Topic Progress:

Topic Four: Dressing Selection

In order to make an informed decision about which wound care product to use for an individual wound, it is important to conduct a full patient and wound assessment.

Morgan’s concept of an ‘ideal’ dressing is well documented and lists ideal dressing characteristics:

  • Maintains a moist environment at the wound dressing interface
  • Provides thermal insulation
  • Low or non-adherent
  • Requires infrequent changing
  • Provides mechanical protection
  • Free from particulate contaminants
  • Safe to use (non-toxic, non-sensitising, non-allergenic)
  • Conformable and mouldable
  • Good absorption characteristics (for exuding wounds)
  • Impermeable to microorganisms
  • Acceptable to the patient
  • Cost-effective
  • Sterile
  • Available in a suitable range of forms and sizes

(Morgan, 1999; Hughes, 2013)

There are a large number of wound care products on the market with a wide range of physical performance characteristics (such as size, adhesion, conformability and fluid handling properties). Although laboratory characterisation tests provide a means of comparing their performance, they cannot always predict how dressings will perform in a clinical situation (NICE, 2015).

There are very few guidelines relating to which products should be used in particular circumstances. NICE (2015) recommends using an appropriate interactive dressing to manage surgical wounds that are healing by secondary intention and referral to a tissue viability nurse (or another health care professional with tissue viability expertise), for advice on the management of surgical wounds healing by secondary intention.

Furthermore, NICE (2015) has highlighted that dressing selection should only be made after clinical assessment of the person´s wound, their clinical condition, and their personal experiences and preferences.

Where there is no clinical evidence supporting the use of a product, prescribers should choose the dressing with the lowest acquisition cost and performance characteristics that provide the optimum environment for the wound and stage of healing.

It must be recognised that no one dressing provides the optimum environment for the healing of all wounds (Dealey, 2005). In general, the key to selecting the appropriate wound care product is a full wound and patient assessment. This will help determine the wound size, depth, exudate level, tissue type, surrounding tissue condition and ultimately, the aetiology of the wound. An appropriate course of action can be planned, and dressing selection made. It will then be necessary to reassess the patient’s wound and the appropriateness of the dressing selection at regular intervals.

Factors that should be considered when choosing a dressing include:

  • The stage of wound healing
  • Location of the wound
  • Extent (size/depth) of the wound
  • The predominant tissue type on the wound surface
  • The amount of exudate
  • Infection and wound bioburden
  • Odour
  • The adhesiveness of a dressing (ease of removal)
  • Irritation caused by the adhesive
  • Absorption
  • Frequency of dressing changes
  • Ease of use of the dressing
  • Amount of pain at dressing changes
  • Protection of the surrounding skin
  • Quality of life and patient well being
  • Patient preference and engagement

(WUWHS, 2019; NICE, 2016)

Selecting the correct dressing for a wound is a complicated process and requires knowledge of the characteristics of wounds, dressings and the patient.

Before applying any dressing, the nurse should ask themselves:

  • What is the action of this dressing?
  • When should it be used?
  • What are the limitations or contraindications to its use?
  • Do I know the correct method of application and removal?
  • Have I had sufficient training about the dressing?

(Benbow, 2004; Edwards et al., 2013)

All decisions made by practitioners must be based on the best available evidence. It is the responsibility of each practitioner to ensure they possess up to date knowledge and skill. Importantly, practitioners need to recognise their own limitations and when it is necessary to refer for specialist advice.

When dressing a wound, it is not uncommon that you may need to use a combination of dressings:

Primary Dressing

A primary dressing is one which is placed directly on the wound surface, e.g. wound contact layer, hydrogel, alginate or gelling fibre. The dressings mentioned usually require a cover dressing. However, not all primary dressings will need covering.

If a dressing is required to absorb leakage or to secure a primary dressing, it may be referred to as the secondary dressing.

Secondary Dressing

A secondary dressing is the dressing that goes on top of the primary dressing. It can be used for several reasons, including extra absorption or securing a primary dressing in place. When selecting a secondary dressing, it is important to consider its compatibility with the primary dressing (Edwards et al., 2013; Hughes, 2013).