aquacel or xeroform?

[newbie'13]

I work in a cv stepdown unit and we have been seeing skin breakdown on patient's sacral and coccyx areas. Most nurses put aquacel on these wounds. Yesterday a nurse told me these dressings remove healthy tissue when changed and it is wrong to use them. She said xeroform is the best choice. Does anyone have any insight on this?

[Anna Flaxis, BSN, RN]

I went to the ConvaTec website, and it specifically states that Aquacel does NOT damage granulating wound tissue. Here is a link if you'd like to look at it for yourself:

ConvaTec - AQUACEL® foam dressing helps reduce pain during dressing changes

[newbie'13]

Yes I researched the site before I talked to this particular nurse about it. She said the "textbook" is wrong.

[Anna Flaxis, BSN, RN]

What "textbook" is she referring to?

[newbie'13]

She was using it as a figure of speech.

[Anna Flaxis, BSN, RN]

Well, unless she can point to any credible research that backs up her opinion, I'd say Aquacel is probably just fine.

[CWONgal]

I will say personally I am not a big fan of Xeroform because it's often used improperly. The specifications are to use it on the wound bed only however people overlap the dressing onto healthy intact tissue and then you end up with macerated wound edges. I have also seen it placed on dry gangrene which can cause the wound to progress to a wet gangrene. I do like Aquacel and there is a lot of bad guidance out there w/ this dressing as well. If you use Aquacel Ag on a wound w/ minimal exudate it will stick to the hydrofiber and then when you remove it it will pull off dead tissue. Problem is it isn't contributing to moist wound healing in this case. Aquacel can be moistened and placed within a wound causing it to turn gelatinous. When it's this consistency it's also much easier to remove from the wound and it's less painful for the patient. If you have a wound w/ some depth Aquacel over the base of a wound w/ a moistened saline gauze over the dressing can help keep the wound moist if the wound isn't producing enough exudate. If you get Aquacel Ag you now have the silver component which is antimicrobial and can help decrease surface bacteria.

[Shelby QI LPN]

I work for a small-town company, and most doctors in this area like to double up on dressings, it feels like if they don't know what to do for a wound, they throw everything at it. My question, does it make sense to put Xeroform over top Aquacel. My understanding of these treatments, Xeroform should be cut down to fit into the wound bed, and Aquacel could be put over top to help wound healing. 

[leonard_huh, BSN, MSN, RN, APN]

all depends on how it is used, if there is healthy granulated tissue, xeroform can help granulate the tissue better, cheap and effective way, but medihoney or santyl would help if there is slough. If the wounds are closed xeroform will macerate the wounds. if a lot of draining aquacel would help keep it dry with some barrier cream on the border of the wounds.