A Tegaderm Matrix dresszing az alábbi sebek és sérülések esetén használható (figyelembe véve a
TIME koncepciót)
égések
felfekvések
vénás fekélyek
diabetikus eredetű fekélyek
A felhasználás menete
Tisztítsa meg a sebet a helyi protokolnak megfelelően
Helyezze fel a Tegaderm Matrix kötszert direkt a sebre, ügyelve, hogy a megfelelő kontatkus létrejöjjön a sebfelszín és a kötszer között. A Tegaderm Matrix szükség esetén méretre vágható, vagy ketté hajtható. A kötés túllógása a sebet övező bőrterületre nem károsítja a környező területet, és nem befolyásolja a szövet integritását.
Mindig helyezzen egy másodlagos kötést a Tegaderm Matrix fölé, hogy biztosítsa a nedves közeget a gyógyuláshoz.
közepesen, vagy nagyon nedvedző sebeknél: 3M™ Tegaderm™ Foam Dressing (adhesive or non-adhesive)
kevéssé vagy nem nedvedző sebeknél : 3M™ Tegaderm™ Film Dressing/li>
A sebszélek védelmére használjon 3M™ Cavilon™ No Sting Barrier filmet minden kötés cserénél.
A kötések cseréjekor távolítsa el a másodlagos kötszert és gyengéden emelje ki a Tegaderm Matrix dresszinget a sebből.
Olyan sebeknél, melyek már nem nedvedzenek a Tegaderm Matrix-ot a kötést kissé megnedvesítve távolíthatja el.
Ha a seb már kiszáradt volna lehet, hogy más fedőkötést (másodlagos kötést) kell alkalmaznia.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Peters
Mrs Peters (name changed) is an 83 year old lady who lives with her husband at home but had become increasingly weak and was taken to hospital for investigations. Nothing was identified during hospitalisation, and it was thought that the weakness was age related. She could no longer cope at home and was transferred to a nursing home. Due to her immobility and frailty, in the day she sat in a chair, with a gel cushion in situ and had an air mattress on the bed during night time. Sacral pressure damage was caused by her immobility prior to the use of air mattress and cushion. However, even with the use of these pressure relieving aids, the wound, which was clean and without slough was not healing.
Previously a foam adhesive, sacral shaped dressing was used. It was changed on a daily basis and use of this product, as a secondary dressing, continued when Tegaderm Matrix dressing was introduced on the 28th October. This dressing combination remained the same until the wound healed (17th December). During the trial the dressing change frequency gradually reduced from daily dressing to twice weekly. Using this particular foam adhesive sacral dressing, size 22cm x 22cm, at cost of £11.00, on a daily dressing change basis, led to a dressing materials cost of £309.00 per month for care of this wound.
Once the wound was dressed with Tegaderm Matrix, the wound rapidly moved from indolent to a healing state and dressing changes were reduced to two changes per week, at a cost saving of £220.64 per month.
Treatment with Tegaderm Matrix dressing: a diabetic patient with a heel pressure ulcer
Mrs Cooper
Mrs Cooper (name changed) is a 79 year old diabetic lady who had previously had an amputated left leg due to pressure damage over the heel. She had a Waterlow score of 20 which placed her at very high risk of development of further pressure ulcers. There was now a pressure ulcer on the right heel that had been present for 8.5 months. Her previous treatment included an electrical dressing and then a hydrogel sheet dressing which had greatly improved the wound and it had almost reached closure. At this point there was a severe breakdown of the wound and dressings (hydrofibre – cost £7.70 per dressing and foam – cost £8.00 per dressing) were being changed on alternate days over several months at a cost of £235.00 per month.
Tegaderm Matrix dressing was first applied on 18th July. The secondary dressing used was gauze and this was held in place by orthopaedic wool and a simple retention bandage. Healing was slow, possibly due to the diabetic pathology. Within a short period of time dressing changes were reduced to twice weekly for 8 weeks and then reduced to once per week until 18th October (92 days) by which time the wound had almost reached full closure. Following the study, the wound completely healed. The overall cost of treatment with Tegaderm Matrix dressing was £170.00 showing a cost saving of £520.00 over the previous dressing regimen used to treat this wound.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Roper
Mrs Roper (name changed) a 72 year old lady with a pressure ulcer was admitted to a nursing home from hospital, in May 2005. Mrs Roper had severe Parkinson’s disease, but was fully compus-mentus and bright and knew exactly how to direct her care. With a little help she was mobile and directed the health care professionals in how she wanted her wound photographed at each visit, sometimes when standing, sometimes when lying down. Previous dressings used were a simple foam at a cost of £1.70 per dressing. The dressing was changed daily at a material cost of £51 per month. The wound appeared to have clean granulating tissue in the base which normally indicates a healing wound. Nevertheless, the wound was not progressing and had been static for several months.
Tegaderm Matrix dressing was commenced on the 12th August. A secondary dressing was required to hold the Tegaderm Matrix dressing in place, and an adhesive bordered foam was the selected dressing at a cost of £3.40 per dressing. Dressing changes were gradually reduced from daily to weekly and by the 20th October (69 days) the wound healed at a material cost of £321.00. Although the material cost of this treatment was higher than the initial dressing costs, cost-effectiveness was still fully demonstrated as this previously non-healing wound went on to heal without complications and without any pain in less than 10 weeks. A very successful outcome for the patient and the funders.
Treatment of an intractable pressure ulcer with Tegaderm Matrix dressing
Mrs Morris
Mrs Morris, an 81 year old lady, with Parkinson’s disease was admitted to a nursing home on the 25 July with an established EPUAP grade IV pressure ulcer. She had a Waterlow score of 25 which placed her at very high risk of further tissue damage. The score reduced to 19 during the period of the case study, although this is still high risk.
