The Wonder of Calcium Alginate
Calcium alginate is a highly absorbent, biodegradable alginate dressing derived from seaweed. Alginate dressings maintain a physiologically moist microenvironment that promotes healing and the formation of granulation tissue. Calcium alginate is readily removed with saline irrigation, making dressing changes virtually painless.1 Calcium alginate has been around for years. More recently, it has been added to wound gels, hydrocolloids, and cleansers. Silver, a known antimicrobial agent, also has been added to many wound products, including calcium alginate. Unadulterated calcium alginate comes in the form of a flat square or mat (in many sizes) or a rope. The ropes can be manipulated to fit easily in wound cavities. Although one of its stated uses is to provide homeostasis, calcium alginate is more commonly thought of as the dressing that can absorb 20 times its weight in exudate, soak up loose debris from the wound bed, provide an optimal environment for healing, and provide a painless dressing change. This study is a reminder that calcium alginate is a valuable tool in our wound care arsenal.
As the wound and ostomy nurse for a new suburban hospital in Louisville, KY, I received a routine consult to see Mr. K, a 68-year-old white male patient admitted for a skin tear. Mr. K had become progressively weakened after 6 days of diarrhea and decreased urine output and had suffered a fall in the home, resulting in bruising to his left hip and a skin tear to his left shoulder. The shoulder was covered with six layers of ABD dressings and a towel, which when gently removed revealed an approximately 2-foot long by three-inch wide blood clot. Every layer of ABD dressing revealed Mr. K was losing a considerable amount of blood. Although I knew calcium alginate was purported to absorb 20 times its weight in exudate, clean up debris and loose yellow sloughy necrotic tissue, and halt bleeding,2 I wondered whether it would stop such severe bleeding; I knew calcium alginate needs exudate (moisture, in this case, blood) to become activated to do its job. The treating physician informed me Mr. K was in acute kidney failure. Due to the patient’s dehydration, even his routine medications had become toxic. In addition, Mr. K also had coagulopathy (as yet not charted), a common complication of liver disease due to his long-standing alcoholism. The physician agreed to my plan of treatment for calcium alginate wound care.
Seaclens (Coloplast Corp, Minneapolis, MN) was used to irrigate the skin tear. I chose a 2 cm x 2 cm flat square mat (Seasorb, Coloplast Corp,) to cover the wound; it was difficult to get the bleeding controlled enough to even apply the dressing, but this was accomplished with some quick maneuvers. I applied a transparent foam dressing Tegaderm Foam Adhesive Dressing (3M, St. Paul, MN) over the calcium alginate and held it in place for a few minutes. No sign of the previous continuous flow of blood was noted. I left the room and completed the electronic documentation in his chart, then rechecked him in an hour. His dressing appeared stable without any bleeding noted. Mr. K’s family was able to visit without the panic of uncontrolled bleeding. The small dressing took the place of the piled on ABD dressings and towel. This incident occurred on a Friday. I wrote orders to change the dressing PRN, thinking it would need to be changed several times per day. I saw the patient the following Monday morning. To my surprise, no one had touched the dressing. No drainage was evident. When I changed the dressing, bleeding recurred, making it still difficult to apply the dressing and stop the bleeding all in one motion, but because I was prepared, I quickly completed the dressing change. Mr. K’s coagulapathy was a factor in, but did not change our approach to, his treatment. Because the liver plays a central role in hemostasis (ie, synthesizes clotting factors, coagulation inhibitors, and fibrinolytic proteins),3 the flow of blood was one more complication to address, but one that could be controlled in this skin tear with calcium alginate.
Healing and Prognosis
Mr. K’s liver and kidney failure due to long-term alcoholism and recent illness caused severe dehydration; his prognosis was not good and he eventually died. However, without the calcium alginate, he would have bled out. Our primary goal was to provide comfort measures and control bleeding, allowing his family time to adjust to his diagnosis of multiple organ failure.
Clinicians need to remember the versatility of calcium alginate. It can be used on acute wounds, chronic wounds, skin tears, incisions, traumatic wounds, venous or arterial wounds, tunneling wounds, partial- or full-thickness wounds — ie, any wound with some drainage/exudate. Calcium alginate turns into a gel when exposed to the exudate to provide an ideal healing environment, making the removal of the dressing virtually painless. Used properly, calcium alginate is an important part of the wound care arsenal. –Debbie Harris, MSN, JD, RN, CWON
1. Sumarsih G. Adrenalin or Calcium Alginate. Available at: http://aminetn.wordpress.com/2009/07/21/adrenalin-or-calcium-alginate/. Accessed February 25, 2011. 2. Hess CT. Clinical guide: Wound Care, 5th ed. Philadelphia: PA: Lippincott Williams & Wilkins;2005. 3. Blonski W, Siropaides T, Reddy KR. Coagulopathy in liver disease. Curr Treat Options Gastroenterol. 2007;10(6):464–473.