Polyurethane Film Dressing Research Articles

Central venous catheter dressings: a systematic review.

Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters (CVCs). Currently, there are no clear guidelines as to which type of dressing is the most appropriate. To identify whether there are any differences between gauze and tape and/or transparent polyurethane film dressings in the incidence of CVC-related infection, catheter-related sepsis, catheter security, tolerance to dressing material, dressing condition and ease of application in hospitalized patients. The Cochrane Controlled Trials Register and Medline, Embase and CancerLit databases were searched to identify any controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings on CVCs. Additional references were sought from published and non-published literature. Twenty-three studies were reviewed. Data were extracted independently from each paper by two members of the review team and results compared. Differences were resolved either by consensus or referral to a third person. Authors were contacted for missing information. Of the 23 studies reviewed, 15 were excluded. Of the remaining eight, data were available for meta-analysis from six studies. Of the six included studies, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared Tegaderm with Opsite IV3000, and one compared Tegaderm with Opsite. There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is unlikely that any of these comparisons would have had sufficient power to detect any differences between groups.

Gauze and tape and transparent polyurethane dressings for central venous catheters.

Central venous catheters facilitate venous access, allowing the intravenous administration of complex drug treatments, blood products and nutritional support, without the trauma associated with repeated venepuncture. However, central venous catheters are associated with a risk of infection. Some studies have indicated that the type of dressing used for central venous catheters may affect the risk of infection. Gauze and tape or transparent polyurethane film dressings such as Tegaderm, Opsite or Opsite IV3000 are the most common types of dressing used to secure central venous catheters. Currently, it is not clear which type of dressing is the most appropriate. To compare gauze and tape and transparent polyurethane central venous catheter dressings in terms of catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised adults and children. The Cochrane Wounds Group Specialised Trials Register (October 2002), the Cochrane Controlled Trials Register (4th Quarter 2002) and the databases; MEDLINE (1966-December 2002, CINAHL (1982-October 2002) and EMBASE (1980-December 2002) were searched to identify any randomised controlled trials comparing the effects of gauze and tape and/or transparent polyurethane dressings for central venous catheter sites. Additional references were identified from bibliographies of published literature and were also sought from other sources. All randomised controlled trials evaluating the effects of dressing type (i.e. gauze and tape and/or transparent polyurethane dressings) on central venous catheter related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised patients. Twenty-three studies were reviewed. Data was extracted from each paper by two members of the review team independently and results then compared. Differences were resolved either by consensus or by referral to a third member of the review team. Authors were contacted for missing information. Of the 23 studies reviewed, 14 were excluded. Nine studies were included. Data was only available for meta-analysis from six of the nine included studies. Of the six included studies with available data, two compared gauze and tape with Opsite IV3000, two compared Opsite with Opsite IV3000, one compared gauze and tape with Tegaderm, and one compared Tegaderm with Opsite. There was no evidence of any difference in the incidence of infectious complications between any of the dressing types compared in this review. Each of these comparisons was based on no more than two studies and all of these studies reported data from a small patient sample. Therefore it is probable that the finding of no difference between dressing types is due to the lack of adequate data. There is a high level of uncertainty regarding the risk of infection with the central venous catheter dressings identified in this review. Therefore, at this stage it appears that the choice of dressing for central venous catheters can be based on patient preference. To identify the most appropriate central venous catheter dressings, further research is necessary. It is paramount that any future studies investigating this issue must be rigorously performed randomised controlled trials.

Pressure ulcers in extended care facilities: report of a survey.

A survey including 15 extended care facilities with access to ET nurse consulting services was conducted to assess current wound care protocols, practices, and educational backgrounds as well as requirements. Sixty-seven percent of facilities surveyed used a system to describe pressure ulcers. Wound care was provided by licensed practical nurses in 90% of the institutions and product decisions were made by the physician in 65% of facilities surveyed. Gauze-type dressings were used most frequently on all stages and types of pressure ulcers. A significant correlation between ulcer type and dressings used was found for stage II pressure ulcers only. Hydrocolloid and polyurethane film dressings were more likely to be used on stage II ulcers without exudate than on any other type of ulcer (p < 0.001). The ET nurse and a variety of other professionals, including product manufacturer representatives, were consulted to assess complicated wounds. In 9 of 15 instances, the ET nurse was rated as the best source of practical wound care information. Respondents preferred wound care meetings that were practical, included all levels of health care providers, focused equally on treatment and prevention, and were not expensive to attend.

