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Types of Wounds and Skin Conditions


Wound Care Skin Care Skin Closure Pressure Ulcer Dressing & Device Secural IV Therapy

Wound Care Solutions

3M's extensive line of easy-to-use products are trusted by clinicians and intended to simplify and improve skin health and treatment of wounds, both acute and chronic. These products provide cost-effective solutions that are supported by educational services, professional and technical support, as well as ongoing research and development.

Skin Tears

Friction

Clinical Condition: Friction

A friction injury is the surface damage, usually superficial, resulting from skin rubbing against another surface. This type of injury is often seen on the elbows or heels from rubbing against bed sheeting and/or re-positioning in bed. It also can occur on the buttocks or sacrum from sliding down in the bed, if the head of the bed is elevated. Friction injuries can also occur from skin to skin contact and rubbing.

Closed Intact Surgical Wound

Abrasions

Superficial Partial-Thickness Burns

Donor Sites

Venous Leg Ulcers

Lacerations

Open Surgical Wounds

Neuropathic Foot Ulcers / Diabetic Foot Ulcers

Clinical Condition: Neuropathic Foot Ulcers / Diabetic Foot Ulcers

Diabetic Foot Ulcers (DFUs) are a common and serious complication of diabetes mellitus and can be particularly difficult to heal. A non-healing DFU can significantly diminish patient quality of life and carries an increased risk of infection, hospitalization, amputation, and loss of life. 3M offers a range of products for use during Standard DFU Treatment to help control microbial load, maintain a moist wound healing environment and improve patient compliance.

Clinical & Socio-economic impacts

  • Nearly 26 million or 8.3% of the U.S. population has diabetes1
  • 25% of diabetics will develop a DFU in their lifetime2,3
  • 85% of lower limb amputations in patients with diabetes are preceded by ulceration2,3,4

1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

2. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients With Diabetes. AMA. 2005;293(2):217-228.

3. Reiber GE. Epidemiology of foot ulcers and amputations in the diabetic foot. In: Bowker JH, Pfeifer MA, eds. The Diabetic Foot. 2001:13-32.

4. American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care. 1999;22:1354-60.

Assessment & Diagnosis

Assessment and diagnosis are the key components of Standard Diabetic Foot Ulcer (DFU) Treatment protocol. This includes off-loading, debridement, infection control, maintaining a moist wound environment, and management of vascular impairment. Each of these components is critical in helping wounds heal during the first four weeks of care.

See resource section for links to organizational sites for more comprehensive information

Treatment

For more information on products, click on product name or refer to corresponding color code in standard treatment section

Infected Wounds

Non- Infected Wounds


3M Wound Care Products for use in Standard DFU Treatment

While prevention is the best and most cost-effective approach, once an ulcer has formed, the most important consideration in caring for a patient with a DFU is expeditious and complete wound healing to avoid the risks and costs of recurrence and other serious complications.

The key components of Standard Diabetic Foot Ulcer (DFU) Treatment protocol include off-loading, debridement, infection control, maintaining a moist wound environment, and management of vascular impairment. Each of these components is critical in helping wounds heal during the first four weeks of care.

3M offers a range of products for use during Standard DFU Treatment to help control microbial load, maintain a moist wound healing environment, improve patient compliance and manage costs.

3M™ Tegaderm™ Ag Mesh Dressings with Silver 3M™ Tegaderm™ Alginate Ag Silver Dressings
Versatile, affordable & effective
  • Fast-acting, long lasting, broad spectrum antimicrobial
  • Easy to customize
Broad-spectrum, soft gelling
  • Reduces a broad spectrum of pathogens
  • Manages excess exudate
3M™ Tegaderm™ Matrix Dressings 3M™ Tegaderm High Performance Adhesive Foam Dressings
Impregnated with low pH ointment
  • Provides optimal moist wound environment
  • Can be rolled or folder
Intuitively adjusts to changing levels of exudate
  • Available in unique sizes and shapes
  • Conforms to challenging body parts and contours
  • Provides great holding power for long wear time and difficult contours
3M™ Tegaderm™ Silicone Foam Border Dressings 3M™ Cavilon™ No Sting Barrier Film
Intuitively adjusts to changing levels of exudate
  • Provides reliable yet gentle secural for fragile skin
  • Conforms to challenging body parts and contours
Breathable, hypoallergenic protection
  • Alcohol-free transparent liquid barrier
  • Protects periwound skin from exudate & adhesive trauma
3M™ Coban™ 2 Layer Lite Compression System
Reduces chronic edema
  • Provides comfortable, therapeutic compression to reduce edema*
  • Comfortable, low-profile bandage

*For patients with an ABPI ≥ 0.5. In diabetic patients, 3M™ Coban™ 2 Layer Lite Compression System should be used with caution due to the possibility of microvascular disease.

