What Do The Studies Guidelines And Books Say About The Use Of Dressings With Calcium Alginate Fibres
Systematic reviews designed with the aim of comparing the benefit of different dressings in venous ulcers conclude that there is no evidence to suggest that any dressing is superior to the others in accelerating wound healing.3,4 However, the studies included in these reviews are few and of poor quality. Well-designed studies would therefore be needed to draw conclusions about the real impact of the use of the different wound dressings.
Given this lack of evidence, guidelines usually recommend thatthe dressing should be selected on the basis of exudate, perilesional skin, frequency of dressing changes, patient preferences and cost-effectiveness.5
And what do we find in the books? This is the most frequent list of indications for calcium alginate fibres:1
It is always highlighted that the frequency of dressing change will depend on the exudate. It is recommended that alginate fibres should not be used on wounds with little exudate and, if the sheet is dry and adhered to the wound bed, it should be moistened so that it gels and thus avoids a traumatic removal.
Essentials Of Decubitus Ulcer Care
1. Consider all bed- or chair-bound persons, or those whose ability to reposition is impaired, to be at risk for pressure ulcers.
2. Select and use a method of risk assessment, such as the Norton Scale or the Braden Scale, that ensures systematic evaluation of individual risk factors.
3. Assess all at-risk patients at the time of admission to health care facilities and at regular intervals thereafter.
4. Identify all individual risk factors to directspecific preventive treatments. Modify care according to the individual factors for proper Decubitus Ulcer Care.
Malnutrition is frequently cited as a risk factor for the presence, development and non-healing of Decubitus Ulcers. Nutritional status influences the integrity of the skin and support structures, and a lack of vitamins and trace elements may predispose the patient to increased risk of pressure damage. Emaciated and obese people have also been associated with being at a higher risk.
Best practice entails monitoring the nutritional status of individuals as part of a holistic assessment procedure and as an ongoing process throughout an individuals episode of care. Initially, this assessment should include documentation and monitoring of the following factors for proper Decubitus Ulcer Care:
- current weight and height
- recent changes in eating habits and intake.
Skin Care and Early Treatment
5. Avoid massage over bony prominences.
2. Include information on:
What Are Alginate Dressings
Highly absorbent, biodegradable alginate dressings are derived from seaweed. They have been successfully applied to cleanse a wide variety of secreting lesions. The high absorption is achieved via strong hydrophilic gel formation This limits wound secretions and minimizes bacterial contamination. Alginate fibres trapped in a wound are readily biodegraded .
Alginate dressings maintain a physiologically moist microenvironment that promotes healing and the formation of granulation tissue. Alginates can be rinsed away with saline irrigation, so removal of the dressing does not interfere with healing granulation tissue. This makes dressing changes virtually painless. Alginate dressings are very useful for moderate to heavily exudating wounds .
Reference 1:Gilchrist T, Martin AM., Wound treatment with Sorbsan–an alginate fibre dressing Biomaterials 1983 Oct 4:317-320
Reference 2:Motta GJ., Calcium alginate topical wound dressings: a new dimension in the cost-effective treatment for exudating dermal wounds and pressure sores Ostomy Wound Manage 1989 25:52-56
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Stage Iii And Iv Ulcers Full Thickness Skin Loss With Visible Underlying Tissues
Full thickness decubitus ulcers have underlying muscle, bone and/or adipose tissue visible and typically require highly absorbent dressings to manage exudate. Hydrofiber dressings are made from soft, absorbent material that transforms into a gel when it comes in contact with wound drainage. This gelling action traps bacteria and maintains optimal levels of moisture within the wound for healing. Calcium alginate dressings are made from seaweed fibers that have been formed into a loose fleece. The fibers are entangled so that the dressing becomes stronger when it becomes soaked with blood or drainage. Calcium alginate sheets can be placed on surface wounds while ribbons are used to pack deep tunneling ulcers. Both hydrofiber and calcium alginate dressings require a secondary dressing to hold them close to the wound bed .
How Do Alginate Dressings Work
There have been few studies of the effect of alginate dressings on the processes of wound healing.
The healing of cutaneous ulcers requires the development of a vascularized granular tissue bed, filling of large tissue defects by dermal regeneration, and the restoration of a continuous epidermal keratinocyte layer. These processes were modeled in vitro in one study, utilizing human dermal fibroblast, microvascular endothelial cell , and keratinocyte cultures to examine the effect of calcium alginate on the proliferation and motility of these cultures, and the formation of capillarylike structures by HMEC.
