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www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Bandaging Techniques For Nurses Who are we?….
The Veterinary Wound Library & its Bandaging Angels
www.vetwoundlibrary.com
We provide independent specialist support to help you heal
and Bandaging Angels in house CPD to help your team
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
The Vet Wound Library how it works…
HELP!Canine - 135 Traumatic wound
Step by step: •Prepare - lavage •Promote - close •Protect - bandage
and support you until your wound is healed.
Suggested Dressings:
?
Share your case in confidence by phone or PC at
www.vetwoundlibrary.com
Your specialist will reply with the advice you need.
1 2 3
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
The Bandaging Angels
We deliver independent practice training covering best practice bandaging and wound management techniques.
We aim to:
Improve skills, engage the team and encourage continuity of care to reduce the risk of bandaging complications
We also run trials and evaluations on products to aid in the development of best practice through evidence based medicine
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Because Bandaging Is Dangerous!
Veterinary Wound Library education requests due to resolve a history of
bandaging injuries is common
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
A Functional,Cosmetic RepairRelief of Pain and Distress
Rapid Return to Normal Use
within a reasonable budget
WHY MANAGE WOUNDS?
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
The Journey of a Wound
Healing by Secondary Intention
Prevent infection and cross contamination
Healthy GranulationClean surgical wound
Traumatic, dirty wound
Debridement: Surgical, Mechanical, Enzymatic, Autolytic
No need or not suitable for surgery or reconstruction?
Reconstructive SurgeryGrafting
Prepare
Promote
Protect
Tissue / skills available to close?
Primary Intention
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Haemostasis
Early Inflammation
MaturationProliferationLate
Inflammation
Hours0123456789
101112131415161718192021222324
Days 1 2 3 4 5 6 7 8 9 10 11 // 4-6 wks // 1 yr
Necrotic Sloughy Granulating Epithelialising
Physiology Works….
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
COMMUNICATION BETWEEN CELLS CONTROLS HEALING
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
INFECTION OR INFLAMMATION?
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Healthy granulation tissue: • Bright red and moist• Slightly granular/uneven appearance
• Exudate levels minimal
MANAGEMENT aim: • Promote a moist wound environment• Manage exudate – wound not to wet or dry• Manage the peri-wound environment• Minimise contamination• MINIMAL DRESSING CHANGES 3-4 days
Proliferation
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
THE RESEARCH THAT CHANGED THE WAY WE MANAGE WOUNDS
Formation of the scab and the rate of epithelisation of
superficial wounds in the skin of the young domestic pig
(Nature 193:293 1962)
OPTIMAL WOUND HEALING?
Removal of bioburden Closure options? Open wound management?
Healthy Granulation
Surgical Closure? Graft / Reconstruction?
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
PREPARE
GEL CLIP WASH
Money Saving Tip!
KY Jelly and Ultrasound Gel are both
water soluble hydrogels!
www.bandagingangels.com 01953 449 059 www.vetwoundlibrary.com
THE IMPORTANCE OF WOUND LAVAGE
Step 1: Clip and Lavage
Ideally compatible with tissue:Saline, balanced electrolyte solution ok to use tap water
Step 3: Repeat until granulation begins to form.
Antiseptics: Do you REALLY need them?
Povidone Iodine: Between 0.5 and 1% for wounds (1:10 or 1:20 dilution of 10% povidone iodine)
Polyhexamine Biguanide (PHMB):Relatively safe - pre-prepared lavage solution(Prontosan® - BBraun)
At pressure 8-15psi(19/20G needle + 20ml syringe)
Wound Lavage:
High Volume (100mls/cm minimum)
Chlorhexidine Gluconate:Scrub - use from dispenser at 4% for hands0.5% - for skin prep with water or alcohol0.05% - for wound lavage
Lavage helps to remove debris,
reduces contamination
and significantly reduces
infection risk
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
THE EARLIER YOU LAVAGE THE BETTER!
Early Wound Irrigation Improves the Ability to Remove Bacteria
Brett D. Owens, MD; Joseph C. Wenke, PhD 2007.The Journal of Bone & Joint Surgery. 2007;
89:1723-1726
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Surgical
Mechanical
Chemical / Enzymatic
Autolytic
Removal of Bioburden
Charity clinic likely to favour surgical options
Fast
Slow
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Wet to dry dressings and the tie over technique
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
TIE OVER DRESSINGSIdeal for open wound management in hard to bandage areas
VERY cost effective
• Suture loops 2 cm from wound margins (in healthy tissue)
• Full thickness ‘bite’ of tissue • Tie sutures over a 2ml syringe to create loop • A minimum of 6 loops to hold dressings in place
• Apply primary dressing to suit wound • Cover with pads of gauze to ‘bulk’ up and hold dressing
in place
• Tie over the top using a coloured suture material. • Change primary dressing as necessary by removing
coloured sutures and replace.
• Suture loops can be used over a period of 14 days
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Case ExampleHeat pad injury
Maltese X female
How old is this wound? What would you do?
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Infection or Necrosis?
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Open Wound Management and Decision Making
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Don’t be afraid to ask for help
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Veterinary wound
care
Advanced
Wound Management
Advanced ‘PLUS’
Wound Management
Technical Progress
Human Wound
care
‘Clean and Cover’
Dry dressings
£
‘Moist Wound Healing’ Autolytic debridement Topical (non-antibiotic)
Antimicrobials £££
Growth factors, ECM substitutes Cytokines, MMP modulation
‘Intelligent’ dressings ££££££
Basic
Wound Management
Open Wound Management Dressing Selection
?
Surgical Wounds Open Wounds Chronic Wounds
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Dressing intervals
Inflammation
1 to 2 days ‘Debridement’
Proliferative phase
3 to 4 days ‘Promote healing’
maintain a moist environment preserve cells
optimise cell migration minimal interference
stabilise patient reduce ‘bioburden’ salvage viable tissue pain management
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Open wound management may not be the fastest route to closure?
12 weeks
£££££?????
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Movement Necrotic Tissue/Foreign Body
Tissue Deficit - Tension Toxicity - Antimicrobials!!
Repeated Trauma - interference Iatrogenic Issues…. technique
Maturation
Hours0 1 2 3 4 5 6 789
101112131415161718192021222324
Days 1 2 3 4 5 6 7 8 9 10 11 // 4-6 wks // 1 yr
contraction
Chronic Inflammation Proliferation
Dressings don’t overcome inhibitors of healing
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
PREPARE Clip and cleanse Remove bioburden
PROMOTE Optimise healing and early decision making • Moist wound management • Surgical Closure Options
PROTECT Manage the factors that cause healing delay - Pre-empt inhibitors of healing
A logical Approach
www.vetwoundlibrary.comIndependent Wound Management Support & Product Expertise
Debride devitalized tissue Maintain a moist environment
Necrotic /
Contaminated Sloughy Granulating Epithelialising
Wet
Dry
ideal moisture level
Wound enters proliferative phase as inflammation subsides and bioburden reduced.
Bioburden prolongs inflammation, risks infection &
prevents proliferation
Inflammatory exudate increases as proteases dissolve bioburden to create slough
Wound contraction and epithelialisation reduce wound size and achieve closurePREPARE PROMOTE PROTECT
®