focus on a message - 3m · i firmly believe in the importance of skin care in wound management –...

ISSUE 3, December 2012

A Message

A big hello to you all! This is the last edition for 2012 and I am sure, like me you are wondering where the year has gone!

Firstly let me introduce Paula Massey, Paula is my colleague in New Zealand and will be joining me as co – editor. This is wonderful news and never has it been more important to share practice from both countries with the 2012 launch of the Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury and the Australian and New Zealand Clinical Practice Guideline for Prevention and Management of Venous Leg Ulcers.

The previous newsletter focused on adhesive trauma and this issue continues on by the discussing the challenges of periwound management, and in particular the consequences of maceration or as you will hear in one of the articles, “periwound moisture associated dermatitis.”

Viable or healthy wound edges are essential for the process of wound healing to proceed efficiently, however this can be delayed when the wound edge is compromised. We are sure you have all seen maceration in your practice, the classic example is when the skin around the wound appears white in colour and has that “pruned” or wrinkled wet look. Maceration is typically associated with wounds that produce larger levels of exudate such as the venous leg ulcer or the infected wound but it needs to be a consideration for all types of acute and chronic wounds.

Other causes of periwound breakdown need to be considered too, such as the use hydrating wound fillers, such as hydrogels which can cause maceration if not adequately contained within the wound margins. Adverse skin changes can also occur when the dressings are unable to manage the volumes of exudate.

Once established, maceration may be difficult to resolve and delay wound healing, especially if exposure has been prolonged and skin changes are severe. There are also implications for treatment costs including nursing time and consumable expenditure. For those reasons, we are sure you will agree that prevention is the key.

We would like to thank all our contributing authors to this issue – they often put together these articles in their own time which is a true reflection of their passion to improve practice and share and learn with their fellow clinicians.

We wish you all a happy and safe holiday season and look forward to bringing you the first newsletter for 2013!

Until next year, happy reading!

Victoria Moss & Paula Massey

RNs / Technical Specialists Skin & Wound Care3M Australia & 3M New [email protected] [email protected]

A Message from the Editors 1Case Study: Managing Skin Integrity in the treatment of chronic Venous Leg Ulcers

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Dates for the Diary 2Protection of Peri-wound Skin: What’s the Big Deal?

3The Challenges of Maintaining Skin Integrity - A Practical Example

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Maintaining Skin Health in the Presence of Lymphorrhea

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RISE Programme 7

Table of

Contents

1.

FOCUS ON PERI-

Woundfrom the Editors

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Patient Assessment and the Management of CareOn initial assessment both chronic wounds were highly exudating and painful. The size of each wound was measured as well as swabbed showing growth of Pseudomonas Aeruginosa and was treated with oral antibiotics and antimicrobial topical dressings. A doppler was performed to assess the vascular flow with an Ankle Brachial Pressure Index (ABPI), the assessment findings were 1.12mmHg and compression therapy was commenced and initially changed daily due to high exudate. The outer wound areas were macerated, painful and the periwound area was consistently breaking down resulting in the ulcers increasing in size. A key management strategy was to protect the periwound from any further breakdown with the use of a protective barrier film wipe. 3M™ Cavilon™ No Sting Barrier Film was introduced and applied to the surrounding skin. The barrier is completely alcohol free and can be applied without causing any pain to the patient. Due to the exudate levels the barrier film and compression were reapplied daily and as improvement in wound condition occurred reapplication could be done every three days.

ConclusionWithin days of using Cavilon™ the size of wound edges stopped breaking down and inflammation was reducing.

3M™ Cavilon™ No Sting Barrier Film has proved to be a vital product at our facility. The continued use of this product is very beneficial to the prevention of wound breakdown and excoriation.

Anna CrispWound Care and Hyperbaric Nurse, Hyperbaric Health, Auckland, New Zealand

Anna completed her Nursing Degree in New Zealand and then moved to Australia where she worked as a community nurse and found her interest and passion for wound care. When returned back to New Zealand she worked in Aged Care and has since taken on a position at Hyperbaric Health as the Primary Nurse with a focus on wound care and hyperbaric nursing.

Case Study: Managing Skin Integrity in the treatment of chronic Venous Leg ulcersPatient HistoryA 75 year old female was referred to our hyperbaric facility with two chronic ulcers to the right and left lower legs. The ulcers had been present for approximately 8 years. The referred client had a complex history of systemic Sclerosis with Scleroderma and Raynaud’s Disease. She also had a history of hypertension which was well controlled on medications and she had no known allergies. At the hyperbaric facility rigorous wound care is undertaken in conjunction with the hyperbaric treatment to maximise the effectiveness of wound care in the short period that the patient is undergoing hyperbaric treatment.

DIARY DATESIntravenous Specialist/Educator/

Team Leader Forum Date: 22 March 2013

Venue: Wild at Heart Conference Centre

Wellington Airport

2013 AWMA Victoria

State ConferenceWounds in our World

Date: 22 – 23 March 2013

Venue: Bendigo, Victoria, Australia

2013 AASTN National Conference

2013 and Beyond – Diversity in

stoma, wound and continence

Date: 20 – 22 March 2013

Venue: Hotel Grand Chancellor, Hobart,

Tasmania, Australia

Leg Ulcers are

a chronic reoccurring

did you know?

condition affecting

2%of thepopulation

during the course of their lives.

