Nursing management of wound care pain

Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject.     

Pain and tissue trauma during dressing change

BACKGROUND: Preventing patient pain and tissue trauma to the wound and surrounding skin are key considerations for nurses at the time of dressing changes. Mark Collier and Helen Hollinworth present the preliminary findings from a recent survey among nurses with an interest in wound care on the selection of dressing types. CONCLUSION: Education of student and post-registration nurses about the properties of dressing products, with an understanding of the potential detrimental effects as a result of pain and trauma, is needed to help promote quality wound care. Selecting appropriate dressings was reported as the main strategy nurses adopted to help prevent pain and trauma at the time of dressing change. Appropriate product selection can improve patients' quality of life and optimise wound healing potential.     

Malignant fungating wounds: A survey of nurses’ clinical practice in Switzerland

BackgroundThe care of individuals with a fungating malignant wound represents challenging cancer management not only for patients and their families but also for health care professionals. Understanding the difficulties faced by nurses when they care for patients with such a wound can help guide practice and service development. The aim of this study was to investigate how many patients with a malignant fungating wounds did nurses see and what kind of difficulties in caring for patients with a malignant fungating wound did nurses experience.MethodA survey was conducted in three different geographical regions of Switzerland over a 6 month period.ResultsA total of 269 nurses participated in this survey. The nurses reported the prevalence rate of fungating wounds as 6.6%. There was a difference in perceived prevalence between the regions. The most frequent location for such wounds was the breast in women with breast cancer. The appearance was mainly ulcerating. The main difficulties nurses experienced in the management of patients related to malodour, pain and difficulties in applying the dressings to the wound. The most frequently used dressing was an absorbent dressing. The difficulties nurses had and what kind of dressings they used were closely connected.Conclusions and implications for practiceStrategies need to be explored to help understand the diverse range of wound problems including physical and psychological components. Furthermore, there is a need to raise the awareness of existing wound management specialists in the support of cancer patients.     

爱康肤银抗菌敷料加速感染切口愈合效果的对照研究

目的评价银离子敷料加速急性感染切口愈合的作用。方法将49例手术切口感染患者随机分为实验组（n=26）和对照组（n=23）,实验组用银离子敷料换药,对照组用常规无菌纱布敷料换药,比较两组患者换药疼痛程度、切口愈合时间、创面拭子细菌培养转阴时间、换药次数、治疗费用及单次平均换药时闯等指标。结果实验组换药疼痛程度、切口愈合时间、创面拭子细菌培养转阴时闯、换药次数、治疗费用及单次平均换药时间均低于对照组（P〈0.05）。结论银离子敷料用于急性感染切口的治疗,起到了加速切口愈合及局部感染控制速度、减轻患者痛苦、提高医护人员工作效率和节省治疗费用的作用。     

Wet-to-dry dressings-evaluating the evidence

In 2008, the use of wet-to-dry dressings for wound care surprisingly remains the mainstay for many practitioners and is considered a traditional dressing. But does traditional practice have a place in wound care today? With the ever-increasing emphasis on evidence-based practice, this article evaluates the evidence of wet-to-dry dressings and its relation to moist wound healing, which is considered the standard of care. A brief history of wound care will also be discussed.     

新型医用敷料的分类及特点

背景：临床应用的多种新型创面敷料可加速创面修复,减少伤口感染,提高治愈率,缩短病程,减轻患者痛苦.目的：回顾传统医用敷料及新型医用敷料的优缺点,展望新型医用敷料的临床应用及发展.方法：应用计算机检索2003年1月至2006年8月 PubMed 数据库及2000年1月至2006年8月 CNKI数据库有关医用敷料种类、特点及临床应用的研究,检索词为“Medical dressing,医用敷料”.结果与结论：医用新型敷料分为薄膜类、水凝胶类、藻酸盐类、泡沫类、水胶体类、药用类敷料.薄膜类敷料透明,便于观察伤口,能密切黏附于创面表面,有效保持创面渗出液,提供有利于创面愈合的湿润环境,促使坏死组织脱落,减轻创面疼痛会,缺点为吸水性能欠佳.水凝胶类敷料能与不平整的创面紧密粘合,减少细菌滋生,加速新生血管生成,促进上皮细胞生长.水胶体类敷料比薄膜类敷料厚许多,胶层的厚度决定其吸收能力的大小,水胶体敷料可吸收少量到中量渗液,不适用于渗出液多的创面.泡沫类敷料具有多孔性,表面张力低,富有弹性,可塑性强、轻便,对渗出液的吸收力强,对氧气及二氧化碳几乎完全通透,可作为药物载体.新型藻酸盐类敷料比较柔软,容易折叠,敷贴方便,在创面上形成柔软类似凝胶的半固体物质,为创面提供一个湿润环境,提高表皮细胞的再生能力,加快表皮细胞移动.药用类敷料有保护创面、止痛、止血、消炎、促进新生肉芽组织及上皮细胞生长,加速创面愈合等功能.     

Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings

Aims and objectives. To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze‐based) in surgical patients after hospital dismissal. Background. The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze‐based dressings, which appears especially useful for homecare patients and could save costs. Methods. We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non‐parametric bootstrapping. Results. Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0·6/day) was significantly (p = 0·008) lower than in the gauze group (1·1/day). Mean daily material costs of modern dressings were €5·31 vs. €0·71 in the gauze group. Mean difference; €4·60 (95% CI, €2·68–€6·83) while daily total (material plus nursing) costs showed no difference between the groups; mean €2·86 (95% CI, €?6·50–€10·25). Wound healing in the gauze‐treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log‐rank p = 0·060). Conclusions. The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home. Relevance to clinical practice. District nurses should reconsider using gauze‐based dressings, particularly in surgical patients with exudating wounds.     

组织工程生物绷带及敷料在创伤修复领域中的应用

背景：医用敷料作为伤口处的覆盖物,在伤口愈合过程中,可以替代受损的皮肤起到暂时性屏障作用,避免或控制伤口感染,提供有利于创面愈合的环境。如何既能快速固定、有效止血,又可以减轻或避免止血后对伤肢血循环造成的不利影响,加快伤口愈合、减轻伤痛是创伤急救医学亟待解决的难题。目的：文章综述了医用生物敷料在创伤修复领域中的应用现状及研究进展,揭示其发展前景,为其在创伤修复过程中的应用提供理论基础。方法：应用计算机检索CNKI和PubMed数据库中1998-01/2008-12关于医用生物敷料的文章,在标题和摘要中以＂医用敷料;生物材料,壳聚糖,水凝胶,组织工程＂或＂medical dressing,chitosan＂为检索词进行检索。选择文章内容与创伤修复相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到146篇文献,中文107篇,英文39篇,根据纳入标准选择38篇文章进行综述。结果与结论：就目前临床使用及研究的医用敷料,根据其所用的材料将其分成了天然材料和合成高分子,无机材料和复合材料,并对敷料类产品质量控制中出现的问题进行了讨论,展望了敷料类产品的未来发展方向。为医用敷料类产品的研发提供理论依据。     

Hydrogel dressings in the treatment of wounds with skin defect complications

Background. The purpose of the present study was to compare the performance of the Hydrogel dressing with that of traditional dressings in the treatment of wounds with skin defects.
Material and methods. 32 patients with traumatic skin defects were included in the study. 16 were treated with Hydrogel dressings, and 16 with traditional dressings. We compared the time required for complete epithelialization and the level of pain experienced on removal.
Results. The trial dressing demonstrated faster healing time (ave. 5-6 days faster). The patients from the experimental group experienced less during dressing changes.
Conclusions. We found that dressings demonstrated significantly faster epithelialization time in comparison with traditional wound dressings. The application of Hydrogel dressings enhanced patient comfort.     

Key principles involved in applying and removing wound dressings

This article aims to help practitioners consider a variety of wound dressings and develop their knowledge about the use of dressings to ensure patients are protected and care is cost-effective. The article focuses on which dressing should be used depending on wound type and how different dressings should be applied and removed. Author     

脓肿切开引流术后伤口应用湿性敷料的效果观察

目的观察脓肿切开引流术后伤口应用湿性敷料的效果。方法选择伤口换药的患者60例,随机分为两组,分别用湿性敷料和常规方法进行换药,比较两组的伤口愈合时间、换药次数及疼痛分级。结果观察组和对照组的愈合时间分别为（19．533±3．335）d和（25．286±3．539）d,观察组愈合较快（P〈0．05）;换药次数分别为（6．333±0．724）次和（8．714±1．437）次,观察组低于对照组（P〈0．05）;换药疼痛分级观察组明显低于对照组（P〈0．05）。结论使用湿性敷料处理脓肿切开伤口,缩短伤口愈合时间,减少换药次数,减轻患者的疼痛。     

A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial-thickness burns: which method is less painful?