In the study, the calcium alginate increased the proliferation of fibroblasts but decreased the proliferation of HMEC and keratinocytes. In contrast, the calcium alginate decreased fibroblast motility but had no effect on keratinocyte motility. There was no significant effect of calcium alginate on the formation of capillarylike structures by HMEC. The effects of calcium alginate on cell proliferation and migration may have been mediated by released calcium ions.
These results suggest that the calcium alginate tested may improve some cellular aspects of normal wound healing, but not others.
Reference 1:Doyle JW, Roth TP, Smith RM., et al Effects of calcium alginate on cellular wound healing processesmodeled in vitro. J Biomed Mater Res 1996 Dec 32:561-568
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Calcium Alginate Dressings For Wound Care
Calcium Alginate Dressings are a strong, versatile, and natural wound care dressing typically applied to diabetic wounds, venous wounds, full-thickness burns, split-thickness graft donor sites, pressure ulcers, cavity wounds, and chronic ulcers. They can also be used on dry wounds when combined with a sterile saline solution. Made from natural alginate fibers derived from brown seaweed, Calcium Alginate Dressings release calcium salts of alginic, mannuronic, and gularonic acids that, when combined with the sodium-rich fluids found in wounds, creates a reaction resulting in the formation of a soluble sodium gel. This natural gel helps to speed up the healing of the wound in promoting the wound’s autolytic debridement, while also absorbing excess fluid. Vitality Medical carries a wide selection of Calcium Alginate Dressings at some of the best prices around. Choose from top brands like 3M, Bertek Pharmaceuticals, Coloplast, ConvaTec, Covidien, Derma Sciences, Dermarite Industries, DeRoyal, Hartmann USA, Hollister, Johnson & Johnson, McKesson, MedLine, Safe N Simple, Smith & Nephew, and more.
Common Causes For Decubitus Ulcer
Shearing and Friction: If a bedridden person is pulled or dragged from his or her bed it causes friction and stretches the skin muscles. Blood circulation of the skin gets marred which causes the damage.
Moisture: Skin is very sensitive at this stage. Perspiration, bed-wetting or feces leads to furthermore chances of bed sores.
Lack of Movement: People, who have been bedridden for a prolonged period of time due to severe medical conditions, bear the brunt. Being in a same position without any movement is one of the main reasons for bed sores.
Lack of Nutrition: A good diet can help you fight this condition easily. Due to lack of proteins, vitamins and other required substances in the body, the patient suffers moreover.
Age: An elderly person is mainly affected because youth is not on his side. The thin skin and failing bodily functions deteriorates the chances of revival.
Lack of Sensation: An injury which leaves you without sensation is another reason for bed sores. This lack of sensation does not allow you to determine the immensity of the pressure applied on the skin.
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Alginate Dressings For Treating Pressure Ulcers
What are pressure ulcers, and who is at risk?
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the tissue that lies underneath. Pressure ulcers can be painful, may become infected, and so affect people’s quality of life. People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility – such as elderly people and people who are ill as a result of short-term or long-term medical conditions.
In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. People with pressure ulcers have longer stays in hospital, and this increases hospital costs. Figures from the USA for 2006 suggest that half a million hospital stays had ‘pressure ulcer’ noted as a diagnosis the total hospital costs of these stays was USD 11 billion.
Why use alginate dressings to treat pressure ulcers?
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used these can vary considerably in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid that is produced by some ulcers.
What we found
This plain language summary is up-to-date as of June 2014.
S In Using Alginate Dressings
In general, using an alginate dressing is a straightforward process that follows the best practices of wound care:
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What Is A Calcium Alginate Dressing
Calcium alginate dressings are non-woven, absorbent dressings made from seaweed. These dressings can hold up to 20 times their weight and are ideal for wounds with moderate to large amounts of drainage.
When the calcium and sodium fibers come into contact with wound drainage, the dressing transforms into a gel consistency that conforms to the shape of the wound bed. This action promotes wound healing by filling dead space within the wound and maintaining a moist environment that is optimal for healing.