Kruger A.J. Raptis S. Filridge RA (2003) Management practices of Australian surgeons in the treatment of venous ulcers. A N Z J Surg. 73: 687-691

Note: Consent for the use of the photographs in this case study have been given with kind permission of the patient.

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Wendy White CnC/Educator Rn. Plastics/ Reconstructive Cert. BEd. MWoundCare (candidate) MRCnA

www.woundconsultant.com.au

Wendy is a Nurse Consultant & Educator in private practice, New South Wales. She has over 20 years of experience in wound management, and has a keen interest and passion to better understand the person’s experience and perspective, when living with a wound.

She is a past President of the Wound Management Association of Victoria (WMAV), the current Vice President of the Australian Wound Management Association NSW (AWMA NSW) and Chair of Scientific Program Committee for 9th National AWMA.

Wendy is an invited expert on both local and international committees and advisory


did you know?

Protection of Peri-wound Skin:

What’s the Big deal?When caring for those with acute or chronic wounds, one important consideration for Health Care Professionals is the maintenance and protection of the general health of periwound skin.

A recent series of consensus documents (Gray et al 2011; Black et al 2011; Colwell et al 2011) have proposed the term ‘Moisture Associated Skin Damage’ (MASD) which they defined as ‘Inflammation and erosion of skin caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucous, saliva & contents.’

Skin damage from moisture can present in a variety of forms and the group has proposed the following terms to describe this type of skin related injury:

• Incontinence-associated dermatitis (IAD) • Peristomal moisture-associated dermatitis • Intertriginous dermatitis (ITD)• Periwound moisture-associated dermatitis

The aetiology and pathophysiology of periwound moisture-associated dermatitis (tissue within 4 cm of the edge of the wound) are not well understood, (Colwell et al 2011). What we do know is that excess exudate (from a variety of causes), can overhydrate skin as the stratum corneum absorbs the fluid and swells. As the lower layers of the epidermis become saturated, the protective epidermal function (as a barrier to water, organisms and irritant) is compromised, which increases the likelihood of maceration, ‘weakness’ of skin to external forces, loss of skin integrity and potential inflammation / infection from pathogenic organisms / irritants.

Another specific contributing factor to the influence of wound exudate on periwound skin comes in the form of chronic wound exudate found to be high in inflammatory cytokines and MMPs, the latter having a corrosive influence on periwound tissue. Thus, moisture plus chemical / irritant, mechanical forces of friction or shear, and pH changes (encouraging micro-organism imbalance) can all contribute to periwound skin risk of injury (Colwell et all 2011; Lawton 2009)

Clinical decisions in practice will need to be guided by identification of the underlying cause and contributing factors leading to the moisture imbalance, and influence product or device selection (size and frequency of care),

• Take action to prevent wound expansion• Is the cause contact with exudate, dressing sensitivity / allergy or a

dermatological condition?• Treat any inflammation as appropriate• Minimise skin contact with exudate and protect periwound skin with a

suitable barrier• Increase fluid handling capacity of dressings• Consider autraumatic dressings and methods of fixation

See Your Name In Print!WantedCase studies, articles, journal or book reviews, conference and educational day reports.

This can include but is not limited to discussion on different risk factors, prevention and management of skin breakdown.

Please email the editors with your submission or any feedback or ideas. Vicky Moss [email protected] or Paula Massey [email protected]

The World Union of Wound Healing Societies (WUWHS) consensus document, Principles of best practice: Wound exudate and the role of dressings suggest the following principles of managementof exudate – related problems for the periwound:

World Union of Wound Healing Societies (WUWHS). Principles of best practice: Wound exudate and the role of dressings. A consensus document. London: MEP Ltd, 2007.

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aiming to prevent leakage, maceration, allergy or sensitivity and minimise trauma to skin and wound bed on any product / device removal.

In a recent review aimed to summarise the clinical and economic literature relating to the effect of 3M™ Cavilon™ No Sting Barrier Film on the incidence of exudate - related periwound skin damage, (Guest et al 2011) the authors concluded it was as effective in periwound skin protection as petroleum ointments and zinc oxide formulations, but more cost-effective. This is an important consideration when selecting a skin and wound formulary of products and devices in today’s health care environment.

I firmly believe in the importance of skin care in wound management – and to periwound skin assessment, protection and management being considered ‘routine’ and essential elements of care. It is our responsibility to see the risk, and/or the injury, act quickly with appropriate interventions, and ensure that in our endeavours to manage one’s wound, we actively contribute to harm minimisation, as we care for the skin surrounding that wound.

