Tips and Tricks :Part 2

Join us twice a month for our insightful podcasts with leading expert guests, who will look at the latest 'hot topics' in wound care to update and inspire you.

Join us for this informative podcast which discusses  some helpful Tips and Tricks with S+N expert and Trainer Darlene Middlecoat.

Part 2 focuses on dressings such as ALLEVYN , OPSITE POST OP and PICO sNPWT.

www.smith-nephew.com/education The website may contain information and discussion (including the promotion of) methods, procedures or products that may not be available in certain countries or regions, or may be available under various other trade or service marks, names or brands.

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SPEAKER:
Welcome to Smith and Nephew's Closer to Zero podcast. Bi-monthly podcast with leading experts and wound care hosted by Smith and Nephew, helping health care professionals in reducing the human and economic costs of wounds.

00:00:01

RUTH TIMMINS:
Hello, I'm Ruth Timmins. Today we will be hearing about some really useful tips and tricks using Smith and Nephew products in practice. I'd like to welcome our special guest today, Darlene Middlecoat, who is the senior training manager for the wound care division. She has extensive knowledge and experience of Smith and Nephew products. Darlene has a registered nursing background and has been with Smith and Nephew for over 12 years. Welcome Darlene and thanks for joining us today to share your knowledge.

00:00:16

DARLENE MIDDLECOAT:
Hi, Ruth. Thanks for having me.

00:00:44

RUTH TIMMINS:
Moving on to some familiar dressings - ALLEVYN, what would be some of the helpful hints or tips that you've got there for application of ALLEVYN ?

00:00:47

DARLENE MIDDLECOAT:
So Ruth, like a lot of our products ALLEVYN comes in a variety of different types as well. So it will depend on which one you have on stock. People might be most familiar or the one that has been around for the longest time, I should say, is the ALLEVYN non-adhesive. All of the ALLEVYN  range is either a three or a five layer foam dressing, it's designed to absorb exudate, hold that exudate within the product and not release it onto this, onto the surrounding skin area. 

And the top layer of all of our ALLEVYN dressings is designed to breathe and transpire. And the reason for that is it acts like your skin does. So when you get hot, your skin sweats, that moisture comes out through pores in the top of your skin and goes out to the atmosphere. When you get cold, those pores in your skin close over and keep that warmth inside. And the top film of ALLEVYN works in a very similar way, so that if your wound has a lot of exudate the pores in that film dressing at the top will open, transpire most of that moisture out to the atmosphere. 

If you have a low exuding wound, they will close down and keep the right level of moisture in the wound. Because of the way that top film works, it's really important that you don't put an additional film product all the way over the top. So if you were using ALLEVYN non-adhesive and you wanted to hold it on, you could either use a film dressing or a medical tape.

00:00:59


But if you were going to use those, you would just window frame the dressing. So if you've got the square of the dressing, it's like looking through the glass of your window and you would just put your tape or film around the edges to hold that on. That way, you're not impacting that breathability of the top layer.

RUTH TIMMINS:
What about other methods for securing just in case someone's not able to use tapes? Is there anything else you'd recommend?

00:03:11

DARLENE MIDDLECOAT:
Yeah, of course. If you were really concerned about your patient and didn't even want to use a silicone tape on them, for example, then of course you could use something like CoolFAST, which is our tubular bandage that will hold the non-adhesive on as well. Or any other sort of bandage that you may have. Any of our crepe bandage range or whatever is most appropriate for that patient. But the tubular bandage, the CoolFAST is a really good way of doing that, quick and easy.

00:03:19

RUTH TIMMINS:
What about rolling?

00:03:50

DARLENE MIDDLECOAT:
So rolling can happen when you have a foam dressing with an adhesive and you know, often, particularly if the dressing is on an area where it's going to come in contact with sheets or bed linen or clothing or that sort of thing. There's always that potential to have rolling at the edges. One good trick around that is to actually use your barrier film or your skin prep sachet in two different ways. 

So best practice for wound care is always going to be to protect that peri-wound area. And that can do a whole lot of things. Obviously, it's going to leave a barrier on that peri-wound and reduce the risk of breakdown or maceration. It's also going to leave a barrier there to reduce the risk of medical adhesive related skin injury or MARSI when you're removing that adhesive dressing. So that's two really good reasons to use your barrier film as a preparation around that peri-wound area right there.

But the additional thing you can do with it is once you have prepped the area, waited for it to dry, put your adhesive dressing over the top, you can then use the little swab, just the leftover moisture in the swab to put a barrier on that edge directly between, on the top of the dressing and the skin, just where that meets the edge. And that will just help seal that edge of the dressing and reduce the risk of any rolling. So that's another good tip there. You know, skin integrity is integral to all that we do in wound care. 