Advanced Therapies

3M solutions do not address advanced therapies. For information on advanced therapies, consult your healthcare professional or visit American Diabetes Association

Resources

American Diabetes Association

Skin Care Solutions

3M's extensive line of trusted products is intended to simplify and improve skin health and the treatment of wounds, both acute and chronic. These products provide cost-effective solutions and are supported by educational services, professional and technical support, as well as ongoing research and development.

Healthy Skin

Clinical Condition: Healthy Skin

All skin types need cleansing and moisturizing. Dry skin, aging, dry temperatures, soaps, dehydration, medications and certain diseases put skin at greater risk for injury.

Dry Skin (Xerosis)

Clinical Condition: Dry Skin (Xerosis)

Dry skin can be due to low environmental humidity, inadequate hydration, use of products that dry the skin (such as soap), or medical conditions. It typically appears as scaling or flaking and often causes itching or burning. Dry skin that is severe or persists despite the use of moisturizers should be evaluated by a physician.

Callus

Clinical Condition: Callus

Callus is a build up of dry and often discolored epidermis that results from repeated exposure to pressure and friction.

Note: Do not cut, shave or file callus on the feet of a diabetic. Foot care should be provided by a podiatrist or person specializing in foot care. Orthotic shoes may be indicated for diabetic feet.

Peri-tube Skin Irritation

Clinical Condition: Peri-tube Skin Irritation

Peri-tube irritation typically results from exposure to body fluids such as gastric drainage or bile or wound drainage. Erythema (redness) of the skin is an early sign. Prevention is critical, especially in situations where the irritating substance is extremely caustic as skin damage may progress rapidly to denudement or deeper tissue damage.

Incontinence-Associated Dermatitis

Clinical Condition: Incontinence-Associated Dermatitis

Exposure to moisture and irritants, changes in skin pH and friction can cause inflammation and irritation. Extent of damage can range from erythema (redness) and rash to severe, partial thickness skin damage.

Moisture-Associated Skin Damage

Clinical Condition: Moisture-Associated Skin Damage

Moisture-associated skin damage is “inflammation and erosion of the skin caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus or saliva.”

* Damage can be exacerbated by the interaction of friction and moisture and can be a particular problem over the sacro-coccygeal area (lower spine and tail-bone) or within skin folds.

Prevention:
Use the suggested products below.

*Reference: Gray et al. Moisture-Associated Skin Damage. JWOCN May/June 2011.

Maceration

Clinical Condition: Maceration

Excess hydration leads to increased permeability and softening of the epidermis (uppermost layer of the skin). Skin is moist, soft and appears white or gray. This is considered a type of Moisture-Associated Skin Damage and can commonly occur at wound edges (potentially delaying healing), between body folds and with long-standing urinary incontinence.

Peristomal Skin Damage

Clinical Condition: Peristomal Skin Damage

Chemical irritation from exposure to urine or stool and damage from adhesives are two of the most common skin problems associated with urinary or fecal stomas (ostomies). An appropriate pouching system that fits properly is critical to maintaining peristomal skin health. Skin damage may also be prevented with careful attention to skin preparation and protection. A WOC Nurse has special education and training in stoma care and can provide expert assistance with pouch selection or troubleshooting as well as treating skin problems.

Tracheostomy Site Trauma

Clinical Condition: Tracheostomy Site Trauma

Complicated tracheostomy sites can present a significant challenge to both clinician and patient. Common problems include compromised skin integrity from excessive moisture due to wound drainage, secretions and perspiration (another example of Moisture-Associated Skin Damage), as well as pressure and friction from the tracheostomy collar and tube stabilization ties. These problems can lead to severe pain, as well as increased risk of wound contamination and infection.

Trauma from Tapes and Dressings

Clinical Condition: Trauma from Tapes and Dressings

Adhesive trauma (skin stripping and tension blisters) is one of the most common problems associated with adhesive use. Many of these injuries can be prevented by careful attention to skin preparation and protection, choice of tape or dressing, and proper application and removal of tape and dressings.

