU-DERM Alginate Wound Dressings may be used when visible signs of infection are present in the wound area only when proper medical treatment addresses the underlying cause.

* Do not use on patients with known sensitivity to alginates.

* NU-DERM Alginate Wound Dressings are not intended to control heavy bleeding.

Application

* Debride the wound when necessary and irrigate the wound site with a suitable wound cleanser.

* Remove excess solution from the surrounding skin.

* Select a size of NU-DERM Alginate Wound Dressing that is slightly larger than the wound.

* Cut (using clean scissors) or fold the dressing to fit the wound. Loosely pack deep wounds, ensuring that the dressing does not overlap the wound margins.

* For heavily exuding wounds, apply NU-DERM Alginate Wound Dressing directly to the wound bed. For wounds with minimal exudate, apply to a moistened wound bed.

* Cover and secure NU-DERM Alginate Wound Dressing with a nonocclusive or semiocclusive secondary dressing.

Removal

* Dressing change frequency will depend on the patient's condition and the level of wound exudate.

* Reapply NU-DERM Alginate Wound Dressing when the secondary dressing has reached its absorbency capacity or when good wound care practice dictates that the dressing should be changed.

* Gently remove the secondary dressing.

* If the wound appears dry, saturate the dressing with normal saline solution prior to removal.

* Gently remove the dressing and discard.

* Irrigate the wound site with a suitable wound cleanser prior to application of a new dressing.

* Follow directions for dressing application.

NU-DERM Hydrocolloid Wound Dressing

Figure. No caption available.

Category

Hydrocolloid

How supplied

Border sheet (film backing): 2"x2", 4"x4", 6"x6"

Border heel/elbow (film backing): 3.15"x4.75"

Border sacrum (film backing): 6"x7"

Thin sheet (film backing): 4"x4"

Standard sheet (foam backing): 4"x4", 8"x8"

Action

NU-DERM Hydrocolloid Wound Dressings are sterile hydrocolloid dressings designed to maintain a moist wound environment, which supports the wound healing process by encouraging autolytic debridement, enabling granulation to proceed under optimum conditions. The dressing material interacts with wound exudate to form a soft gel. Due to the matrix formulation of the hydrocolloid material, most of the gel is removed with the dressing, resulting in little or no damage to the newly formed tissue.

NU-DERM Hydrocolloid Wound Dressings consist of a wound contact layer of hydrocolloids. The top layer is either a semipermeable polyurethane film (border and thin) or a film-coated polyurethane foam (standard).

The border product is conformable, has a top layer of low-friction film, and has beveled edges. The border is a continuation of skin-friendly hydrocolloid adhesive material.

The standard product has a top layer of foam, rounded corners, and is uniform in thickness.

The semitransparent thin product, which is conformable and has a top layer of low-friction film, allows close and easy monitoring of the wound bed without dressing removal.

The dressings are waterproof and remain in place during showering. They protect the wound against bacterial con-tamination.

Indications

* Border and standard products: to manage light to moderately exuding pressure ulcers and leg ulcers.

* Thin product: to manage superficial dry/lightly exuding wounds, postoperative wounds, and superficial wounds and abrasions; also useful on small wounds toward the end of the healing phase.

Contraindications

NU-DERM Hydrocolloid Dressings are not indicated for use on the following:

* muscle, tendon, and exposed bone

* full-thickness burns (also known as third-degree burns)

* clinically infected wounds.

* Remove the large part of the protective backing paper from the dressing.

* Apply the exposed part of the dressing, centering it over the wound bed.

* Remove the small part of the protective backing paper from the dressing and apply.

* Ensure all edges are smooth and firmly secured.

Difficult-to-Dress Wounds

Difficult-to-dress wounds, such as those on the heel, elbow, or sacral areas, need special attention. Use the dressings specifically designed for those locations.

For the heel/elbow area:

* Remove both parts of the protective paper.

* Place the dressing on the heel or elbow, leaving the precut "flaps" detached.

* Affix the side flaps to wrap the heel or elbow.

* Affix the center flap.

For the sacral area:

* Remove one part of the protective backing paper.

* Place the exposed adhesive portion on the buttock by first placing the "hinge" in the area between the buttocks.

* Remove the remaining protective backing paper and place the second half of the adhesive portion on the other buttock.

* Ensure all edges are smooth and firmly secured.

Removal

Change the dressing after a maximum of 7 days or when full absorbency has been reached. In case of leakage, the dressing should be changed immediately.

To avoid trauma to the intact skin, follow these steps:

* Press down gently on the skin and carefully lift the dressing starting at one edge.

* Pull toward the center of the wound until the dressing is removed.

* Irrigate/cleanse the wound if necessary.

PROMOGRAN Matrix Wound Dressing

Figure. No caption available.

