Download LO.0889B Cavilon - wound exudat

Macerated and excoriated tissues. A randomised
controlled trial in wound care. Case Studies.
Sylvia Hampton. BSc (Hons) DPSN RGN Research and Tissue Viability Nurse. Eastbourne Hospital NHS Trust.
INTRODUCTION
The Eastbourne Hospital Trust Research & Tissue Viability
nurse (TVN), was concerned with the large number of wounds that
became excoriated over peri-wound areas, and approached six
companies, searching for an appropriate product to solve the
problem. This case study is a direct result of that search.
There are significant differences in structure and
characteristics of skin of various people of all ages. Skin that is
oily, dry, moist, papery or normal will react differently to any
mechanical insult applied to it. Therefore, patient’s wounds may
be treated in identical ways with one having a successful outcome
and another’s healing delayed by complications. Maceration is
one of the complications that can occur, caused possibly by a wet
discharge from the wound or wound dressing which moistens the
viable tissue around the wound. Tissues, softened in this way
become easily damaged and have the potential to breakdown more
easily, offering an entry for infection. Maceration can occur
around a wound or stoma or can be a direct result of faecal or
urinary incontinence. Injury caused to tissues from faecal fluid
incontinence is particularly difficult to treat as dressings may
constantly require removal following each episode of diarrhoea.
A literature search revealed very little work had been
completed on the problem of maceration and excoriation with
only one major reference (Dealey, 1992). The TVN approached six
companies for advice and a solution. Various options were offered
including skin wipes and creams. However, a new product by 3M
called Cavilon( No Sting Barrier Film (NSBF) offered a possible
solution. This was acceptable to infection control as it was
presented in a one use only package in the form of a swab
(“lollipop”) soaked in a film. Cavilon NSBF was primarily
produced as a protection for skin from incontinence, however, the
TVN believed there was a potential for this barrier film to be used
for treatment of macerated peri-wound areas, various types of
stoma sites, to increase the adherence of some dressings and to
protect patients from skin sensitivities from tape. The following
study was developed to establish whether the product would
protect skin and promote a healing environment. The purpose of
this study was to explore the potential of Cavilon NSBF in
reducing maceration and excoriation that sometimes occurs in
patients with wounds, stoma sites and on perennial and gluteal
maximus areas in faecal and urinal incontinence. The study
extended, during the six months, to include sensitivity to
dressings and tapes as it was found that Cavilon NSBF reduced
erythema and skin damage caused by the adhesive in some
products.
The aim of the study on Cavilon NSBF was to assess the
film’s effect on areas that were difficult to protect. Randomised
controlled trials (RCT) in wound care are considered often too
difficult to undertake because of many variables such as medical
condition and mobility. Each patient is so completely different
that, unless a very large sample population is used, it is
impossible to show that the product is having an effect on wound
healing. Large populations of certain types of wounds can only
be found if a multi-centered study is undertaken which can create
organisational problems. This study used the patient as their own
control by placing the film on one half of the peri-wound with a
conventional treatment - such as a barrier cream - placed on the
other half of the peri-wound area. Choice of control treatment
relied on the patient’s named nurse to dictate. Photographs were
taken at dressing changes, preferably daily. This relied heavily on
the prescribed and optimum period that the primary dressing
should remain in situ.
CONCLUSION
As there has been very little work completed on the treatment of
macerated and excoriated wounds, this RCT has important
implications in the treatment of peri-wound areas and any other
area affected by maceration and excoriation. Each peri-wound area
and each patient with excoriation from diarrhoea showed
improvement with the use of Cavilon NSBF and, although the
experiment could not be taken to conclusion, which might have
demonstrated healing on the experimental side of the peri-wound
area and non-healing on the control tissues, it illustrated that
there are solutions to the problem of maceration and that further
research is necessary.
The primary objective of the study had been to find a
treatment that would support healing in the surrounding tissues
whilst not interfering with treatment of the wound. This was a
comparatively small sample number.
Of the 62 patients taking part in the study, 61 showed
improvement under Cavilon NSBF and 53 patients who survived
(85%) went on to complete healing of the macerated tissues when
the film was applied to the whole area. Only 2 patients took
longer than 3 weeks to complete. As the study progressed, it was
regarded to be more ethical to treat all the affected area rather than
just one part. Although this proved to be highly beneficial for the
patients, it created a major deviation from the protocol.
It is often found that the dressing used in a wound
contributes to the maceration of the peri-wound area. Altering the
dressing to support the surrounding tissues can delay healing in
the wound bed; not altering the wound dressing means that there
could be deterioration in the wound as the surrounding tissues
deteriorate. Nevertheless, as a difference was noted in every case,
it is possible that this is a reflection of results that could be taken
from a larger population sample. Using patients as their own
control is the only way to obtain comparative differences in
wound healing. The versatility of Cavilon No Sting Barrier Film
made this study very exiting and new.
REFERENCE
Dealey, C. (1992) Using skin wipes under adhesive tapes. Journal
of Wound Care. 1. 2. 19-22
Torrance, C. (1983) Pressure Sores: Aetiology, Treatment and
Prevention. London. Croome Helm.
3Health Care
The use of Cavilon™ No Sting Barrier Film in the treatment of macerated
tissues caused by wound exudate
A case study.
Mrs Roberts was a 68 year old lady who had bilateral
swelling of the legs with a large ulcer on the back of her
calves. The general acceptance was that this was
lymphoedema with associated bilateral ulceration.
Assessment of the skin showed that there was little
hypertrophy, reduced pitting and enhanced natural skin
folds. The swelling was large and affected both lower and
upper parts of the legs. Mrs Roberts was obese and
required a zimmer frame to mobilise. The ulcers had begun
when she had received a knock with a shopping trolley.
The left ulcer became clinically infected with
staphylococcus aureus and the redness extended from the
wound to her heel at the base of the wound and for about 8
cms surrounding the wound (figure 1). The ulcer was
(figure 2). Erythema, caused by infection, would not leave
white patches in the creases.
Figure 2
Figure 1
malodorous and extremely painful. The slough in the
wound was cleaned with hydrogel and covered with a foam
sheet. The exudate from the wound was destroying the
epithelium surrounding the wound and this can be
identified by the white patches in the creases of the foot
LO.0889B 10/98
The only way that the many variables in a randomised
controlled trial can be “controlled”, is to use the patient as
their own control and so Cavilon No Sting Barrier Film
(NSBF) was applied to the right side of the peri-wound area.
To comply with ethical requirements, the study stated
that if the experimental half of the wound showed
improvement before the control half of the wound, then
Cavilon No Sting Barrier Film would then be applied to the
entire area. If the experimental half of the wound showed
deterioration when compared to the control side, then the
study would be halted. The peri-wound area improved on the
right side within 36 hours and so Cavilon NSBF was
applied to the whole peri-wound. The pain in the peri-wound
area reduced and Mrs Roberts said she felt “more
comfortable”. Compression would have shown good results
but this was refused by Mrs Roberts. On discharge, the
wound was successfully being treated with a zinc bandage.