Radiation Skin Injury

Clinical Condition: Radiation Skin Injury

Many patients undergoing radiotherapy experience some degree of skin reaction. Make sure you consult with the physician managing the radiation therapy before using any skin care product.

Skin Closure Solutions

3M's skin closure product line includes the family of reliable and trusted 3M™ Steri-Strip™ Adhesive Skin Closures. You can rely on Steri-Strip Adhesive Skin Closures to make wound closure fast and simple while reducing the risk of infection compared to staples and sutures.

Surgical Incision - Cosmetic Results

Clinical Condition: Surgical Incision - Cosmetic Results

Cosmetic results may be desired from more than just cosmetic and reconstructive surgery. Several studies have shown that once the technique of applying adhesive skin closure strips is mastered, it is more cost effective and the cosmetic results are superior to other skin closure methods, such as staples and sutures. Use adhesive skin closure strips following early suture/staple removal (as early as 24 hours) when further wound support is needed and/or to prevent scar widening.

Surgical Incision - Small Incision

Clinical Condition: Surgical Incision - Small Incision

A surgical incision is a cut or a wound intentionally produced by cutting with a sharp instrument. A small incision requires a minimal number of sutures, staples and/or adhesive skin closure strips for wound closure.

Surgical Incision - Large Incision

Clinical Condition: Surgical Incision - Large Incision

A surgical incision is a cut or a wound intentionally produced by cutting with a sharp instrument. Large incisions require more extensive closure with use of suture, staples and/or skin closure strips.

Skin Laceration

Surgical Incision - Musculoskeletal Movement

Clinical Condition: Surgical Incision - Musculoskeletal Movement

Musculoskeletal Movement: movement pertaining to or comprising the skeleton and the muscles, as musculoskeletal system; e.g. finger, knee, wrist, elbow or shoulder.

Pressure Ulcer Conditions

The National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) define pressure ulcer as a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

Pressure Ulcer Stage I

Clinical Condition: Pressure Ulcers Stage I: Nonblanchable Erythema

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk). *

Pressure Ulcer Stage II

Clinical Condition: Pressure Ulcers Stage II: Partial Thickness Skin Loss

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Presents as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation. Bruising indicated suspected deep tissue injury. *

Pressure Ulcer Stage III

Clinical Condition: Pressure Ulcer Stage III: Full Thickness Skin Loss

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable. *

Pressure Ulcer Stage IV

Clinical Condition: Pressure Ulcer Stage IV: Full Thickness Tissue Loss

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable. *

Suspected Deep Tissue Injury

Clinical Condition: Suspected Deep Tissue Injury

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment. *

Unstageable

Clinical Condition: Unstageable: Depth Unknown

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed. *

NOTE: Debridement of ulcers with devitalized tissue is necessary. Notify MD/Wound Consultant for debridement options.

Pressure Ulcer Prevention

Pressure Ulcer Prevention

Hospital acquired pressure ulcers (HAPUs), considered a never event by the Centers for Medicare and Medicaid Services (CMS), have hospital staff looking at all ways possible to prevent pressure ulcer development.

In addition to other components of an effective pressure ulcer prevention program, the following 3M products may be used to help reduce the risk of friction and shear damage - contributing factors to pressure ulcer development.*

Dressing & Device Secural

3M's full range of hypoallergenic medical tapes have helped set the standard for more than 50 years. 3M Medical Tapes enable clinicians to provide better patient care by offering a full line of products that allow them to select the right tape for the exact performance qualities needed. Each tape has backing and adhesive characteristics for your specific taping technique and situation. When non-adhesive securement is needed, consider using 3M™ Coban™ Self-Adherent Wrap* or 3M™ Coban™ LF Latex Free Self-Adherent Wrap, an elastic wrap that functions like a tape, but sticks only to itself.

* Caution: This product contains natural rubber latex which may cause allergic reactions.

Dressing Secural Surgical

Clinical Condition: Surgical Wound

A surgical wound is the result of an intentional incision into the skin and underlying tissues under aseptic conditions. Within 48-72 hours of closure, clean surgical wounds have deposited enough fibrin at the incision site to prevent bacterial contamination. Post-wound closure surgical site infection prevention measures include appropriately managing the wound environment with a dressing and reducing the risk of impaired skin integrity by proper application and removal of tapes and dressings.

