Les pansements Indications et utilisations recommandées - Fiche BUTS - Good Practice-Dressings-Indications and recommended uses

Has

Description

Posted on Mar 01 2010 National Committee for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS) La HAS a procédé à la réévaluation des descriptions génériques des articles pour pansements. Ceci a permis de préciser les indications des pansements primaires, placés au contact direct de la plaie, et des pansements secondaires et matériels de fixation/maintien.Les pansements disposant d’une AMM (ou médicaments présentés sous forme de pansement) étaient hors du champ d’investigation.La fiche de synthèse détaille les indications et utilisations recommandées des pansements primaires, en tenant compte :de la phase de cicatrisation de la plaie,du type de plaie : chronique ou aigu,de situations cliniques spécifiques. Posted on Mar 01 2010

Informations

• Publié par: haute-autorite-sante-maladies-peau-et-tissu-conjonctif
• Publié le: 01 avril 2011
• Nombre de lectures: 49
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: Français

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L E A F L E T O N G

O O D P R A C T I C E I N H E A LT H C A R E T E C H N O L O G Y U S E

Dressings Indications and recommended uses

Certain chronic or acute wound types qualify for the reimbursement of dressings included in the list of products and services qualifying for reimbursement (LPPR) 1 . These have been assessed by the Haute Autorité de Santé (HAS) National Committee for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS). Following this report, the classification of reimbursable dressings was amended (order dated 16 July 2010, published in the Official Journal dated 7 August 2010). The use of the various dressings listed in this classification, as amended by the HAS recommendations, is summarised here to help healthcare professionals prescribe the most suitable dressings for wound care.

WOUNDS AND PRINCIPLES OF USE FOR DRESSINGS

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Whatever the wound, its treatment is based primarily on aetiology: Treatment of venous ulcers is based first and foremost on compression and treatment of diabetic foot lesions on the relief of pressure.

A chronic woundis a wound that takes a long time to heal. A wound is considered chronic after 4 to 6 weeks, depending on aetiology. Common causes of chronic wounds include leg ulcers, pressure ulcers, diabetic wounds and amputation stumps. An acute woundis one where there is no local or systemic factor that could delay healing. Common causes of acute wounds include burns, frostbite, bites, grafts and graft donor areas, deep dermabrasions, postoperative guided tissue regeneration and surgical removal of pilonidal cysts.

►The medical prescription (if necessary) of a given type of dressing should be as specific as possible. ►When applying a dressing it is essential to follow strict rules of hygiene: washing hands, cleaning the wound, etc. These play a vital role in the prevention of infection. ►Different primary dressings should not be used together on the same wound (except when activated charcoal dressings are used).

1. The definition “dressings and articles for dressings” covers both primary dressings placed in direct contact with the wound and secondary dressings, including compresses and fixation and maintenance materials.

ASSESSMENT OF PRIMARY DRESSINGS

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Most dressings are intended to promote healing in a moist environment. Hydrocolloid dressings, which were introduced in the early 1980s, can be considered the model for such dressings, which are generally known as “modern” dressings. The assessment does, however, also cover petrolatum dressings, which are categorised as “conventional” dressings (alongside cotton dressings, moist compresses, etc.).

The clinical importance of dressing types not mentioned in these recommend- ations could not be established.Any further claims of activity require the demonstration of additional clinical efficacy.

• Alginate dressings : These consist primarily (> 50%) of alginates, with or without carboxymethyl cellulose (CMC). Alginates are alginic acid polymers obtained from algae and are characterised by their absorption capacity and haemostatic properties. They are supplied as compresses or ribbon gauzes. • Carboxymethyl cellulose fibres (CMCs, also called hydrofibres): These dressings consist primarily (> 50%) of nonwoven fibres of pure carboxymethyl cellulose (CMC). On contact with exudates, these fibres form a cohesive gel characterised by its absorption capacity. CMCs are supplied as compresses or ribbon gauzes. • Hydrocellular dressings : These consist of absorbent polymers (generally polyurethane foam). They are supplied as adhesive or non-adhesive sheets in anatomical shapes and forms suited to filling cavitary wounds. • Hydrocolloid dressings : These consist of absorbent polymers with properties linked to the presence of carboxymethyl cellulose. They are supplied as adhesive sheets, powders or pastes. • Hydrogels are gels containing over 50% water. Their primary purpose is to: These provide a moist wound environment. They are supplied as sheets, impregnated compresses and gels. • Petrolatum dressings (e.g. paraffin gauzes) : These consist of a matrix impregnated or coated with petroleum jelly. Removing them is sometimes painful because they gradually adhere to the wound. • Interface (nonadherent) dressings : Interface dressings consist of a matrix coated with different types of polymer, such as silicone gel. They differ from simple tulle dressings on account of their low adherence, which does not increase over time while in direct contact with the wound (no migration of the impregnating or coating substance). This minimises injury and pain when removing the dressing. • Activated charcoal dressings These consist of various support materials: treated with activated charcoal to absorb substances responsible for bad wound odours. They are supplied as sheets and compresses. • Silver dressings : These consist of various support materials (creams, compresses, sheets, etc.) treated with silver in various physicochemical forms for its supposed antibacterial properties. • Hyaluronic acid-based dressings : These contain varying concentrations of hyaluronic acid (a natural constituent of the dermis). They are supplied in various forms (creams, compresses, sprays, etc.).