Despite recent improvements in analgesia, pain control during dressing changes continues to be a major challenge in patients with burns. We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change. Patients with partial-thickness burns that required only topical wound care were assigned randomly to treatment with Acticoat (Smith and Nephew USA, Largo, FL) or silver sulfadiazine (AgSD). The outcome variable was pain during wound care, which was measured using visual analog pain scores. The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9, respectively (P < .0001; paired Student's t-test). In 41 of the 47 paired pain score observations, the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat. Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns.     

Modern wound dressings

With the wide array of wound dressings available today, it can be a difficult task to select the appropriate dressing required for a particular wound. Georgina Casey reviews the healing process and discusses the characteristics of different types of dressing.     

不同敷料应用于慢性伤口治疗中的效果观察

[目的]观察蜂蜜敷料与功能性敷料应用于慢性伤口中的效果。[方法]将96例慢性伤口病人随机分为观察组和对照组各48例,分别使用蜂蜜敷料、功能性敷料处理伤口,观察两组伤口不同时间面积愈合率、换药时间、伤口2次损伤积分及治疗费用。[结果]观察组病人伤口换药第20天及第30天面积愈合率高于对照组、换药时间快于对照组、治疗费用少于对照组(P均<0.05)。[结论]蜂蜜敷料治疗慢性伤口安全有效、经济适用,效果优于功能性敷料,为临床难愈压疮和手术后感染难愈伤口的处理提供有效方法。     

A prospective controlled trial of Biobrane versus scarlet red on skin graft donor areas

A prospective trial of Biobrane versus scarlet red as a skin graft donor site dressing was done in 21 burn patients with mean total body surface area burns of 31.9%. Corresponding body areas were randomly selected on each patient to receive one of the dressings. Daily evaluations were made of subjective expression of pain, exudate formation and infection, and time of separation of the dressing from the wound. Biobrane was found to be superior in reducing donor site pain. However, with Biobrane there was a higher incidence of infection (57% v 9.5%) and a significant delay in separation from the wound. Scarlet red was found to be more cost-effective. Occlusive dressings have previously been shown to have a high incidence of complications (30%). In extensive burns, isolating the donor site from the wound is difficult and may lead to increased complications. Scarlet red appears to be superior to Biobrane for skin graft donor sites in this patient population.     

Gabapentin for pain control in cancer patients' wound dressing care

A patient with mycosis fungoides illustrates the problem of pain management during wound care and suggests the utility of a novel treatment, gabapentin. Skin lesions, be they induced through necrosis of tumor, therapy (e.g., radiotherapy), or by pressure ulceration, are often the cause of continuous pain or acute wound dressing pain. Optimizing the analgesic treatment in those patients is thus of major importance. Anti-inflammatory drugs and opioids are the cornerstones in the treatment of cancer pain but are rarely sufficient to control wound pain. Different adjuvant techniques can be used, including topical analgesics, psychological distraction techniques, anxiolytics, and co-analgesics. There is growing evidence that anticonvulsants, and sodium channel blockers in particular, are effective not only in neuropathic but also in inflammatory pain. Gabapentin, a voltage sensitive sodium and calcium channel blocker, was used as a co-analgesic to supplement morphine in this case of cancer wound dressing pain.     

Developing affordable and accessible pro‐angiogenic wound dressings; incorporation of 2 deoxy D‐ribose (2dDR) into cotton fibres and wax‐coated cotton fibres

The absorption capacity of cotton dressings is a critical factor in their widespread use where they help absorb wound exudate. Cotton wax dressings, in contrast, are used for wounds where care is taken to avoid adhesion of dressings to sensitive wounds such as burn injuries. Accordingly, we explored the loading of 2‐deoxy‐D‐ribose (2dDR), a small sugar, which stimulates angiogenesis and wound healing in normal and diabetic rats, into both types of dressings and measured the release of it over several days. The results showed that approximately 90% of 2dDR was released between 3 and 5 days when loaded into cotton dressings. For wax‐coated cotton dressings, several methods of loading of 2dDR were explored. A strategy similar to the commercial wax coating methodology was found the best protocol which provided a sustained release over 5 days. Cytotoxicity analysis of 2dDR loaded cotton dressing showed that the dressing stimulated metabolic activity of fibroblasts over 7 days confirming the non‐toxic nature of this sugar‐loaded dressings. The results of the chick chorioallantoic membrane (CAM) assay demonstrated a strong angiogenic response to both 2dDR loaded cotton dressing and to 2dDR loaded cotton wax dressings. Both dressings were found to increase the number of newly formed blood vessels significantly when observed macroscopically and histologically. We conclude this study offers a simple approach to developing affordable wound dressings as both have the potential to be evaluated as pro‐active dressings to stimulate wound healing in wounds where management of exudate or prevention of adherence to the wounds are clinical requirements.     