Skin Injuries - At Risk Skin

Clinical Condition: Adhesive Trauma

Superficial skin damage can occur when adhesive products are used. The most common problems associated with taping are skin stripping and tension blisters. Less common types of skin damage are irritant contact dermatitis, allergic contact dermatitis, folliculitis and maceration.

A small percentage of individuals may experience hypopigmentation or hyperpigmentation of the skin following the removal of an adhesive product. Many of these injuries may be prevented by correct use, including careful attention to skin preparation, choice of tape, and proper application and removal of tape. Patients at increased risk for adhesive trauma include: the elderly, the very young, those with dermatological conditions, with long-term steroid medications, with acute severe illness, following surgical procedures, with long-term chronic illness, with malnutrition, dehydration or with vitamin deficiency.

Skin Injuries - Mechanical Injury

Clinical Condition: Skin Injuries - Mechanical

Two types of mechanical skin injury are skin stripping and mechanical injury due to tension. These are the most common skin injuries that can occur with application and removal of medical adhesive products, including formation and distention. The most common causes of tension injury are inappropriate stretching of tape during application and distention of skin under an unyielding tape.

Stretching tape across skin is mistakenly thought to increase adhesion. As the tape backing resists stretch or regains its original shape, the epidermis begins to lift. This results in "tension blisters," typically seen at ends of the tape. Skin tears may occur before a blister even forms.

Tension injuries may also occur when edema, hematoma or distention distort the skin surface or when a joint or other area of movement is covered with an unyielding tape.

Skin Injuries - Contact Dermatitis

Clinical Condition: Skin Injuries - Allergic and Irritant Contact Dermatitis

There are two types of dermatitises that can occur with use of medical adhesives - allergic dermatitis and irritant contact dermatitis.

Allergic reactions are cell-mediated immunologic responses to a particular component of a tape adhesive or backing and occur infrequently. Allergic dermatitis is a true allergy and is usually defined by a larger, less distinct area of swelling and erythema. Options may include identifying an alternative hypoallergenic tape or contacting 3M for assistance.

Patients may be mistakenly identified as having tape allergies when, in fact, they have experienced a irritant contact dermatitis. Clinical signs of irritant contact dermatitis include, well-defined areas of erythema and edema, presence of vesicles, and small erosions.

Irritant contact dermatitis can be caused by chemicals being trapped under skin or by preps not being completely dry before the tape is applied.

The photo on the top is representative of irritant contact dermatitis. The irritant contact dermatitis has well demarcated pink square areas. However, this example should not be considered diagnostic and should not take the place of professional medical evaluation if there is any question about the etiology of the dermatitis. The photo on the bottom is more indicative of allergic dermatitis, with larger, less demarcated area of involvement.

Skin Injuries - Maceration

Clinical Condition: Skin Injuries - Maceration

Maceration refers to skin changes seen when moisture is trapped against the skin for a prolonged period. The skin will turn white or gray, and may soften and wrinkle. Macerated skin is more permeable and prone to damage from friction and irritants.

Tube and Device Secural - Infusion & Monitoring

Tube and Device Secural - Infusion & Monitoring

Critical tubes and devices are those for which there is a risk of significant impact to a patient if the tubing or device does not perform as expected. The more critical the tubing or device, the higher the adhesion required. Heavy tubing and immobilization splinting typically requires high-adhesion securement. Strength of adhesion and backing may be more important than gentleness. Some medical tapes are less gentle (e.g. cloth adhesive tape) but are used for applications requiring:

  • High initial adhesion
  • High long-term adhesion
  • High strength backing

Both 3M™ Durapore™ Surgical Tape and 3M™ Cloth Adhesive Tape have a strong woven backing and high adhesion, which are appropriate for critical tube and device securement.

3M™ Medipore™ H Soft Cloth Surgical Tape has high adhesion, but is more gentle to skin and may be used for certain critical tube applications. However, consideration must be given to the fact that the backing of this tape contains perforations, which will decrease the overall strength of the backing. Plastic performated tape is also an option for lighter weight tubing and devices. It sticks well to dry skin, although the backing is not as strong as the woven backings of 3M™ Durapore™ Surgical Tape or 3M™ Universal Cloth Adhesive Tape. Studies have not evaluated 3M™ Kind Removal Silicone Tape for use as primary securement of critical tubing. 3M does not recommend it for this use. Clinical judgement is needed when making decisions about patient care.