ReferencesBlack, J.M., Gray, M., Bliss, D.Z., Kennedy-Evans, K.L., Logan, S., Baharestani, M.M.& Ratliff, C.R. (2011). MASD part 2: Incontinence-associated dermatitis and intertriginous dermatitis: A consensus. Journal of Wound Ostomy & Continence Nursing, 38(4), 359-370

Colwell, J.C., Ratliff, C.R., Goldberg, M., Baharestani, M.M., Bliss, D.Z., Gray, M., et al. (2011). MASD part 3: Peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis: A consensus. Journal of Wound Ostomy & Continence Nursing, 38(5), 541-553

Gray, M., Black, J.M., Baharestani, M.M., Blis, D.Z., Colwell, J.C., Goldberg, M. & Ratliff, C.R. (2011). Moisture-associated skin damage: Overview and pathophysiology. Journal of Wound Ostomy & Continence Nursing, 38(3), 233-241

Guest J. Greener, M. Vowden, P. Vowden, K. (2011). Clinical and economic evidence supporting a transparent barrier film dressing in incontinence associated dermatitis and periwound skin protection Journal of Wound Care ;20 (2)

Lawton (2009). Assessing and managing vulnerable periwound skin. www.worldwidewounds.com

groups including the Johanna Briggs Institute Wound Healing and Management Node Expert Reference Group & Corresponding Reference Group and the Wound Management Innovation Collaborative Research Centre (CRC) Education subcommittee.

In 2012 she was awarded an AWMA Fellowship in recognition of her contribution to clinical practice, education, research and leadership in wound management throughout Australia, and the Asia pacific region.

She has presented at regional, state, national and international wound conferences and educational events, and is a respected invited speaker in the region.

Wendy is proud to be a nurse, while acknowledging and actively promoting the essential role of all members of the person centered interdisciplinary team, placed in the privileged position of caring for those with wounds.

did you know?

Practice points for skin and wound hygiene from the new Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury include:• Cleanse peri-wound skin with a pH neutral appropriate skin

cleanser. • To obtain optimal ulcer and wound pH avoid the use of

alkaline soaps and cleansers.• Applying a moisturiser contributes to the maintenance of

the healthy skin. • Consider applying a topical barrier preparation to the peri-

wound skin to protect it from exudate.1

In the recent Flow Chart for the Management of Venous Leg Ulcers, it identifies the need to: • Prepare the surrounding skin: • Cleanse the leg at dressing changes • Maintain Skin integrity of surrounding leg skin • Control venous Eczema 2

1. Australian Wound Management Association. Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury. Cambridge Media Osborne Park, WA: 2012. 2. Australian and New Zealand Clinical Practice Guideline for Prevention and Management of Venous Leg Ulcers. 2011

Note: Consent has been given for use of the photographs in this article

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Skin we are told is the largest organ in the body - mind you, some would argue that this is incorrect as the bowel is the largest organ in the body if you take into account all the villi and their surface area. What we would all agree on however is the importance of skin. Without it you will succumb to infection and if enough of it is destroyed and not replaced quickly death is usually inevitable.

Working with the aged or those with other conditions which render the skin at risk of maceration or infection, I am sure you will agree often provides us with challenges. We need to protect the skin from further damage and at the same time treat the wound and protect the periwound - this requires a strategic approach.

Health care professionals must be able to clearly articulate their objectives of care, have a good understanding of the products available to help meet these needs and also the environment in which the products may be ‘challenged’.

Let’s put it into practice! When looking at this image – it is possible to conclude the following:

1. A superficial wound with high volume of exudate2. Relatively healthy skin further away from the wound however the skin closely around the wound is

‘burnt’ and at extreme risk of further deterioration

Questions to ask when assessing the wound and surrounding skin

Answers following assessment

What is the origin of this wound? A small trauma wound caused by a scratch on a twig whilst working in the garden.

Has infection been considered and / or being treated?

A wound swab has been performed and she is on antibiotics but it does not seem to be responding.

What was the dressing that has just been removed?

The dressing was a mesh dressing with a absorbent pad known to manage small amounts of fluid and then covered with a polyurethane film dressing.

What are the properties of the dressing that was removed?

The mesh was vaseline on gauze, used for superficial - partial thickness wounds but has no antimicrobial ability. It was observed that exudate beneath the dressing was trapped as the small holes tend to occlude with the exudate. The pad has very minimal fluid handling capacity. The film dressing is useful to waterproof and hold dressings in place.

Have you considered the indications for use of the current dressings?

The Vaseline mesh offers no antimicrobial function and usually requires frequent changing. The pad is for minimal draining wounds and again usually requires changing frequently. Film dressings may not be the optimal dressing especially for infected wounds.

How long had that dressing been on the wound?

One week.

What activities does the patient put the limb with the wound through?

The patient is not walking very much due to pain in her leg and she cannot elevate her leg because of hip pain. She sits around most of the day with her leg down and sitting very near the heater to keep herself warm.

The Challenges ofMaintaining Skin Integrity- A Practical Example

Jan Rice Coordinator: Wound Education World of Wounds www.worldofwounds.comLaTrobe/Alfred Health Clinical School, Alfred Hospital. Victoria

Jan has been nursing since the early 70’s. Her passion has been surgical nursing, specialising in Plastic and Reconstructive Surgical Nursing. She worked with the Wound Foundation of Australia from 1994-2007 and in 2008 joined La Trobe University and World of Wounds. Her role there sees her teaching, mostly in Victoria but also other locations within Australia and overseas. She has her own Wound Consultancy Service in which she is mostly working in aged care and she also took the initiative to set up a wound clinic in a busy Metropolitan General Practice.