Also a good best practice is to make sure you're using REMOVE wipes or something like that if you're using a standard adhesive dressing when you're removing that off the patient's skin.

00:03:53

RUTH TIMMINS:
We often get asked about cutting the dressings, Darlene. Can you give us any advice about that?

00:05:57

DARLENE MIDDLECOAT:
Yeah. So all of our three layer versions of ALLEVYN, so that would be ALLEVYN Non-Adhesive, standard ALLEVYN Adhesive and ALLEVYN Gentle Border or ALLEVYN Gentle, can all be cut. So you can cut and shape those to your heart's content. The only thing is that leaves an open edge. So if you want to then ensure that that dressing will remain waterproof so the patient can shower with it, you need to cover that cut edge with a waterproof film or a waterproof tape. 

Like we said with the non-adhesive, you don't want to put that film all the way over that top layer. You just want to cover the cut edge. All of our three layer dressings can be cut. We don't recommend that you cut the standard ALLEVYN Life, that's our five layer dressing though . And the reason for that is that has a couple of extra layers in it which contain different things to ensure that the exudate is locked away and you don't want to cut into that layer.

00:06:05

RUTH TIMMINS:
OK, well thanks for clarifying that. OPSITE Post-Op is very common, commonly used in clinical settings for lots of types of wounds. Do you have any particular tips or tricks in regards to using OPSITE?

00:07:15

DARLENE MIDDLECOAT:
Yeah, sure. So OPSITE Post-Op is a great post-op dressing that you can use for a whole range of different things, whether it just be post-surgical wounds, small minor wounds, cuts and grazes, that sort of thing, where you want a waterproof, bacteria-proof product that will maintain moist wound healing for you for the wear time of the product. The way, some of the things about OPSITE Post-Op, is when you first look at the film, you'll notice that there's what we call a grid pattern adhesive. It looks like little squares and that's the way the adhesive is deposited onto the film. 

That does a few different things. The first thing is it makes 75% less adhesive be in contact with your skin than if you had an adhesive that covered the entire film. This is really good if you've got a patient who's sensitive or prone to allergies or things like that. It's a very low allergy adhesive and because it only has so much less in contact with your skin, it's going to reduce the potential risk of patients being sensitive to it. So that's a really good starting point.

00:07:33


Because of that grid pattern adhesive, though, what you'll notice is that when you get in the shower and come out, that actually makes it look like the product has kind of shrivelled up a bit. So if you've had OPSITE Post-Op in the shower and you come out, you'll notice that it kind of looks a bit scrunched up. This does not mean that it's leaked or that you need to change the dressing. 

OK, if you wait and give the film time to readjust to the different level of moisture in the air to the shower, you'll notice that it goes flat again within half an hour or an hour or so. OK, so don't think that you need to change it if you get that shrivelled up look. The other really good thing about that grid pattern adhesive is it means that when you use what we call the stretch and release technique to remove the product, it has a lot of extensibility or it stretches really easily.


We always recommend that when you remove your OPSITE Post-Op, you lift a little corner and then you pull laterally and keep pulling around the edge of the dressing until you can remove it easily. The other thing that's really good about this adhesive and also the acrylic adhesive on things like the ALLEVYN adhesive, is it's deactivated by water. If you don't have any REMOVE wipes or ZOFF or anything like that available, you can lift a corner, saturate a swab with water and just use that between the skin and the adhesive and it will easily help you remove that dressing. 

So that's another good tip to remember. The last tip about your post-ops, I guess, is that if you're having difficulty lifting that initial corner, rather than trying to dig into the patient's skin with your nails or anything, you can just get a piece of your medical tape, put that on the edge and use that to help lift up the edge and then use your swab of water or your REMOVE wipe to take the rest of it off if you're concerned.

RUTH TIMMINS:
Well, those are some great tips there, Darlene and I guess just moving finally to PICO Single-Use negative pressure wound therapy. Do you have anything we should keep in mind when using these dressings? So they're obviously a little bit more advanced, perhaps to some of the others that we've discussed as far as the technology, but any simple tips there?

00:11:14

DARLENE MIDDLECOAT:
Yeah, of course. PICO's another one of my favourite products, Ruth. And the nice thing about PICO is that it gives you all of the benefits of negative pressure wound therapy, but in a really easy to use product. So even if you've never use negative pressure wound therapy before or any of the traditional systems, you would easily be able to use PICO because the dressing goes on just like a foam dressing does, for example. So there are some key things to remember when you're using PICO. The first thing is make sure you have the correct size dressing for the wound. 