Tube and Device Secural - Lightweight Tubes & Devices

Clinical Condition: Tube and Device Secural - Lightweight Tubes & Devices

The use of lightweight tubing and devices, which are less "critical" or pose less risk of impact to patient, may be appropriate situations for securement with a more gentle tape with strong adhesion. A gentle tape may also be appropriate when repeated taping is needed for at-risk skin. Examples of devices may include: lightweight splint, ostomy pouch, post-op eye dressing, and stabilization of lightweight, long tubing.

Occlusive Coverage

Clinical Condition: Occlusive Coverage needed

In certain situations occlusive coverage is needed to:

  • Protect dressings from external moisture, fluids and contaminants
  • Enhance penetration of topical medications
  • Enable dermatological patch testing

IV Therapy Solutions

3M offers reliable, clinically proven solutions for managing a variety of infusion therapy sites. 3M's array of cost-effective products are designed to: reduce the challenges of device securement and site assessment, protect the sites from outside contaminants and improve skin health.

PIV

Clinical Condition: Peripheral Intravenous Catheter (PIV)

A short catheter (<3 inches in length) usually inserted in the veins of the forearm or hand. These catheters are rarely associated with bloodstream infections, but prolonged use may be associated with phlebitis and other complications.

PICC (CVC) / Mid-Line

CVC Short Term (subclavian, internal juglar or femoral)

Clinical Condition: Central Venous Catheter (Non-tunneled)

Non-tunneled: a central venous catheter percutaneously inserted into central veins (subclavian, internal juglar or femoral) with the catheter tip residing in the vena cava. These catheters are intended to be used for a short term.

CVC Tunneled (subclavian, internal jugular or femoral)

Clinical Condition: Central Venous Catheter (Tunneled)

A central venous catheter, with a cuff, that is surgically implanted into the subclavian, internal jugular or femoral veins. The cuff, usually made of Dacron, lies in the subcutaneous tunnel encouraging tissue growth (epithelialization) of the exit site to anchor the catheter and inhibit the migration of organisms into the catheter tract. This type of catheter has a lower rate of infection than the non-tunneled CVC.

CVC Dialysis

Clinical Condition: Dialysis Central Venous Catheter

A dual lumen central venous catheter specifically made for hemodialysis. Hemodialysis catheters have larger lumens and are shorter and less flexible than regular central catheters. These catheters may have a cuff to encourage epithelialization of the exit site to inhibit the migration of organisms into the catheter tract. The use of catheters for hemodialysis is the most common factor contributing to bacteremia in dialysis patients. To reduce the rate of infection, these catheters should be avoided in favor of arteriovenous fistulas and grafts. if temporary access is needed for hemodialysis, a cuffed catheter is preferable to a non-cuffed catheter, even in the ICU setting, if the catheter is expected to stay in place for >3 weeks.

CVC Implanted Port

Clinical Condition: Central Venous Catheter for Implanted Port

A central venous catheter surgically tunneled beneath the skin, placed into a vessel (subclavian or internal jugular vein) or body cavity and attached to a reservoir located under the skin. The stainless steel, plastic or titanium reservoir has a silicone septum in the center which is accessed with a "Huber" needle. With the advent of needle-safe devices, some Huber needles have a higher profile, requiring a larger sized dressing to secure the needle. This catheter has the lowest risk for CRBSI.

Arterial Line

Clinical Condition: Arterial Catheters

An arterial catheter is similar to an IV catheter but it is inserted into an artery, usually the radial artery. These catheters are connected to a transducer which allows for constant monitoring and assessment of critical care patients. It also provides an easy access to collect arterial blood gas samples (ABG's).

Epidural

Clinical Condition: Epidural Catheter

A flexible catheter inserted percutaneously into the epidural space, located between the wall of the vertebral canal and the dura matter, of the spinal column. The tip of the catheter is placed in the epidural space as close to the spinal level requiring the analgesia as appropriate. For longer term therapy, the catheter may be tunneled or totally implanted under the skin.

Subcutaneous

Clinical Condition: Subcateneous Catheter

A non-vascular alternative infusion route for certain medications and solutions (eg, continuous opioid infusion, immune globulin, hydration fluids for short-term treatment of dehydration). The site change of the device is variable, based on fluid volume and the integrity of the site, ranging from every 2 days for patients who receive higher volumes associated with hydration fluids to every 7 days for low-volume medication infusions.

*Some products may be used in combination. Consult product Instructions for Use and facility protocols.

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