Jan is the Nursing Representative for AWMA, currently Chairs the Education & Professionals Development Committee with AWMA and is on the Venous Leg Ulcer and Pressure Injury Development Guidelines Committee.

Approach to rectify the problems/management plan:

1. Wash the limb well in the shower with a pH balanced skin cleanser known to have some antimicrobial effect.

2. Rinse all cleansing agent off and pat the skin dry.3. Remove any dead dry skin and other debris.4. Apply a protective barrier film to the periwound area.5. Apply an antimicrobial agent that will manage the exudate and

bacterial load, and if possible also protect the tissue. (There are a number of products on the market that can do all these functions or a number of products individually can meet each of these aims).

6. Preferably do not use any adhesive agent at this stage as the periwound skin is so fragile. Hold the dressing in place with tubular retention bandage or light bandage, however if needing use tape to secure the bandage, a silicone tape may be used (in small amounts only).

7. Provided there are no contraindications, application of a support sock or stocking and encouraging ankle exercises and walking every hour may help to improve her dependent oedema as well as boost her mentally as she becomes more active.

Note: Consent has been given for use of the photographs in this article

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Maintaining Skin Health in the Presence of Lymphorrhea

Gary Bain Rn CnC MClinEd Bn dipApSc

Wound Management Service, Sydney Adventist Hospital, NSW

Gary Bain (also known as “The Wound Guy”) is a Clinical Nurse Consultant in Wound Management at the Sydney Adventist Hospital, NSW and has over 20 years experience in this specialist field. He is a member of the Australian Wound Management Association, Advanced Wound Care Network (HEMI Australia) and International Wound Infection Institute

His qualifications include Diploma of Applied Science, Bachelor of Nursing and Masters Degree in Clinical Education. He is a senior lecturer at the SAN College of Education and a lecturer at Sydney University Clinical School (SAH Campus). Gary has conducted a nurse-led wound clinic and inpatient wound management service for 23 years and is passionate about promoting principles of patient empowerment, clinical mentorship and professional development

To learn more about “The Wound Guy” visit: www.garybain-woundguy.yolasite.com

Copious leakage of fluid from the skin is greatly distressing for patients. Added to any associated pain, limb swelling, odour and embarrassment are the co-existent realities of additional laundering, increased use of dressing products and greater expense. Put a wound into the mix and the anxiety stakes are raised even further. Why is it happening? What can be done about it?

The interstitial or tissue space is a hydrated, gel-like environment in which metabolic, immunologic, physiologic and reparative cellular events all take place. Its vasculature is comprised of minute arterial and venous capillaries, and the lymphatic system. These vessels maintain the fine balance between capillary filtration, reabsorption and skin drainage - vital for oxygenation, cellular nutrition, host defence and waste removal.

There are numerous reasons why the tissue space fluid equilibrium can become disturbed. Over hydration, renal and cardiac failure can result in a filtration/reabsorption imbalance causing too much fluid to accumulate in the interstitium. Trauma, deep vein thrombosis, obesity, radiotherapy, parasitic infestation and malignancy can cause drainage obstruction. Infections leading to cellulitis produce significant changes in the permeability of capillaries and reduce lymphatic function. Medications such as antihypertensives and steroids alter capillary pressures and modify electrolyte balances, producing a fluid shift into the skin. Malnutrition also disrupts oncotic pressures and tissue fluid status.

Lymph can leak out directly from a wound or from multiple, miniscule fissures along the skin surface – especially when a limb is swollen and inflamed. The lymph fluid has a high concentration of protein, fatty acids, inflammatory cells, metabolic waste, hormones, viruses, bacteria and cell fragments (including cancer cells). It is a perfect medium for causing pH change to the skin, allowing protease tissue stripping, fungal growth and secondary bacterial invasion. This produces discomfort, irritation, epithelial breakdown and malodour.

It makes sense that when confronted with a patient who has watery-like fluid seeping out of their skin, that the underlying pathology is identified and treated. Sometimes a number of domains have to be treated at the same time, like correcting the heart failure, using antibiotics to combat the cellulitis and instigating a careful compression regime to reduce the lower limb lymphorrhea. In fact, the considered application of compression therapy is often an essential component in assisting the reparative process.

A multi-disciplinary team approach is necessary in order to identify and treat the instigating causes for the Lymphorrhea. However, the nursing team are very much in charge of skin care - a vital activity in returning the patient to wellness. The skin needs regular, gentle washing to remove the devitalised skin debris, lymph fluid and any correlated deposits. Some practitioners prefer to use only tepid water for cleansing. Others advocate the use of tea-tree foam cleansers and/or polyhexanide washes in their protocols.