Alginate dressings are non-occlusive and non-adherent, allowing for gas and heat exchange at the wound surface while also minimizing trauma and discomfort with dressing changes
Why It Is Important To Do This Review
Pressure ulcer prevention and management is a significant burden to all healthcare systems. It is an internationally recognised patient safety problem and serves as a clinical indicator of the standard of care provided. Pressure ulcers are the second most reported incident that leads to patient harm in the health system, and are a significant source of suffering for patients and their care givers . Over recent decades significant investment has been placed in strategies aimed at pressure ulcer prevention. Treatment strategies for pressure ulcers can also be costly and complex, and there is a large range of wound care products available. Despite a growing amount of literature concerned with wound care interventions, relatively few research studies have used clinical trial methodology to evaluate clinical effectiveness. The complexity of suggested interventions, and range of options available suggests that the evidence requires evaluation and presentation to the clinician to assist with effective decision making. This review is part of a suite of reviews investigating the use of individual dressing types in the treatment of pressure ulcers. Each review will focus on a particular dressing type. These reviews will then be summarised in an overview of reviews which will draw together all existing Cochrane review evidence regarding the use of dressing treatments for pressure ulcers.
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How Useful Are Alginates For Packing Deep Wounds
A controlled trial set out to compare calcium alginate with the more traditional saline-soaked gauze for packing abscess cavities, following incision and drainage. Patients were randomized to receive either calcium alginate or gauze dressing . At the first dressing change the patient marked on a linear analogue scale the pain experienced the nurse noted similarly the ease of removal of the dressing.
Calcium alginate was significantly less painful to remove after operation , and also easier to remove than gauze dressings. If abscess cavities are packed after incision and drainage, calcium alginate appears to be an improvement on conventional dressings .
Reference 1:Dawson C, Armstrong MW, Fulford SC, et al., Use of calcium alginate to pack abscess cavities: a controlled clinicaltrial R Coll Surg Edinb 1992 Jun 37:177-179
Risk Of Bias In Included Studies
Risk of bias for all included studies is summarised in . In order to represent âvery highâ risk of bias, we have used two columns so very high risk of bias occurs when the cell is red in the final column .
Risk of bias summary: review authorsâ judgements about each risk of bias item for each included study
We judged only one of the 51 studies to be at low risk of bias and ten to have unclear risk of bias . We judged 14 studies to be at very high risk of bias, that is, to have high risk of bias for two or more domains . We assessed the rest of the studies at high risk of bias. We grouped the low and unclear categories together.
*Studies marked with an asterisk were not included in the individual network.
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What Does Clinical Experience Tell Us
Our experience with the use of calcium alginate fibres in our clinics suggests that their interest is not limited to the indications traditionally given in the literature.
We use this dressing in any situation where we want to simulate a physiological scab to promote healing. More than one will be surprised by this statement, because many of you will have in mind the axiom: scabs must always be removed. Undoubtedly, the scab must be removed if either there is underlying pus when pressing or attempting to move the scab, or the crust is too thick and makes pressure on the wound bed or is easily detached. But wouldn´t acute wounds close with the formation of a scab that ends up coming off on its own, and if we remove it early healing may be delayed? Dont forget that scabs are deposits of dry exudate and cellular debris that, in the absence of infection, behave like a protective layer that maintains optimal micro environmental conditions for healing.
Now we are going to talk about two applications in which daily clinical observation indicates that calcium alginate fibres are interesting:
If we use portable negative pressure therapy devices to promote graft attachment in complicated locations or situations , we also tend to cover the grafted lesion with alginate sheets before placing the device.
Medihoney Calcium Alginate Dressing
MEDIHONEY® Calcium Alginate Dressing contains 100% active Leptospermum honey impregnated onto a calcium alginate pad. Supports removal of necrotic tissue and aids in wound healing. For wounds with moderate to heavy amounts of exudate or when light packing is needed. Non-traumatic removal.
As wound fluid enters the dressing, the honey is released while the dressing forms a gel Maintains effectiveness even in the presence of wound fluid, blood and tissue Easy to use with potential for extended wear times depending on exudate Promotes a moisture-balanced environment conducive to wound healing Can be used before, during and after negative pressure applications Can be used as a cover dressing for skin grafts or substitutes Helps stalled wounds progress toward healing Osmotic potential draws fluid through the wound to the surface, helping to liquefy non-viable tissue Low pH of 3.5-4.5 – maintaining more acidic pH levels within the wound environment can help to keep a wound on track towards healing Non-toxic, natural and safe
MEDIHONEY® Calcium Alginate Dressing is indicated for moderately to heavily exuding wounds such as: diabetic foot ulcers, leg ulcers , pressure ulcers , first- and second-degree partial-thickness burns, donor sites and traumatic or surgical wounds.
Contraindicated for use on individuals with an allergy to honey, on third-degree burns or to control heavy bleeding.
Store at 50°F-77°F.
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