Transparent polyurethane film dressings: A possible risk-factor for an increase in group 1 sternal wound infections

Transparent polyurethane film dressings: A possible risk-factor for an increase in group 1 sternal wound infections

Wound Management Products

Background: Little objective information is available on the influence of occlusive dressings on the healing of cutaneous full-thickness wounds. Objective: Our purpose was to examine the effects of three occlusive dressings—two hydrocolloid dressings (Comfeel Ulcer Dressing, Coloplast A/S, Espergærder, Denmark [hydrocolloid dressing A] and DuoDERM; ConvaTec, Princeton, N.J. [hydrocolloid dressing B]) and one polyurethane film dressing (OpSite, Smith & Nephew, Hull, U.K. [film dressing])—on tissue reactions, degree of inflammation, wound contraction, and epithelialization in full-thickness wounds in domestic pigs. Methods: Standardized 20 mm full-thickness punch biopsy wounds were treated for 10 days. Healing was assessed by light microscopy and by planimetry. Results: Material from both hydrocolloid dressings was phagocytosed as indicated by the presence of foam cells in the granulation tissue. Granulomatous tissue reactions around extracellular vacuoles were found in 10 of 12 hydrocolloid dressing B–treated wounds compared with one in hydrocolloid dressing A–treated wounds and in none of the 10 film dressing–treated wounds ( p < 0.0001). Inflammation was significantly ( p < 0.002) more pronounced in hydrocolloid dressing B–treated wounds. The extracellular vacuoles in the hydrocolloid dressing B group contained dressing material as demonstrated by Fourier transform infrared microscopy. There was a tendency ( p < 0.07) towards a delayed entry into the contraction phase with hydrocolloid dressing B, but there was no significant difference in epithelialization between the three dressings. Conclusion: Wound tissue reactions to different hydrocolloid dressings vary depending on composition. The tissue reactions had no significant effect on wound contraction or epithelialization. (J Am Acad Dermatol 1997;36:53-8.)

Profile - Wound Healing Research Institute

Background: Little objective information is available on the influence of occlusive dressings on the healing of cutaneous full-thickness wounds. Objective: Our purpose was to examine the effects of three occlusive dressings—two hydrocolloid dressings (Comfeel Ulcer Dressing, Coloplast A/S, Espergærder, Denmark [hydrocolloid dressing A] and DuoDERM; ConvaTec, Princeton, N.J. [hydrocolloid dressing B]) and one polyurethane film dressing (OpSite, Smith & Nephew, Hull, U.K. [film dressing])—on tissue reactions, degree of inflammation, wound contraction, and epithelialization in full-thickness wounds in domestic pigs. Methods: Standardized 20 mm full-thickness punch biopsy wounds were treated for 10 days. Healing was assessed by light microscopy and by planimetry. Results: Material from both hydrocolloid dressings was phagocytosed as indicated by the presence of foam cells in the granulation tissue. Granulomatous tissue reactions around extracellular vacuoles were found in 10 of 12 hydrocolloid dressing B–treated wounds compared with one in hydrocolloid dressing A–treated wounds and in none of the 10 film dressing–treated wounds ( p < 0.0001). Inflammation was significantly ( p < 0.002) more pronounced in hydrocolloid dressing B–treated wounds. The extracellular vacuoles in the hydrocolloid dressing B group contained dressing material as demonstrated by Fourier transform infrared microscopy. There was a tendency ( p < 0.07) towards a delayed entry into the contraction phase with hydrocolloid dressing B, but there was no significant difference in epithelialization between the three dressings. Conclusion: Wound tissue reactions to different hydrocolloid dressings vary depending on composition. The tissue reactions had no significant effect on wound contraction or epithelialization. (J Am Acad Dermatol 1997;36:53-8.)

Pressure sores. Epidemiology and current management concepts.

