Maceration and Hydrogels? Just Say Whoa

How do you use hydrogel dressings to keep wounds moist without causing maceration? Very carefully.  

 

Maceration and Hydrogels? Just Say Whoa

 

If you’ve ever taken a long bath or spent an afternoon in a swimming pool, you’re familiar with what happens to your hands and feet: they become soft, white, and wrinkled up like prunes. This is a classic case of maceration, which occurs when skin tissue is exposed to excessive moisture over a period of time.

As clinicians, we regularly treat patients with wounds (which need to be kept moist) that are surrounded by tissue that needs to be kept dry. So knowing how to properly treat the wound without causing maceration makes all the difference in the healing process.

What causes maceration?

When maceration occurs, it causes the skin to break down, which in turn may enlarge the wound and prevent it from healing properly. But what actually causes maceration? A number of conditions are to blame, including:

  • excessive wound drainage
  • urinary incontinence
  • sweating
  • improper use of wound treatments.

Patients can also experience significant pain due to maceration, as the exposed tissue under the skin becomes raw, and can be further irritated during the cleaning process. (For a discussion of moisture and skin breakdown, see the blog, “Moisture Associated Skin Damage: Know Your Type”.)

The role (and challenge) of hydrogels

As clinicians, one of the first lines of wound-care defense for faster healing is the use of amorphous hydrogel dressings. These are 90% water in a gel base, and available as a free-flowing gel packed in tubes, foil packets, and spray bottles.

Hydrogels provide moisture to the wound, promote autolytic debridement, and maintain an optimum wound environment. But since excess moisture can cause damage to the skin, the challenge is to make sure the gel stays in the wound bed without overlapping onto the wound edges or periwound area.

Applying Wound Gels: The Do’s & Don’ts

So what’s the best way to apply hydrogels? It’s really pretty simple.

The Don’ts

First and foremost, do not use hydrogels on skin that is already macerated. Period.

Secondly, if you’re going to use hydrogels, do not apply them the way you’ve probably seen other clinicians do – by taking a tube of hydrogel and squirting it directly into the wound. With this application, once the secondary dressing is placed on top, the hydrogel will inevitably ooze over the edges and onto the healthy tissue. This is not good practice.

The Do’s

The correct way to use hydrogel is to keep it confined to the wound bed. Do not squeeze the tube directly over the wound. Instead, apply it with a cotton swab, which will give you better control of the application. In addition, be sure to apply a moisture barrier, like skin prep, around the wound edges to prevent maceration. This is a good habit to practice every time you use hydrogel as a treatment.

 

 

In addition, always follow the manufacturer’s instructions and make sure the you use products appropriate for the wound.

Are you a hydrogel pro?

Using hydrogel effectively can simply be a matter of slowing down and applying with caution and care – or not using it at all. But we’d love to know if you have any other tips or tricks to share. And along with that, have you observed colleagues squeezing the tube directly on the wound and then dressing it? Please leave your comments or start a conversation below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

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Maceration and Hydrogels? Just Say Whoa.  How do you keep wounds moist with hydrogel dressings without causing maceration? Very carefully.

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