Pearls for Practice: A Specially Constructed Hydroconductive Wound Dressing to Eliminate Peristomal Maceration and Excoriation Around Tracheostomies and Enteric-cutaneous Tubes

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Thomas L. Wachtel, MD; Danielle Abernathy, MSN, RN, CWCA; Martin C. Robson, MD University of Arizona, Department of Surgery, Critical Care and Emergency Surgery, Tucson, AZ; and University of South Florida Department of Surgery, Tampa, FL

When left for a period of time on the skin, bodily fluids and exudates can cause irritation ranging from peristomal dermatitis to maceration to skin loss. The chemical dermatitis is due to irritants in the fluids such as irregular pH, unbalanced electrolytes, bacterial products, and increased enzyme content.1 The exact content varies depending on whether the internal source is pulmonary, urinary, or enteric. The exudate from a tracheostomy site can be copious, watery, or viscous, and contain blood, bacteria, and/or injurious cytokines. Similarly, the effluent leaking around enteric-cutaneous tubes such as gastrostomy or jejunostomy tubes can cause maceration and excoriation. Historically, passive absorptive dressings such as gauzes, foams, hydrofibers, or alginates have been used to absorb exudate and effluent but with poor success of preventing skin problems.2 

A specially constructed hydroconductive dressing (Drawtex Tracheostomy and Tube Dressing (SteadMed Medical LLC, Fort Worth, TX), known to draw off excessive exudate, bacteria, and harmful chemicals, was tested in a series of 30 patients as a means to protect and treat the skin problems accompanying tracheostomy or enteric-cutaneous tube usage.3 The dressing has a central hole with radial cuts to allow a snug fit around tubes of various diameters (see Figure 1). It also has interlocking cuts that can spread for easy application and then refitted to hold the dressing in place (see Figure 2). The dressing was used in patients with acute tracheostomy or tube placements and in persons with chronic tube placements with less exudate or effluent; the dressing was changed daily. The peristomal skin was serially evaluated for skin maceration, excoriation, or breakdown. 

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The hydroconductive dressing proved effective in all acute and chronic tracheostomy cases, as well as all enteric-cutaneous tube cases. It drew exudate, debris, bacteria, and chemicals into the dressing and prevented peristomal skin problems. The dressing proved to be useful in cases using both silastic and metal tracheostomy tubes (see Figure 3) regardless of the type of enteric-cutaneous tube utilized (see Figure 4).

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The Drawtex Tracheostomy and Tube dressing proved useful in a large series of cases in preventing skin injury from bronchial discharges and enteric effluents exuded from tracheostomies or enteric-cutaneous tubes. Its unique capacity to draw injurious substances away from the skin and into the substance of the dressing protected the skin to a greater degree than has been reported for more passive absorptive dressings.2 

References

1. Amling J. The use of hydroconductive dressings to prevent a prevent and treat skin excoriation in young children. Ostomy Wound Manage. 2015;61(5):16–17.

2. Ahmadinegad M, Lashkarizadeh MR, Ghahreman M, Shabani M, Mokhtare M, Ahmadipour M. Efficacy of dressing with absorbent foam versus dressing with gauze in prevention of tracheostomy site infection. Tanaffos. 2014;13(2):13–19.

3. Wachtel TL. A novel tracheostomy dressing: extension of a hydroconductive wound dressing. Ostomy Wound Manage. 2013;59(2):10–11.