Having worked in advanced wound care through various evolutions in treatments (e.g., V.A.C.® Therapy, the introduction of silicone dressings), I’ve seen their impacts on wound trauma and pain during wound dressing changes.
Changes in healthcare reform now dictate that wound care providers have to be even more creative with finding solutions to addressing these areas. For starters, looking at the wound care formulary is low-hanging fruit that addresses both clinical and financial challenges. Small tweaks in a formulary can make a significant difference in the lives of patients, as well as for your area of treatment.
Wound Dressing Pain in NWPT/V.A.C.® Therapy
As you likely know, “dressing change pain” was one of the top five complaints patients and caregivers had/have about V.A.C.® Therapy (which uses Negative Pressure Wound Therapy, or NWPT). There have been numerous solutions suggested, including:
Injecting lidocaine through the tubing to the dressing.
Injecting saline through the tubing to the dressing.
Placing a layer of hydrocolloid or transparent adhesive dressing on the surrounding skin to prevent skin stripping.
Leaving the V.A.C.® drape in place and cutting out the foam so the next drape was adhered to drape (rather than skin).
Using skin preps or sealants to protect the skin.
Wound Dressing Pain Effects on Patients
If you have been in wound care long enough, you have pre-medicated some patients to make wound dressing changes easier, re-wet gauze (and other dressings) to make it release when it has dried to the wound bed, and been traumatized when healthy granulation was stripped from the wound bed, causing bleeding and pain. In some cases, patients have refused certain treatments or dressing changes due to pain and have even been taken to the OR for dressing changes.
Wound dressing changes can have several effects on the wound and the patient:
Pain, in regards physical and psychological effects (read: quality of life).
Skin stripping changes the skin integrity and increases the risk of infection.
Regression of the wound (e.g., increased size, tissue loss).
Delayed healing due to the disruption of the granulation or re-epithelialization process.
Cost increases due to the prolonged healing process, treatment of infection or use of analgesics.
Wound Associated Pain vs. Procedurally Associated Pain
Although pain is often a forgotten vital sign, it is becoming more important as research is published that shows the effects of pain on wound healing and quality of life.
There are different types of pain—for example, wound dressing change pain falls under “Procedural Pain.” Determining if the pain is wound associated or procedurally associated is important and why a pain assessment should be part of the patient and wound assessment. If the pain is due to the dressing or dressing change, what are the options to mitigate or relieve it?
Let me hear your thoughts and interventions. Next month, I plan to discuss more specific interventions for dressing change (procedural) pain.
Tags: MediPlus™ Advanced Wound Care Products, Advanced Wound Care Dressings, Nursing