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The purpose of the assessment conducted by HAS (report published in 2007) was to determinethe therapeutic effect and undesirable effects of various primary dressings: • this being limited to chronic or acute wounds sufficiently serious in nature in respect of the indications currently covered (which specifically exclude common wounds of daily life) and • excluding certain specialised care protocols, e.g. those of major burns units. Outside the scope of the study: cell matrices, growth factors, negative-pressure wound treatment systems (which are the subject of a specific assessment and a good practice leaflet), topical dressings other than the cream or gel forms of the dressings studied and medicinal products in presentations that take the form of dressings.

USE OF DIFFERENT DRESSINGS 2

 The classification of the indications for dressings and the definitions and types of dressings recommended in each indication aretools to help guide the choices of healthcare professionals.  However, the data on which preference for certain types of dressings over others is based have onlya weak level of evidence. In some indications, no category of dressing can be recommended.

Healing Stage

All phases (non-sequential treatment)

Debridement (sequential treatment)

Granulation (sequential treatment)

Epithelialisation (sequential treatment)

Specific clinical situations

Fragile skin (bullous diseases)

Wound Type Chronic

Acute

Chronic

Acute

Chronic

Acute

Chronic

Acute

Infection prevention (irrespective of aetiology)

Wound infection (irrespective of aetiology)

Haemorrhagic wound (including graft donor areas) Epistaxis and other bleeding of the skin and mucous membranes in patients with haemostasis problems Malodorous wound (particularly ENT cancers, skin or breast cancers)

Recommended dressings Hydrocolloid Hydrocellular 3 CMC fibre (hydrofibre) 3 Alginate 3 – hydrogel 4 – Interface 5 – hydrocellular 3 – petrolatum 6 Petrolatum 6 Interface 5 – hydrocolloid Interface 5

Recommended dressings Interface 5

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4 –

Algosteril ® (alginate)

Coalgan ®

Activated charcoal

2. According to the opinion of the Committee and as mentioned in the order dated 16 July 2010. 3. Highly exudative wounds. 4. No basis for recommending a particular type of dressing in this case. 5. Mepitel ® , Urgotul ® , Altreet ® , Physiotulle ® and Hydrotulle ® (brand names). 6. Petrolatum dressings are widely used and appear on the LPPR despite the absence of high- level evidence data demonstrating their efficacy.

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Use of protective dressings, compresses and cotton

Pressure ulcers in adults and the elderly, to protect reddened skin (due to urine or maceration)

Care of acute sutured wounds and surgical incisions

Protection of slightly haemorrhagic and/or exudative acute wounds (intravenous catheterisation sites and surgical incisions)

Protection of slightly or moderately haemorrhagic and/or exudative acute wounds (intravenous catheterisation sites and surgical incisions)

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Exudative acute wounds (postoperative wound covering, gynaecology, wound drainage, etc.) Exudative chronic wounds: covering of dressings for drainage of exudates and mechanical protection of the wound

Cleaning of wounds or healthy skin in the perioperative period (preparation of the operative site and postoperative care) and for acute wounds at risk of infection (particularly burns) Preparing postoperative dressings and dressings for acute wounds at risk of infection (burns, etc.)

Cleaning wounds beyond the perioperative period Preparation of dressings (chronic wounds)

Local cleaning of the skin where there is no open wound

Thin, transparent adhesive sheets (hydrocolloids) Sterile adhesive dressings with integrated compress (fabric support) Sterile adhesive dressings with integrated compress (film support) Sterile hydrophilic cotton compresses with adhesive border Sterile non-adherent hydrophilic cotton compresses

Sterile non-adherent absorbent dressings/compresses for productive wounds

Sterile compresses

Nonsterile compresses Note: Sterile compresses for cleaning some superinfected wounds or wounds exposing muscle or bone tissue.

Nonsterile hydrophilic cotton

CNEDiMTS recommendations for dressings assessed after 2007

A hyaluronic acid-containing dressing (Ialuset ® , Opinion dated 29 April 2008) Three silver dressings (Cellosorb Ag ® , Urgotul Ag ® and Urgotul Duo Ag ® , Opinion dated 30 September 2008)

Use limited to leg ulcers

Use limited to leg ulcers*

Four-week sequential treatment of inflammatory leg ulcers with at least three of the following five clinical signs: pain between two dressing changes, perilesional erythema, oedema, malodorous wound, abundant exudate.

This document has been validated by the HAS National Committee for the Evaluation of Medical Devices and Health Technologies and was based on an in-depth review of the literature, the results of a formal consensus of experts, by examination of dossiers submitted by the manufacturers, recommendations of a multidisciplinary working group, the LPPR and reports and opinions of the CNEDiMTS. These opinions, like all HAS publications, are available for download atah.was-s.etnrfww

April 2011