Made EasyHydrocolloids in practice

Hydrocolloids in practice

Pressure Ulcers, Skin integrity | Ousey K, Cook L, Young T, Fowler A



Hydrocolloids for minor traumatic injuries
Hydrocolloid dressings can be used in minor injuries to provide a protective barrier. The dressings are low profile and less bulky than traditional finger padding and bandaging regimens. They can be used on skin tears to keep the realigned lacerated skin edges in position, while thin versions are easily removed from fragile skin. Hydrocolloids are also very effective at drawing out foreign bodies such as splinters or gravel from the wound bed, preventing the need for surgical intervention.

Hydrocolloids can also promote self-management as dressing changes can be performed by patients/carers at home and may offer a flexible option for people who need to balance work with effective wound management (see Box 5). Patients can also shower with the dressings in place, allowing them to maintain normal daily activities. The types of minor injuries suitable for treatment with a hydrocolloid dressing, include lacerations, digit injuries, skin tears and scalds.

Hydrocolloid dressings are available in a variety of sizes, but the main advantage is the clinician's ability to cut the dressing into strips and shapes to fit individual wounds and/or areas that are difficult to dress, e.g. between fingers and toes, or to prevent damage from shearing forces, e.g. ears, heels, elbows. This technique works well with thin hydrocolloids (Fletcher, 2007), which can provide  better conformabilty, improved fit and allow greater mobility of the affected area.



Key principles for cutting and shaping hydrocolloid dressings, include:
n     Always use sharp, clean/sterile scissors to prevent shredding of the dressing edges and contamination
n     Always cut across the peelable adhesive back on dressings - otherwise this will be difficult to remove
n     Round off cut edges to reduce the chance of uneven edges catching on bedding and clothing (Fletcher, 2007).
Hydrocolloids for burns management
Hydrocolloids have been used for over the last 20 years in clinical practice in burns, but there remains little evidence to support any particular dressing, especially in relation to small partial thickness burns, skin grafts and donor site wounds.

Until the early 1980s, only a few wound care products were available in minor burns care - traditional dressings (e.g. petroleum-gauze based products such as Jelonet or Paranet™) and an antimicrobial agent (e.g. Flamazine™). Paraffin-based gauze dressings remain one of the most common burns dressing, despite the literature suggesting that it adheres to wounds, requires more frequent dressing changes and may traumatise newly epithelialised surfaces.

Hydrocolloid dressings provide an occlusive moist wound environment to optimise healing and are associated with less frequent dressing changes. Observational evidence suggests that hydrocolloids may lead to fewer operative interventions and should be used preferentially in paediatric burns (Martin et al, 2010)

Hydrocolloids are suitable in burns care for the following:

  • Superficial to partial thickness burns
  • Donor sites  - clean open shallow wounds
  • Burn wounds healing by conservative methods, e.g. not indicated for skin grafting, with a small to moderate amount of exudate
  • Healing skin grafts - low exudate, not infected or colonised and with a superficial granulating base
  • Any burn wound, graft or donor site that is close to healing and in need of a small amount of protection (the local condition of the wound bed determines the dressing choice)
  •  Any other burn wound that appears clean, superficial with minimal drainage or minor sloughing and/or scabbing.

Hydrocolloid dressings should not be used on full thickness burns and on clinically infected wounds (see Box 4).

Application of hydrocolloid dressings in minor burns and scalds
Hydrocolloids may be considered 3-5 days post burn injury, following initial assessment and treatment. Once the acute traumatic inflammatory phase subsides a thin hydrocolloid can prove useful, especially for children with small burns (Afilalo et el, 1992; Martin et al, 2010). Management of the superficial burn is aimed at providing dressings that deliver pain-free wound care, protect the wound and encourage re-epithelialisation. Hydrocolloid dressings meet these aims, although where there is a high risk of infection or suspicion of colonisation, an antimicrobial dressing should be selected instead.

Application of hydrocolloid dressings on split thickness skin graft donor site wounds
The management of a partial thickness burn injury and a split thickness skin graft donor site is similar. The donor site should have a low risk of infection and antimicrobial dressings are not normally required. Initially an alginate may be the primary dressing of choice, but once haemostasis is achieved, a hydrocolloid may prove to be more beneficial from a comfort and infection control perspective (Cadier and Clark, 1996). As with superficial burns, the presence or suspicion of infection will preclude the use of a hydrocolloid.

Tip: Hydrocolloid dressings have a distinctive odour on removal. This is normal for occlusive dressings and should not be mistaken for a problem with the wound

Benefits of using hydrocolloid dressings
Hydrocolloids can be used on a wide range of low to moderately exuding wounds and are available in a number of sizes, shapes and specifications. They are simple to apply, are conformable and pliable. This allows them to be used where greater flexibility is required. Thinner, more transparent versions may also allow visual checks of the wound without removal of the dressing. Hydrocolloid dressing may also result in less pain on application and on removal (Queen, 2009).

Hydrocolloid dressing are waterproof and can be used as secondary dressings to hold other products in place to reduce the risk of contamination.

In the current economic climate, cost savings are essential, without reducing the quality of care offered to each patient. Hydrocolloids may provide a cost-effective option in patients with pressure ulcers and venous leg ulcers when compared with gauze (Meaume et al, 2002, Harding et al, 2000). This may be due to a reduction in the number of clinic visits required during treatment and faster healing times (Queen, 2009).

Tip: Prior to the application of gelatin-based hydrocolloids derived from porcine, patients should be informed to avoid any cultural concerns




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