So PICO dressings, come in a range of different sizes and it's always better to have one that's slightly larger rather than slightly smaller. The reason for that is even if your dressing is sitting a good way out over that peri-wound area, that just means that you're getting the benefits of negative pressure to the surrounding skin and superficial underneath the skin layers and not just on the wound. So there's a lot of newer studies that have come out in the last year or so that show that that really gives you additional benefit from the PICO. So that's the first thing. 1,2

Bigger is better, so long as you can get a seal. It's really important that the port or the connection between the dressing and the pump is superior to the wound, not directly over the wound. If you've used traditional negative pressure in the past, you would be used to putting the trackpad or the port directly over the wound, whereas with PICO you don't want that. And the reason for that is because with PICO, you don't have a canister. So you're not trying to suck the fluid out of the wound into a canister. The dressing is handling the fluid. OK. 

The other tip would be, your dressing kits come with adhesive strips. The way to put your PICO dressing on in three short steps is place your dressing, connect pump and  the batteries, press the button to make sure you've got a seal, wait for it to suck down and have a seal. And then you put the adhesive strips just over the edges of the dressing, window framing it like we were talking about before with the ALLEVYN non-adhesive. If you have a patient or a customer or client that has really fragile skin, those adhesive strips that come in the kit have a standard acrylic adhesive. 

You could use something like your Flexifix  Gentle, OPSITE Flexifix Gentle tape, which has a silicone adhesive in place of those adhesive strips, if you want to, and that way you would make sure that when you're removing that PICO dressing, there's a silicone adhesive over the dressing and then you've got a silicone adhesive on those extra bits of tape if you use the OPSITE Flexifix Gentle. So that's just going to again, really make sure that we're maintaining the integrity of the skin for the customer as much as we possibly can. So those would be the key things with PICO.

00:11:38

RUTH TIMMINS:
Would you recommend using a barrier film again, with the PICO dressing?

00:15:00

DARLENE MIDDLECOAT:
Yeah absolutely, barrier film is going to be your best practice, regardless of what sort of adhesive dressing that you're using.

00:15:05

RUTH TIMMINS:
And with perhaps deeper wounds, Darlene, are you able to use fillers with PICO?

00:15:16

DARLENE MIDDLECOAT:
Yeah, absolutely you can. So you could use the black foam that you might be familiar with from your traditional systems, or you could use the gauze that we sell with our RENASYS system as a filler as well. So with the PICO dressings, if you've got no filler underneath and your wound is not deeper than two centimetres, so if the dressing can suck down to the base of the wound and have good intimate contact, because that's the key with your negative pressure, you need to make sure that the negative pressure is dispersed evenly over the wound bed. 

So if you're confident that the dressing of the PICO can suck right down to the base of the wound and you don't have a filler in between, then you can leave that dressing of the PICO on for up to seven days. OK. If you have a filler, so if you're using the foam or gauze, best practice would suggest that you change it at least twice a week for the gauze and every third or every two to three days for the foam. So generally, three times a week with foam, twice a week with gauze.

00:15:23

RUTH TIMMINS:
OK, and could you use ACTICOAT Flex with PICO?

00:16:39

DARLENE MIDDLECOAT:
Yeah, absolutely you can. That's a great option if you've got a wound that you know has a high bacterial load or if you know that patient has had a previous wound infection, say they've had a surgical wound dehiscence because of infection, ACTICOAT Flex is going to be a great adjunct therapy to your PICO negative pressure.

00:16:44

RUTH TIMMINS:
OK, great. Could you just clarify, 'cause recently the PICO14 has been launched. Can you just tell us what the difference between the 7 and the 14 is?

00:17:05

DARLENE MIDDLECOAT:
Yeah. Of course that's a great question. So the PICO 7 just means that the pump will last for seven days before it is pre-programmed to die. OK, so if you have a kit that says PICO 7 on it, at the end of day seven it will die. The pump will die regardless. There's nothing you can do to extend the wear time of the pump for any longer than that seven days. With PICO 14, everything about the product is essentially the same, but the pump will last for 14 days of therapy rather than just seven. 

So if you have a wound that you think is going to require a minimum of two weeks treatment, then you're going to get some cost savings by purchasing a PICO 14 kit. If you think it's only likely to have one week of treatment, then the PICO 7 kit is obviously going to be more economical for you.

00:17:18

RUTH TIMMINS:
OK, great. But the dressing's themselves aren't any different are they, so the way we change them and so on is the same. OK, that's wonderful.