Once the skin is cleaned then appropriately dried, the priorities then revolve around the issues of protection, comfort and correct skin hydration. Barrier lotions, zinc pastes, paraffin-based emollients and oat-meal moisturises have been used as skin treatments. 3M™ Cavilon™ Durable Barrier Cream happily provides both a barrier and moisturising function. Should an anti-inflammatory action also be desired, then a medically prescribed topical product can be utilised prior to the creams application. The frequency of skin treatment will need to be determined for each patient and to be guided by the ongoing assessment of the response to systemic, local and topical interventions.

Lymphorrhea is alarming for a patient. However, once the underlying cause is identified and corrective steps are well targeted, then resolution of skin distress (or containment at least) should be forthcoming. Incorporating quality products in the skin care regime is contributory to a successful outcome.

References :1. www.lymphedemapeople.com/phpBB3/viewtopic.php?f=23&t=2152. www.lymphedemapeople.com/thesite/lymphedema_lymphorrhea.htm3. Cheville, A.J “ Lymphedema and palliative care”. National Lymphedema Network Vol 14 No 1 Lymph Link Article 4. Department of Human Genetics www.hgen.pit.edu/projects/lymph/faq.php5. Rucigaj, T.P & Zunter, V.T Lympedema:Clinical picture, diagnosis and management. Radioisotopes-Applications in Bio-Medical Science November 2011, InTech Europe, Croatia www.intechopen.com

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Comparison of two periwound skin protectants in venous leg ulcers: a randomised controlled trialCameron J, Hoffman D, Wilson J, Cherry G, Journal of Wound Care 2005;14(5):233-6.Study Type: RCT, n=35

objEctIvE of study

Compare the efficacy and cost-effectiveness of two skin protectants, 3M™ Cavilon™ No Sting Barrier Film

and zinc paste compound, in the management of maceration and irritation of the periwound area of venous

leg ulcers.

KEy fINdINGs / ANALysIs

There was a significant difference in time required to remove and re-apply the skin protectants: an average of

0.19 (±0.17) minutes in the Cavilon No Sting Barrier Film group and 5.53 (±2.10) minutes in the zinc paste

group. Cavilon No Sting Barrier Film was easier to apply and transparent—hence not requiring removal for

assessment. The zinc paste was messy to apply and difficult to remove, and thus took up considerably more

nursing time than Cavilon No Sting Barrier Film.

Periwound protection with 3M™ Cavilon™ No Sting Barrier Film for patients with chronic venous leg ulcers, a randomized multi-centre trialBonnetblanc J, Vin F, Poster presentation at the World Union of Wound Healing Societies (WUWHS) in Paris; 2004. Study Type: RCT, n=40

objEctIvE of study

Compare the effect of 3M™ Cavilon™ No Sting Barrier Film to no treatment on periwound skin in patients with

venous leg ulcers receiving compression therapy.


Results from this study indicate significantly better periwound skin protection for patients in the

Cavilon No Sting Barrier Film group.

The protective effects of a new preparation on wound edges Neander KD, Hesse F, Journal of Wound Care 2003;12(10):369-71.Study Type: Comparative, paired design at wound level, n=227

objEctIvE of study

Investigate the effects of 3M™ Cavilon™ No Sting Barrier Film on erythema on the edges of highly exuding

wounds in patients with venous stasis ulcers.


In the Cavilon No Sting Barrier Film group, erythema disappeared in 88.1 percent of patients within three

days of treatment, and in the remaining 11.9 percent, it had completely disappeared after four days. In the

control group, the erythema intensity remained essentially unchanged throughout the study observation

period. Cavilon No Sting Barrier Film helped to control erythema in all patients.

Periwound Skin Protection

8 | Clinical Evidence Summaries

Periwound skin protection: a comparison of a new skin barrier

vs. traditional therapies in wound management Coutts P, Queen D, Sibbald RG, Wound Care Canada 2003;1(1).

Available from URL: http://cawc.net/images/uploads/resources/Peri-wound_Skin_Protection.pdf

Study Type: Prospective case series, split wound design, n=30objEctIvE of studyCompare the periwound protection performance of 3M™ Cavilon™ No Sting Barrier Film to two routinely used

barrier products. Wound types included: diabetic foot ulcers, pressure ulcers and venous ulcers.

KEy fINdINGs / ANALysIsSignificant differences were found favoring Cavilon No Sting Barrier Film with regard to application time.

Results indicate that all treatments were similar in clinical efficacy with no differences noted for change in

wound size, drainage or periwound condition. The authors concluded that Cavilon No Sting Barrier Film was

more caregiver/patient friendly, allowed for better visualization of the wound edges, and was quicker to apply

in the clinical setting.

The use of 3M™ Cavilon™ No Sting Barrier Film to prevent

maceration in pressure ulcers treated with an adhesive

hydrocolloid dressingGonzález G, Soriano V, Fornells G, Lopez R, Gómez S, et al., Poster presentation at the European Wound Management Association

(EWMA) Conference in Granada, Spain; 2002. Study Type: RCT, n=60

objEctIvE of studyCompare the effect of 3M™ Cavilon™ No Sting Barrier Film to no treatment in the control of maceration

associated with use of hydrocolloid dressings on ulcers with moderate to large amount of exudate.