How supplied

Sheet: 28 cm²/4.34 sq in; 123 cm²/19.1 sq in

Action

PROMOGRAN Matrix Wound Dressing is an advanced wound care dressing of a sterile, freeze-dried composite of 45% oxidized regenerated cellulose (ORC) and 55% collagen. In the presence of exudate, the PROMOGRAN Dressing transforms into a soft, conformable, biodegradable gel, which allows contact with all areas of the wound. PROMOGRAN Dressing maintains a physiologically moist microenvironment at the wound surface. This environment is conducive to granulation tissue formation, epithelialization, and rapid wound healing. PROMOGRAN Dressing is a primary dressing that can be cut with sterile scissors to fit a wound and used in combination with either a semiocclusive or nonocclusive secondary dressing. Prior to application in dry wounds, saline solution should be used to hydrate PROMOGRAN Dressing.

Indications

To manage exuding wounds, including diabetic, venous, and pressure ulcers; ulcers caused by mixed vascular etiologies; full- and partial-thickness wounds; donor sites and other bleeding surface wounds; abrasions; traumatic wound healing by secondary intention; and dehisced surgical wounds; PROMOGRAN Dressing may be used under compression therapy with supervision by a health care professional.

Contraindications

* PROMOGRAN Dressing is not indicated for wounds with active vasculitis, fullthickness burns (third-degree burns), or patients with known sensitivity to ORC or collagen.

* Prepare the wound bed according to the facility's standard wound care protocol and debride when necessary. The wound bed should be clear of any visual signs of infection.

* For optimal effect, apply PROMOGRAN Dressing to the entire wound bed.

* For a wound with low or no exudate, apply PROMOGRAN Dressing and hydrate with saline solution. This will initiate the transformation of PROMOGRAN Dressing into a gel matrix.

* After hydration, through exposure to wound exudate or saline, the PROMOGRAN gel matrix will come into contact with the wound surface.

* The biodegradable PROMOGRAN gel matrix is naturally absorbed into the body over time.

* To maintain a moist wound healing environment, PROMOGRAN Dressing must be covered with a semiocclusive dressing or a nonocclusive secondary dressing and fixed to the skin with nonirritating tape.

Removal

* After initial application, reapply PROMOGRAN Dressing to the wound up to every 72 hours, depending on the amount of exudate. It is not necessary to remove any residual PROMOGRAN Dressing during dressing changes.

L.A.M. PHARMACEUTICAL CORPORATION

Figure. No caption available.

How supplied

Tube: 10 grams

Action

L. A.M. IPM Wound Gel is a clear, viscous, odorless, aqueous gel composed principally of sodium hyaluronate, a derivative salt of hyaluronic acid. Hyaluronic acid is a naturally occurring molecule found in various parts of the body. L.A.M. IPM Wound Gel is derived from avian sources and has demonstrated value in the management of certain skin ulcers and wounds where maintaining a moist environment is supportive of the healing process. In human skin, hyaluronic acid is involved in such biological functions as tissue hydration and proteoglycan organization (formation of proteins and sugars).

Indications

To manage leg ulcers, pressure ulcers, diabetic ulcers, and wounds that are prone to bleeding, such as wounds that have been mechanically or surgically debrided.

Contraindications

* Do not administer to patients with known hypersensitivity to this product or to avian proteins.

* Prolonged use of L.A.M. IPM Wound Gel may give rise to a sensitization phenomenon. Should this occur, discontinue use of the product immediately and consult a health care professional.

* To prevent the possibility of cross-infection, a tube of L.A.M. IPM Wound Gel should be used on only 1 patient.

* Direct contact with the wound and the container should be avoided.

* Do not use if the package is damaged.

* Do not use after the expiration date noted on the package.

* Keep out of reach of children.

Application

* Cleanse the ulcer or wound with normal saline solution (other cleansing agents are not recommended).

* Remove excess moisture with dry gauze.

* Apply L.A.M. IPM Wound Gel liberally to the cavity of the ulcer or wound site and the surrounding area.

* Apply a nonstick gauze dressing over the wound site.

* After L.A.M. IPM Wound Gel is applied, the gel should not be touched.

* Wrap a self-adhesive bandage over the nonstick gauze dressing.

* Repeat the process of wound cleansing, applying L.A.M. IPM Wound Gel, and bandaging daily.

Removal

* Change L.A.M. IPM Wound Gel daily or when clinically indicated.

* Dispose of the dressings according to facility policy.

MEDLINE INDUSTRIES, INC

Figure. No caption available.

How supplied

Bottle: 10-gram bottle, with screw cap

Action

Arglaes Antimicrobial Barrier Powder Dressing is a sterile, single-use alginate powder containing ionic silver, making it ideal for difficult-to-dress and/or highly exudating wounds. Utilizing controlled-release polymers that are activated by moisture, Arglaes Powder delivers a constant stream of antimicrobial silver ions into the wound. Continuous delivery at a constant rate means that only minute quantities of silver ions are required to maintain a continuous antimicrobial barrier without cytotoxicity. The sustained-release effect remains constant until Arglaes Powder is removed from the wound site (up to 5 days). In addition, Arglaes Powder contains an alginate to aid in fluid handling. As the powder mixes with wound exudate, it turns into a gel that adheres to the wound bed and removes easily during wound irrigation. Arglaes Powder has been shown to be effective against a broad range of fungi and Gram-positive and Gram-negative bacteria, including Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Candida albicans, Aspergillus niger, methicillinresistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococcus.