Pressure sores remain common, with a prevalence of 5 to 9% and more than 70% occurring in patients over 70 years of age. They are often falsely ascribed to poor nursing care, but can more usefully be regarded as a potentially preventable complication of an acute immobility illness. Prevention involves identification of patients at risk, appropriate nursing care measures and the use of special equipment. Much of the special equipment is excessively complex and not validated by clinical trial work. The airwave system, polystyrene bead bed system and Vaperm mattress have been best studied and are effective. Management of the established sore involves treatment of the underlying medical condition(s), attention to hydration and nutrition, prevention of further tissue trauma and the use of special dressings and procedures which facilitate the inflammatory repair response. There is considerable doubt about the use of 'traditional' wound applications such as gauze or chlorinated lime and boric acid solution ('Eusol'). An extensive range of newer products is now available but these have not yet been subjected to controlled clinical trials. A useful starting point is to classify pressure sores into 4 clinical types depending on amount of tissue damage and depth of ulcer. The least severe sore (type 1) can be protected using polyurethane film dressings. Deeper ulcers (types 2 and 3) can be easily and quickly treated by hydrocolloid or alginate dressings which optimise the local wound environment, thus facilitating tissue repair. However, there may be no satisfactory dressing for sacral (near-anal) sores which are more difficult to treat than those at other body sites because of dressing detachment. Cavity ulcers (type 4) can be managed with silastic foam or hydrocolloid or alginate dressings. Debridement of necrotic material is best done manually by scalpel/scissors, although streptokinase/streptodornase (Varidase Topical) may also help if used correctly. Antiseptics have little part to play and ulcers are best cleaned with warm normal saline. Systemic antibiotics are indicated only when surrounding cellulitis is present, although metronidazole is useful for malodorous sores.

Pain associated with an adherent polyurethane wound dressing

Patient ratings of pain associated with autograft skin donor sites covered by an adherent polyurethane film dressing (Op-Site, Smith & Nephew) were collected using a modified Visual Analogue Scale. Analyses were undertaken to examine differences between pain levels under conditions of rest and activity, and with variations in application technique. It was found that with proper application and with at-rest patients, Op-Sitecovered donor sites could be maintained relatively pain free. However, both specific conditions of application and increases in patient ambulation could result in the patient experiencing donor-site pain of an intensity comparable to concurrent burn-wound pain. To utilize fully their potential for pain control, the polyurethane film dressings must be appropriately applied and maintained, and their use coupled with an adequate analgesic regimen.

The effect of a semiocclusive dressing on the microbial population in superficial wounds.

Superficial wounds in a Yorkshire pig were treated with a semiocclusive polyurethane film dressing (PUD) or left open. The number and types of microflora present in the wounds each day was determined by a scrub technique, selective media, and the spiral plating system. In wounds covered with the PUD, the number of organisms increased, and there were more gram-negative pathogens. We concluded that microorganisms in wound beds multiply and survive better beneath a semiocclusive dressing than with air exposure.

Laboratory investigation of the composition and properties of pig skin wound exudate under Op-site

Abstract We have studied the cell population, neutrophil bactericidal activity, protein type and content of the exudate which accumulates on partial thickness wounds, on pigs, covered by an adhesive polyurethane film dressing (Op-Site∗) (Seymour et al., 1972), and compared the results obtained with those from a similar study in humans. Whilst there are some differences between the results from the two experiments, the pig wound exudate shows an antibacterial activity similar to that of human exudate, and we therefore conclude that the animal model described here is suitable for further studies on the bactericidal activity of wound exudate.

Clinical and laboratory investigation of the composition and properties of human skin wound exudate under semi-permeable dressings

We have studied the cell population, neutrophil bactericidal activity, protein type and the content of human wound exudate which accumulates under an adhesive polyurethane film dressing (Op-Site ∗ ∗ Op-site (Registered Trade Mark): supplied by T. J. Smith & Nephew Ltd, Welwyn Garden City, Hertfordshire, England. ). The cell type and numbers of cells in the exudate are typical of an inflammatory response, and the protein content of the exudate is virtually indistinguishable from that of plasma. Also, the neutrophils present in the exudate killed Staphylococcus aureus at a rate similar to normal whole blood, indicating that there would be a minimal risk of clinical infection under Op-Site.