Evaluation of a honey-impregnated tulle dressing in primary care

Honey has been used for its healing properties for centuries and has been used to dress wounds with favourable results. The emergence of antibiotic resistance and growing interest in "natural" or "complementary" therapies has led to an interest in honey dressings. Much of the research to date has been related to honey's antibacterial properties. However, the healing properties claimed for honey also include stimulating new tissue growth, moist wound healing, fluid handling and promoting epithelialization. Until recently, honey had not been developed as a wound management product and was not a certified pharmaceutical device. Activon Tulle is a sterile, non-adherent dressing impregnated with Leptospermum scoparium hone. The claimed properties of honey dressings would make this a valuable addition to the dressing currently available in the primary care setting. An evaluation was undertaken involving 20 patients with a variety of wounds. A conclusion is drawn that while further research is needed, medical grade honey does appear to be a valuable addition to the wound management formulary.     

水胶体敷料预防I期闭合结肠造瘘皮肤瘘口感染的效果

目的评价水胶体敷料预防I期闭合结肠造瘘皮肤瘘口感染的效果。方法将43例I期闭合结肠造瘘皮肤瘘口患者随机分为实验组（24例）和对照组（19例）,实验组使用水胶体敷料覆盖伤口,对照组使用3L商品切口敷贴,比较两组伤口感染率、平均住院日和术后伤口换药平均费用等指标。结果实验组I期闭合皮肤瘘口感染率4．16％,对照组为31．57％,差异有统计学意义（x2=5．8,P〈0．05）;实验组术后平均住院（6．03±1．17）d,对照组（13．64±4．09）d,两组比较差异有统计学意义（t=-2．173,P〈0．05）;实验组患者伤口换药费用（297．50±33．69）元,低于对照组的（544．90±103．48）元,差异有统计学意义（t=2．050,P〈0．05）。结论水胶体敷料应用于结肠造瘘还纳后I期闭合皮肤瘘口的术后管理,降低伤口感染率、缩短住院时间、节省治疗费用,为此类高感染风险伤口的治疗提供了一个新的思路。     

A systematic review of foam dressings for partial thickness burns

BackgroundPartial thickness burns are the most common form of thermal burns. Traditionally, dressing for these burns is simple gauze with silver sulfadiazine (SSD) changed on a daily basis. Foam dressings have been proposed to offer the advantage of requiring less frequent dressing change and better absorption of exudates.ObjectiveTo compare the impact of silver-containing foam dressing to traditional SSD with gauze dressing on wound healing of partial thickness burns.MethodsWe performed a systematic literature search using PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library database and Google Scholar for trials comparing traditional SSD dressings to that of silver-containing foam dressing on wound healing in partial thickness burns <25% of the body surface area. We excluded studies that enrolled burns involving head, face, and genitals; burns older than or equal to 36 h, non-thermal burns, and immunocompromised patients. Quality of trials was assessed using the GRADE criteria. The main outcome, complete wound healing, is reported as percentages of wound with complete epithelialization after the follow up period. Relative risks of complete healing are also reported with respective 95% CI. Time to healing and pain score before, during, and after dressing change at each follow up visit are compared between the groups (means with standard deviation or medians with quartiles).ResultsWe identified a total of 877 references, of which three randomized controlled trials (2 combined pediatric and adult trials and 1 adult trial) with a total of 346 patients met our inclusion criteria. All three trials compared silver-containing foam dressing to SSD and gauze on partial thickness burns. Moderate quality evidence indicated no significant difference in wound re-epithelialization between the groups across all three trials as confidence intervals for the relative risks all crossed 1. Although pain scores favored foam dressing at the first dressing change (7 days), there was no significant difference between the groups at the end of the treatment period at 28 days. Time to wound healing was also similar across the three trials with no statistical difference. Infection rates favored the foam-dressing group, but data were inconsistent.ConclusionModerate quality evidence indicates that there is no significant difference in wound healing between silver-containing foam dressing and SSD dressing. However, foam has the added benefit of reduced pain during the early treatment phase and potentially decreased infection rates.