KEy fINdINGs / ANALysIsResults confirm that the use of Cavilon No Sting Barrier Film reduces the periwound maceration caused

by hydrocolloid dressings. Periwound maceration was not dependent on the degree of severity of pressure

ulcers.

Ulcer edge protection with a polymer protective film

Bär M, Vanscheidt W, Zeitschrift fur Wundheiling 2001;22(1):16-20.

Study Type: RCT, n=20objEctIvE of studyCompare the efficacy and tolerability of 3M™ Cavilon™ No Sting Barrier Film to a zinc oxide paste for use in

protecting macerated wound margins in lower extremity ulcers. KEy fINdINGs / ANALysIsCavilon No Sting Barrier Film provided a rapid improvement of maceration at the wound’s margins, patient

tolerability was regarded as very good, therapeutic steps were not disturbed, transparency of the film made

it possible to observe underlying tissue, and the film could be used as an ideal base for wound dressings.

The use of Cavilon No Sting Barrier Film for indolent leg ulcers with macerated wound margins proved to be

effective, well tolerated and cost-effective.


Clinical Evidence Summaries | 9

Instrumental evaluation of the protective effects of a barrier film on surrounding skin in chronic woundsDini V, Salibra F, Brilli C, Romanelli M, Wounds 2008;20(9):254-57.Study Type: Non-randomized, comparative study, n=40

objEctIvE of study

Investigate the effect of 3M™ Cavilon™ No Sting Barrier Film on skin surrounding chronic wounds by

monitoring transepidermal water loss (TEWL) as a marker of skin health.


Twenty patients with pressure ulcers and 20 patients with venous leg ulcers were evaluated. Statistical

evaluation showed an overall reduction of 45 percent in TEWL values in both groups by the conclusion of the

study period when compared to baseline values. The study objectively demonstrated that Cavilon No Sting

Barrier Film can help in the management of skin surrounding chronic wounds. An additional benefit was

that the skin could be observed through the film. Cavilon No Sting Barrier Film application was a quick and

simple process and removal was not necessary.

In vivo evaluation using confocal microscopy of protective effect of No Sting Barrier Film 3M™ Cavilon™ on periwound skinGómez T, Morán J, González S, Gerokomas 2008;19(1):41-46.Study Type: Comparative, paired design at wound level, n=2

objEctIvE of study

Evaluate the protective properties of 3M™ Cavilon™ No Sting Barrier Film on the periwound skin of venous

ulcers, and assess changes in the periwound skin of venous ulcers after use of Cavilon No Sting Barrier Film

using confocal microscopy.


After one week of treatment, there was general improvement of periwound skin but in the areas treated

with Cavilon No Sting Barrier Film, necrosis nearly disappeared and there was a significant reduction of

exocytosis, spongiosis and a better structured epidermis and also an improvement in inflammation. The

Cavilon No Sting Barrier Film group showed greater histological improvements compared to areas not

treated with the barrier film. Cavilon No Sting Barrier Film is an effective treatment for periwound skin in high

exudative chronic ulcers.

A liquid film-forming acrylate for periwound protection: a systematic review and meta-analysis (3M™ Cavilon™ No Sting Barrier Film)Schuren J, Becker A, Sibbald RG, International Wound Journal 2005;2(3):230-8.Study Type: Periwound review meta-analysis

objEctIvE of study

Undertake a systematic review of all reliable evaluations of the clinical performance and cost-effectiveness of

3M™ Cavilon™ No Sting Barrier Film in the protection of periwound skin in chronic ulcers.


A total of 49 papers were identified and considered. Possible data from eleven controlled trials were

considered and a total of nine eligible studies were included in this analysis. The authors concluded that

Cavilon No Sting Barrier Film is a safe and effective barrier to protect the periwound skin of chronic ulcers.

Its benefits include: visibility of wound margins, reduction of erythema, pain control, patient comfort and

reduced staff time.



Application of 2 layer barrier film in negative pressure wound therapyNg HW, Nallathamby V, Ho M, Ho S, Wong JM, Naidu S, et al. Poster presentation at 8th Asia-Pacific Burn Congress and The 3rd Congress of the Asia Wound Healing Association; 2011. Study Type: Prospective (n: not reported)

objEctIvE of studyEvaluate the use of 3M™ Cavilon™ No Sting Barrier Film on the periwound skin of acute wounds (necrotizing fasciitis, Fournier’s gangrene, skin graft recipient site and flap closures for pressure sores and other wounds) prior to the application of drape/film for NPWT.

KEy fINdINGs / ANALysIsCavilon No Sting Barrier Film was applied using a 2-layer technique with a 45 second interval between layers. The NPWT was changed every 48-72 hours for a period of 1-3 weeks. Following closure, NPWT was applied for 7-10 days with Cavilon No Sting Barrier Film. In this study, there was no evidence of periwound skin maceration or skin stripping. There was also an outcome of reduced pain reported.

Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon™ (no sting barrier film) in the treatment of venous leg ulcersSerra N, Palomar F, Fornes B, Capillas R, Berenguer M, Aranda J, et al. Gerokomos 2010; 21 (3): 1-7.Study Type: RCT, n=98

objEctIvE of studyEvaluate the clinical effectiveness of a multi-layer compression bandage and 3M™ Cavilon™ No Sting Barrier Film on the periwound skin of venous ulcers.

