Appropriate dressing selection

First Line

Second Line

Specialist

Hospital Only

Dressing products must be chosen to suit a particular wound and individual patient needs at a particular stage of healing. The ideal dressing should provide the optimum environment for wound healing and protection from further injury and/or infection.

Heel and sacral dressings have not been included as it is usually possible to get a better dressing fit for most patients by cutting and moulding flat dressings to the correct shape.

The ideal dressing needs to ensure that the wound remains:

Moist with exudate, but not macerated
Free of clinical infection and excessive slough
Free of toxic chemicals, particles or fibres
At the optimum temperature for healing
Undisturbed by the need for frequent changes
At the optimum pH value

Please ensure you order only what the patient requires and only change dressing regime as clinically indicated.

Symptoms or signs of infection see Infected wounds

Choices of primary dressing depending on the type of wound - see below

It is essential that you are familiar with the instructions for use and indications for a dressing before using or prescribing the product. Please refer to the products packaging and most recent BNF and Drug Tariff for further information.

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Remove the cause & reduce or minimise the causation

Rehydrate tissue
Facilitate autolysis
Maintain moist / not dry or wet environment (for pressure ulcer and patients with diabetes see separate internal policies)
Hydration may not be appropriate in patients with peripheral vascular disease as hydration may facilitate opportunistic colonisation with bacteria
Dry eschar on heels should be kept dry, left intact and referred to the tissue viability service

Dry / Low exudate

Moist / Moderate exudate

Address systemic influences

Look to enthuse fibroblast activity (remember that friable 'red' tissue can also indicate bacterial presence)

Rehydrate tissue & absorb excess exudates
Control odour through sequestration or quorum sensing
Consider short course of topical antimicrobial to reduce bacterial burden e.g. iodine or silver dressings

Dry / Low exudate

Moist / Moderate exudate

Wet / Heavy exudate

Symptoms or signs of infection see Infected wounds

Address systemic influences

Look to enthuse fibroblast activity (remember that friable 'red' tissue can also indicate bacterial presence)

Maintain moist environment, protect delicate tissues, aim to reduce dressing changes

Dry / Low exudate

Moist / Moderate exudate

Wet / Heavy exudate

Treat gently

Maintain moist environment, protect delicate tissues, encourage epithelialising tissue
Remember that the elderly have limited ability to achieve this stage of the healing process

Dry / Low exudate

Moist / Moderate exudate

Dry:

Wound bed is dry; there is no visible moisture and the primary dressing is unmarked; dressing may be adherent to the wound. This may be the environment of choice for ischemic wounds

Moist:

Small amounts of fluid are visible when the dressing is removed; the primary dressing may be lightly marked; dressing change frequency is appropriate for dressing type. In many cases, this is the aim of exudate management

Wet:

Small amounts of fluid are visible when the dressing is removed; the primary dressing is extensively marked, but strikethrough is not occurring; dressing change frequency is appropriate for dressing type

Saturated:

Primary dressing is wet, and strikethrough is occurring; dressing change is required more frequently than usual for the dressing type; peri-wound skin may be macerated

Leaking:

Dressings are saturated and exudate is escaping from primary and secondary dressings onto clothes or beyond; dressing change is required much more frequently than usual for dressing type

Formulary