Topic Five: Hydrogel Dressings
Composition & Properties
Hydrogels are available in an amorphous gel or sheet form. All hydrogels characteristically have a high water content of around 70%, with the majority of hydrogels containing propylene glycol,l which acts as a stabiliser and a humectant. They also typically contain a gel-forming product such as carboxymethyl cellulose or a starch polymer. These ingredients mean that moisture is trapped within the product (Williams, 1998).
Note: propylene glycol increases the incidence of mortality in larvae (see ‘larvae’ section for more information). In preterm and neonates, propylene glycol is often used as an excipient for administering drugs. Frequent use and exposure can cause harm by increasing the risk of side effects and toxicity (De Cock et al., 2013; Cuzzolin, 2018; Valeur, 2018). This needs to be taken into account before considering using a hydrogel product.
Hydrogels are designed to hold moisture and donate water at the wound surface, providing an environment for wound cleansing and autolytic debridement and are therefore very useful in dry sloughy and necrotic wounds (Moody, 2006; Morris, 2006; NICE BNF, 2020). Different brands of hydrogels will contain varying amounts of water. However, none of them will completely dissolve in the wound (Moody, 2006).
Indications for use
Hydrogels are indicated for use in dry wounds where rehydration is required to remove slough or necrotic tissue from the wound bed (Vuolo, 2009). They can also be used on wounds where loss of moisture due to dressing materials has reduced wound bed cellular activity to provide a moist wound healing environment (Hedger, 2013).
Some hydrogels also have the ability to absorb very small amounts of exudate (refer to the product’s instructions for use). It can be used in the form of a sheet dressing, which is frequently used in burns and scar tissue. Hydrogels may be used for painful wounds as they can have a cooling, soothing effect, which could assist in the reduction of pain. (Hoffman 2007, Hedger 2013)
The use of a hydrogel dressing, either on its own or in conjunction with other dressings, has been reported to be effective in the management of extravasation injury in neonates. (King et al., 2013) (refer to local policy)
Hydrogels do not absorb fluid, so they are not recommended for wet wounds. They should not be used on heavily exuding wounds as this can encourage maceration of the surrounding skin (Benbow, 2005). Hydrogels in a gel form require a secondary dressing. In addition, they can macerate the surrounding skin if overused. They may require daily dressing changes and may vary in viscosity amongst brands according to the products water base (water and glycerin).
Hydrogels have been used in other areas of skin and wound care:
- Dermatological skin conditions
- Inflamed skin flexures
- Skin damaged by radiotherapy
- Extravasation injuries in neonates
- Excoriation of the skin caused by incontinence
- Management of fistula
- Nappy rash in infants
(Morris, 2006)