KEy fINdINGs / ANALysIsAfter 12 weeks of treatment, the average reduction in ulcer area was statistically greater in patients treated with Cavilon No Sting Barrier Film (83%) compared to the control group (no treatment) (72%) (p=0.046). The reduction of the ulcer area ≥ 50% at four weeks was 69.4% in the Cavilon group compared to 46.9% in the control group (p<0.01). The clinical effectiveness of a multi-layer compression bandage in patients with venous leg ulcers, as measured by percentage reduction of area, was increased by the concomitant use of Cavilon No Sting Barrier Film.

Reducing skin maceration in exudative diabetic foot ulcersLazaro-Martinez JL, Garcia-Morales EA, Aragon-Sanchez FJ, Ano-Vidales P, Allas-Aguado S, Garcia-Alvarez Y. Rev ROL Enf 2010; 33(3). Study Type: Observational study, n=40

objEctIvE of studyDemonstrate the effectiveness of 3M™ Cavilon™ No Sting Barrier Film in resolving periwound skin maceration in diabetic foot ulcers.

KEy fINdINGs / ANALysIsSeventy percent of diabetic foot ulcers showed a healthy edge or less exudate after 30 days of treatment (p<0.05) with Cavilon No Sting Barrier Film. The use of Cavilon No Sting Barrier Film for maceration management of highly exudating diabetic foot ulcers was effective.



RISE Programme Reducing the Incidence of Skin breakdown through Education

The RISE Programme is an educational programme which 3M can offer to help your organisation to reduce the incidence of skin breakdown. Not only can we provide clinically proven products from the 3M™ Cavilon™ Professional Skin Protection Range but we can also offer you with clinical protocols tailored to your organisations’ needs in order to ensure the most cost effective and best practice outcomes are provided for you. We also offer educational support for health care professionals, patients and residents through a wide variety of resources including information leaflets, online learning and educational workshops and webinars.

If you are interested in any of the elements of the RISE programme, please contact your local 3M Skin and Wound Care Representative.

RISE & Periwound Management3M™ Cavilon™ No Sting Barrier Film is an ideal choice for providing periwound protection because it provides a breathable, transparent coating (which allows for continuous visualisation and monitoring of the skin) that repels moisture and irritants. In addition, it is non-cytotoxic and hypoallergenic and is easy to apply (see below) and does not require removal, minimising pain and discomfort to the patient and potentially saving time and money.

The film forms a protective interface between the epidermis and the adhesive coating of a dressing or the tape. When the dressing is removed, it removes 3M™ Cavilon™ No Sting Barrier Film instead of the skin cells further enhancing the skin integrity of the patient.

Questions to ask yourself:• Do you see periwound maceration in your practice? • Are more wound types more prone to maceration in your

clinical experience?• Do you find that maceration is delaying healing or limiting

treatment options?• What do you currently use for periwound management?• How does that work for you?

3M™ has over 60 pieces of clinical evidence supporting the efficacy and cost effectiveness of 3M™ Cavilon™ No Sting Barrier Film. As you can see, the 3M™ Cavilon™ No Sting Barrier Film Clinical Evidence Summaries brochure provides more than five pages of clinical summaries specifically relating to periwound management with a focus on venous leg ulcers, diabetic foot ulcers and negative pressure therapy:

Step 1: Select the most appropriate delivery method of 3M™ Cavilon™ No Sting Barrier Film.• Use the 1ml wipe or the 1ml wand applicator for small to

medium wounds.• Use the 3ml wand* applicator for large wounds.

Step 2: Cleanse the wound and peri-wound margins.

Step 3: Apply a uniform coating of 3M™ Cavilon™ No Sting Barrier Film around the wound to provide a protective film barrier over the skin exposed to drainage and where a dressing will be applied.• Note: Begin at wound edge and work outwards

over area of exposure.

Step 4: Allow the film to dry (about 30 seconds).

Step 5: If an area is missed allow the first coat to dry before applying more 3M™ Cavilon™ No Sting Barrier Film.

Step 6: Reapply with each dressing change

* The 3ml wand applicator is not available in nz

A copy of the complete clinical evidence summaries for 3M™ Cavilon™ No Sting Barrier Film is available, for your personal copy or to find out how the RISE Programme can benefit your organisation, please contact your local 3M Skin and Wound Care Representative.

A comparison of an alcohol-based and a siloxane-based periwound skin protectantRolstad B, Borchert K, Magnan S, Scheel N, Journal of Wound Care 1994;3(8):367-368.Study Type: Observational, comparative study, n=19

objEctIvE of studyCompare the clinical effectiveness of a siloxane-based liquid polymer skin protectant (3M™ Cavilon™ No Sting Barrier Film) to an alcohol-based liquid polymer skin protectant (Smith & Nephew Skin-Prep™). Patients with intact or compromised skin adjacent to wounds, tubes or stomas using frequently removed adhesives were included in the study.