00:18:25

DARLENE MIDDLECOAT:
Dressing application, everything else is exactly the same. Yeah.

00:18:36

RUTH TIMMINS:
OK, well, those are some really useful tips there. Just to finish off then Darlene, what would be your top three messages, I guess, to take home today?

00:18:40

DARLENE MIDDLECOAT:
So I guess the top number one thing is become familiar with your wound dressing products. OK. As a nurse or a clinician or anyone who's doing dressings, it's just as much our responsibility to understand how the dressing product works as it is to understand how a drug works. Just like you would know whether a dose of pethidine is too much, you should have that same level of understanding about the dressing products that you're using. So get to know the dressing products. 

If you have a product that has been used on a patient or a client that you are unfamiliar with, tip number two would be, read the instructions for use. Every box of product of wound care that is sold in Australia or New Zealand comes with an instructions for use brochure. There's a whole lot of interesting information on those things that will give you information about how to use that particular product. So that would be my second top tip. The third top tip would be think skin integrity first. 

So using things like your barrier film or your SKIN PREP wipes or your REMOVE wipes when you're going to remove an adhesive dressing ,or using a silicone adhesive in preference to an acrylic adhesive if that's appropriate for that patient. Remember, silicone adhesive works great for babies and young children just as well as it does for elderly fragile skin. So fragile from both ends of the spectrum, not just in aged care. So that would probably be my three top tips, and then of course if you have any other questions, by all means, call your local Smith and Nephew representative or our customer service line on 131360.

00:18:52

RUTH TIMMINS:
OK, well, thank you, Darlene, that's been really wonderful to hear those tips and tricks there, and I'm sure that's been really useful. Thank you for joining us today and thank you to our listeners.

00:20:46

DARLENE MIDDLECOAT:
Thanks so much for having me.

00:20:59

RUTH TIMMINS:
Thanks, Darlene. Be sure to tune in for our next podcast. And we hope to see you soon. Thank you.

00:21:01

SPEAKER:
At Smith and Nephew, we are proud to provide you with continued innovations in negative pressure wound therapy. Our latest technology, the PICO 14 single use negative pressure wound therapy system, with air lock technology has been designed with a pump duration of up to 14 days and is aimed for hard to heal and deep wounds. Early intervention with PICO has shown a 94% success rate in healing the standard dressings.3,4  For more information on how PICO can kick start the healing trajectory of your chronic wounds, contact your local Smith and Nephew representative, or email us at profed.anz@smith-nephew.com

The information presented in this podcast is for educational purposes only. It is not intended to serve as medical advice. Products listed, outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. Fo detailed product information including indications for use, contraindications, precautions and warnings, please consult the products applicable instructions for use prior to use. Helping you get closer to zero, human and economic consequence of wounds.

00:21:09


Refs

  1. Brownhill et al., 2020.  Pre-clinical Assessment of a No-canister, Ultra-portable, Single-use Negative Pressure Wound Therapy (sNPWT) System in a Porcine Model of Wound Healing: Unlocking the Mechanism of Action, Advances in Wound Care.  DOI: 10.1089/wound.2020.1218


  1. Watkins & Huddleston, 2019. Unlocking the Mode of Action: Why Might a No-canister, Ultra-portable, Single-Use Negative Pressure Wound Therapy (sNPWT) Device Be Clinically Superior to Traditional Negative Pressure Wound Therapy (tNPWT)? SAWC Spring Meeting Abstract

https://www.woundcarelearningnetwork.com/poster/unlocking-mode-action-why-might-no-canister-ultra-portable-single-use-negative-pressure


  1. Dowsett C, et al. Use of PICO◊ to improve clinical and economic outcomes in hard-to-heal wounds. Wounds International. 2017;8:53–58


  1. Kirsner R, Dove C, Reyzelman A, Vayser D, Jaimes H. A Prospective, Randomized, Controlled Clinical Trial on the Efficacy of a Single‐use Negative Pressure Wound Therapy System, Compared to Traditional Negative Pressure Wound Therapy in the Treatment of Chronic Ulcers of the Lower Extremities. Wound Repair Regen 2019; 27:519-29.

https://pubmed.ncbi.nlm.nih.gov/31087729/




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Speakers

Darlene Middlecoat

Senior Commercial Training Manager – Wound

Darlene first commenced nursing about 30 yrs ago. Since that time, she has worked in many roles in the healthcare industry and has been with Smith and Nephew for the last 12 years. She is  currently the Senior Training Manager for ANZ for the wound division. She is passionate that all clinicians understand how to get the best performance and value from the wound products they use for their patients and that they are also maximising the use of their healthcare budget.

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