Integumentary – Application of Transparent Film SECTION: 4.07

Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE:

To identify function, description, indications, advantages/disadvantages, and usage of this specialized dressing.

CONSIDERATIONS:

1. There are several transparent, semipermeable membrane adhesive dressings on the market.

2. This type of dressing may be used for prophylaxis on high-risk intact skin, partial thickness, superficial wounds with minimal or no exudates, and eschar covered wounds when autolysis is indicated.

3. The advantages for this type of dressing are:

a. The dressing reduces the need for frequent changes and, in many instances, may remain in place until the wound is completely healed.

b. The wound can be inspected through the transparent dressing.

c. The dressing retains the serous exudate, keeps the wound moist and hastens healing.

d. The dressing does not adhere to the wound's surface.

e. The dressing may be applied over a joint without reducing mobility.

f. Bathing and showering are permitted without removing the dressing.

g. The dressing affords pain relief.

h. The dressing may be used on bony prominences and other areas, prophylactically, to prevent skin breakdown.

i.  If dressing to be used to facilitate autolysis in an eschar-covered wound, it must be monitored closely and possibly changed more frequently.

4. The disadvantages of this dressing are:

a. Contraindicated for infected wounds or arterial wounds that require frequent monitoring.

b. Not recommended for wounds with moderate to heavy drainage.

c.  Not recommended for third-degree burns.

d. Not recommended for use on fragile skin.

e. May be difficult to apply and handle.

f. May dislodge from high-function areas.

g. Requires a margin of intact skin to adhere.

5. This dressing may be used as a secondary dressing with exudating wounds.

EQUIPMENT:

Gloves

Skin protectant (optional)

Transparent film

Hypoallergenic tape (optional)

Scissors

Impervious trash bag

Normal saline

PROCEDURE:

1. Adhere to Standard Precautions.

2. Explain procedure to patient.

3. Assemble necessary equipment at the bedside.

4. Thoroughly cleanse area and clip the hair (optional) within 2 inches (5 cm) of the site. Apply skin protectant wipe, if desired, and allow to dry.

5. Measure the burn/wound and choose the correct dressing size. Apply the transparent film, leaving 4-5 cm overlap from the wound margin to the surrounding skin to insure total coverage. DO NOT stretch the dressing, because a stretched dressing restricts mobility and may cause discomfort.

6. Follow manufacturers’ guidelines for use and application of dressing.

7. As you apply the dressing, explain its advantages to the patient and explain why the patient should not remove it.

8. To apply the dressing on a contoured area of the body, the dressing can be overlapped up to 3 times and still remain semi-permeable.

9. Care should be exercised when applying the semi-permeable dressing on the coccyx or perineal area as feces or urine can contaminate the wound. The dressing can, even if properly applied, become loosened and subsequently become contaminated.

10. If fluid accumulates under dressing, consider using absorptive dressing (e.g. Alginate) under film to allow dressing to remain in place longer.

11. Replace dressing when it leaks or every 3 to 7 days.

12. Remove dressing by gently lifting corner of dressing and stretch the dressing away from the center of the wound, partially lifting it. Peel the dressing back until you feel resistance; repeatedly stretch and peel the dressing as necessary until it is removed.

13. Discard soiled supplies in appropriate containers.

AFTER CARE:

1. Document in patient's record:

a. Patient's response to the procedure.

b. Temperature and vital signs per agency policy.

c. Wound appearance including size, drainage and odor.

d. Response of the wound to the prescribed regimen.

2. Instruct patient/caregiver in wound care, including:

a. Reporting signs or symptoms of infection including pain, change in color, amount or character of drainage or elevated temperature.

b. Exercising caution to not remove or disturb dressing.

c. Leaking of dressing.

d. Diet to promote healing.

e.  Dressing on an open wound will produce thick, sometimes foul-smelling drainage and this is not necessarily a sign of infection.

REFERENCES:

Rolstad, B. & Ovington, L. (2007). Principles of wound management. In R. Bryant and D. Nix (Eds), Acute and Chronic Wounds: Current Management Concepts (3rd ed., Rev., pp 258-304). St. Louis, MO: Mosby.

Baranoski, S., Ayello, E., McIntosh, A., Galvan, L. & Scarborough, P. (2008). Wound treatment options. In S. Baranoski and E. Ayello (Eds), Wound Care Essentials: Practice Principles (2nd ed.) P. 136-149. Philadelphia, PA: Lippincott Williams & Wilkins.

Bates-Jensen, B. (2001). Management of Necrotic Tissue. In C. Sussman & B. Bates-Jensen (Eds.) Wound Care: A collaborative Practice Manual for Physical Therapists and Nurses (2rd ed.) P.206. Philadelphia, PA: Lippincott Williams & Wilkins.