KEy fINdINGs / ANALysIsThe condition of periwound skin improved in all cases with no significant difference between study groups. All applications of Cavilon No Sting Barrier Film were rated as pain-free, whereas, only 57 percent of the Skin Prep allocations were rated as pain-free. There was a preference for the wand applicator (Cavilon No Sting Barrier Film). Because of the painless characteristic of the siloxane-based skin protectant, expanded indications for the use of this type of skin protectant may be considered.



3M™ Cavilon™ No Sting Barrier Film: an evaluation of periwounds prone to macerationGarcia RF, Gago M, Adame S, Romero J, Jimenez A, et al., Poster presentation at the European Pressure Ulcer Advisory Panel (EPUAP) Conference; 2000. Study Type: Comparative, paired design at wound level, n=26

objEctIvE of study

Evaluate the use of 3M™ Cavilon™ No Sting Barrier Film on periwounds prone to macerated skin when

treated with moist wound healing dressings.


Eighty-eight percent of patients’ maceration of the periwound areas disappeared or decreased at sites where

Cavilon No Sting Barrier Film was applied in the first 48-96 hours. In all cases, the use of Cavilon No Sting

Barrier Film allowed adhesion and removal of the dressing without affecting the periwound skin. Cavilon No

Sting Barrier Film protected the periwound area of chronic wounds and did not cause discomfort. The foam

applicator presentation was more appropriate for small specific areas with periwound maceration.

Film subjects win the dayHampton S, Nursing Times 1998;94(24):80-2.Study Type: Paired design at wound level, n=62

objEctIvE of study

Determine if clinical use of 3M™ Cavilon™ No Sting Barrier Film would reduce maceration and excoriation in

at-risk patients and to see if protection could be afforded to those who had erythema or skin damage as a

result of tape being applied to the skin.


Patients were categorized into six main types: cellulitis around a stoma, macerated periwound areas,

excoriated periwound areas, sensitivity to tapes/dressings, baby eczema/nappy rash, and adherence to

dressings. Sixty-one patients showed improvement after treatment with Cavilon No Sting Barrier Film, and

53 went on to heal completely when Cavilon No Sting Barrier Film was applied to the entire wound. The

author concluded that Cavilon No Sting Barrier Film would be a useful addition to a wound care formulary for

use as protection, to secure dressings that are difficult to hold in place. The study suggests that the use of

film can improve the outcome for excoriated and macerated tissues.

Improvement in patient comfort and compliance through the use of 3M™ Cavilon™ No Sting Barrier FilmJones J, Poster presentation at the Wound Care Conference in Harrogate, UK; 1998. Study Type: Case studies, n=2

objEctIvE of study

Describe experience of using 3M™ Cavilon™ No Sting Barrier Film on the surrounding skin of leg ulcers of

different etiology.


In the first case study, patient comfort was increased and there was an improvement in the surrounding skin.

The patient had considerable improvement in quality of life, plus compliance with the dressing regimen. In the

second case study, patient comfort was increased with an improvement in surrounding skin in a once a week

dressing regimen.



3M™ Cavilon™ No Sting Barrier Film

Clinical Evidence Summaries

TM

ClinicalEvidence

Summaries

2_AM45_Cavilon_Clinical_Studies_v2.2.indd 2

9/18/12 8:39 AM

Beyond the Edge:Skin Care Considerations for Lower Extremity Venous Disease

Learning objectives• Understand the impact of

oedema on skin integrity• Describe common skin integrity

problems associated with lower extremity venous disease

• Describe three steps to maintaining or improving skin integrity

Duration: 45 minutes

Target AudienceHealth care professionals involved in managing venous leg ulcers and associated skin conditions.

Evidence-based insights to improve your clinical practice

This programme has been endorsed by APEC number 120705422 as authorised by Royal College of Nursing, Australia according to approved criteria.

Attendance attracts 0.75 RCNA Continuing Nurses Education (CNE) points as part of RCN’s Life Long Learning Programme (3LP).

Reference herein to any specific commerical products, process or service by trade name, trademark, manufacturer or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favouring by RCNA.*

* RCNA endorsement only offered in Australia

3M are delighted to offer the latest offering in our education program to you. It is a 45 minute webcast, hosted by your local 3M Skin and Wound Care Representative.

Faculty PresenterDebra Thayer, MS, Rn, CWoCn

3M Health CareSkin and Wound Care division

Skin & Wound Care Division3M Australia Pty. LimitedABn 90 000 100 096Building A, 1 Rivett Roadnorth Ryde nSW 2113Phone 1300 363 878www.Cavilon.com.au

Skin & Wound Care Division3M New Zealand Limited94 Apollo driveRosedaleAuckland 0632Phone 0800 80 81 82www.Cavilon.co.nz

3M and Cavilon are trademarks of 3M.All other trademarks are propertyof their respective owners.Please recycle.© 3M 2012. All rights reserved.

To express interest in viewing this webcast, please contact your local 3M Skin and Wound Care Representative, or e-mail us at:Australia - [email protected], New Zealand - [email protected]

focus on a message - 3m · i firmly believe in the importance of skin care in wound management –...

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