Indications

To manage infected or noninfected wounds, such as pressure, arterial, venous, and diabetic ulcers; donor sites and other bleeding surface wounds; dermal lesions; trauma injuries; incisions; and minor burns.

Contraindications

* Not intended for use on dry wounds or wounds that are completely covered with black necrotic tissue.

* Not intended for surgical implantations.

* Not intended for use on full-thickness burns (third-degree burns).

* Not intended for use on individuals with known hypersensitivity to silver.

* Arglaes Powder is a sterile, single-use product. Do not use this dressing if the packaging has been damaged.

* If signs of clinical infection develop at the wound site, appropriate medical treatment should be initiated by a physician. Arglaes Powder may be continued during treatment of the infection at the discretion of the physician.

* Do not use topical antibiotics or antiseptics in conjunction with Arglaes Powder.

* If present, eschar should be debrided from the wound before Arglaes Powder is applied.

Application

* Cleanse the wound site with sterile saline or an appropriate wound cleanser.

* One 10-gram bottle of Arglaes Powder is sufficient to dress a wound area of up to 4"x4" (10 cmx10 cm).

* Gently dry the surrounding area.

* Shake the bottle thoroughly, then open Arglaes Powder by removing the tamper-evident collar and screw cap.

* Apply the dressing by squeezing the bottle (gently tap the bottle if flow is blocked) and "puffing" the powder into the wound bed. Apply until wound surfaces are completely covered to a depth of not less than 1 mm.

* Cover the site with an appropriate secondary dressing. Heavily exudating wounds may require a more absorbent secondary dressing covered with an island dressing. The dressing may remain in place for up to 5 days.

* Arglaes Powder should be changed when the secondary dressing is wet or if there is any sign of leakage. Heavily draining wounds may require more than 1 change per day.

Removal

* To remove Arglaes Powder, gently lift and discard the secondary dressing. Irrigate the wound thoroughly with normal saline or an appropriate wound cleanser. Continue irrigating the wound until all gelled or ungelled powder is removed.

* Redress the wound as appropriate.

SilvaSorb

Figure. No caption available.

How supplied

Sheet (sterile): 2"x2", 41/4"x4 41/4", 4 41/4"x4 41/4" perforated, 4"x8", 4"x10" perforated

Cavity: 6 grams

Action

SilvaSorb is a sterile, single-use wound dressing for use in moist wound management. It combines patented MicroLattice technology with sustained-release silver. The MicroLattice synthetic matrix helps maintain an optimal moist wound environment by either donating moisture or absorbing at least 5 times its weight in excess wound exudate. The MicroLattice matrix also controls the release of ionic silver, which is triggered by contact with moisture.

SilvaSorb's increased fluid management and antimicrobial performance make it ideal for chronic wounds. SilvaSorb is an effective barrier to bacterial penetration. The antimicrobial barrier function of the dressing may help reduce infection by inhibiting the growth of S aureus, including MRSA, P aeruginosa, E coli, C albicans, VRE, and other clinically significant microorganisms. SilvaSorb's sustained-release effect remains constant until the dressing is removed from the wound (up to 7 days, depending on exudate level).

SilvaSorb is biocompatible and will not stain or discolor tissue. It does not require preconditioning or periodic irrigation.

Indications

To manage partial- and full-thickness wounds, such as pressure ulcers, diabetic foot ulcers, and leg ulcers; skin tears; superficial and partial-thickness burns (first- and second-degree burns); grafted wounds and donor sites; surgical wounds; lacerations; and abrasions.

Contraindications

There are no contraindications for SilvaSorb.

Precautions

* If signs of clinical infection develop at the wound site, appropriate medical treatment should be initiated by a physician. SilvaSorb may be continued during the treatment of a wound infection at the discretion of the physician.

* If present, eschar should be debrided before SilvaSorb is applied.

Application

* Cleanse the wound using sterile saline or an appropriate wound cleanser.

* Remove the dressing from the package, then remove the 2 inner liners. For the perforated version, prestretch the sheet to open the perforations and allow the dressing to relax.

* For the sheet styles, place either side of the dressing in contact with the wound base, ensuring that more than 1/2"covers the periwound skin. For the cavity version, adequate spacing is obtained by loosely filling one-half to two-thirds of the wound deficiency.

* If either the sheet or cavity style is too large for the wound, tear or cut it to the appropriate size.

* Cover the dressing with an appropriate secondary cover, such as a transparent film or a composite island dressing. The secondary dressing selection and wear time will depend on the amount of exudate and the condition of the periwound skin.

* SilvaSorb may remain in place up to 7 days, depending on the amount of exudate. Change the dressing if the wound exudate begins to pool within the wound or if there is significant strike through. Generally, dressings should be changed more frequently in heavily exudating wounds.

Removal

* Carefully remove the secondary dressing and SilvaSorb from the wound.

* SilvaSorb is normally nonadherent to the wound, but can be remoistened with saline or wound cleanser to ease removal.

* Gently cleanse the wound with sterile saline or an appropriate wound cleanser.

* Follow the directions for reapplying a new SilvaSorb dressing, if appropriate.