Previous treatment of her wound included use of a range of dressing combinations including hydrofibre ribbon covered by a hydrocolloid dressing; Metrotop™ gel and a hydrogel sheet. Use of a hydrofibre dressing covered with an adhesive foam sacral dressing was the most recent treatment. This was changed every three days at a cost of £243.00 per month. Mrs Morris always insisted on sitting out in a chair on a static cushion. She would nap on her bed following lunch and then sit out again.
The only change to her care was the introduction of Tegaderm Matrix dressing to replace the hydrofibre dressing, which was applied initially on the 4th August. A simple adhesive foam was used as a secondary dressing. Dressing changes were gradually reduced to two changes per week at a cost of £199.00 per month representing a saving of £44.00.
Treatment with Tegaderm Matrix dressing: treatment of a pressure ulcer over the elbow
Mrs Ashford
Mrs Ashford was a 75 year old lady who lived in a nursing home. She was nursed on an air mattress when in bed but she developed a very nasty pressure ulcer on her elbow which was grade IV, (down to bone). It was thought that she had developed the sore from the arm of her chair when sitting out during the day. This had been rectified a month previously by padding her elbow. She was placed on bed rest but the ulcer did not improve. After 3 months the wound was indolent and required stimulating to initiate the healing process.
The previous dressing used was a hydrofibre dressing which was held in place by retention bandages. As the dressing was changed twice weekly the cost of treatment was low (approximately £77.00 per month).
Tegaderm Matrix dressing was first applied on 15th July. It was covered with a simple foam dressing to absorb fluid and provide a moist wound healing environment. Orthopaedic wool and a simple retention bandage held the dressings in place and padded the elbow.
The progress of the wound was remarkable, healing within 1 month from a large grade IV ulcer to complete closure. Since a healed wound bears no cost of treatment, a saving of £77 per month resulted from the use of Tegaderm Matrix dressing after one month’s treatment.
Treatment of a grade II pressure ulcer with Tegaderm Matrix dressing
Mr Andrews
Mr Andrews (name changed) was a 62 year old gentleman with diabetes and several pathologies, including multiple sites of cancer that placed him at very high risk of pressure damage. He was admitted into a nursing home from hospital with a pressure ulcer over his left hip and sacrum. The hip wound was extremely sore and, even though he was placed on an air mattress, was not healing.
Tegaderm Matrix dressing was applied on the 9th May with a simple adhesive foam as a secondary dressing. The wound healed within 6 weeks and without problems. Rapid healing was achieved despite his multiple pathology including throat cancer, which meant nutrition was poor. Unfortunately, shortly after his wound healed, Mr Andrews died.
A Tegaderm Matrix egy sebkötözőszer, melyet polihidrogenált ionogénnel (PHI) impregnáltak, ami kenőcsként egyensúlyban tartja a krónikus seb környezetét, segítve ezzel a sebgyógyulást. A PHI különböző fém-ionok citromsavl puffere, egy hidrofil matrixra felvíve.
Az MMP-k egy speciális zink-tartalmú proteolitikus enzim csoport. Fontos szerepet játszanak az extracelluláris matrix képződésében a gyógyulási folyamat során, segítve az epithelializációt. A normál sebgyógyulási folyamatban az elhalt szövet eltávolítása és az új szövet keletkezése egyensúlyban van. A krónikus sebek során azonban ez az egyensúly kibillen, és lassúbb (vagy teljesen leálló) szövetregeneráció tapasztalható.
Számos tanulmány mutatta ki a krónikus sebekben az MMP szintjének megemelkedését. A huzamosabb ideig tartó, emelt szintű MMP jelenléte roncsolja az új szöveteket, csökkentve ezzel a sebgyógyulás lehetőségét. A TMP (Tissue Inhibitor Metalloproteinases) az MMP természetes inhibitora.
Normális sebgyógyuláskor a TIMP és MMP szintek egyensúlyban vannak és lehetővé teszik új sejterétegek létrejöttét, a seb progresszív hegedését. Krónikus sebekben azonban ez az egyensúly felborul és instabil extracelluláris háló keletkezik, ami megakadályozza a normális gyógyulást. Ahhoz, hogy e folyamat ismét helyreálljon, vissza kell állítani a TIMP és MMP egyensúlyát.
Az orvostudomány számos MMP-t ismert, ezek közül a MMP 2 és 9 a legfontosabb a sebhegedés szempontjából. A nehezen gyógyuló sebekben ezek szintje megemelkedik.
A Tegaderm Matrix dressing fém-ionokat tartalmaz (rubidium, kalcium, cink and kálium), melyek egy PHI-kenőcsben találhatók. Mindezt polyethylene glycol (PEG) és citomsav puffer tartja az acetát-bázisú filmen.
Az acetát hordozófólia celulóz-acetátból készül, mely nem szálas, így nem tapad a sebbe, ám mégis átengedi az exudátumot.
A PEG lehetővé teszi a PHI (polyhydrated ionogens) bejutását a sebbe, aktiválva ezzel a fém-ionok felvételét. A PEG hidrofil molekula, aminek nedvességre és hőre van szüksége, hogy aktiválhassa a formula sebbe jutását.
Négy különféle fém-ion található a PHI-tartalmú kenőcsben: rubidium, kalcium, cink and kálium. Ezek az ionok szabályozzák a fibroblasok MMP-2 termelődését (túltermelődés regulátor).
Először a rubidium hatol be a sejtmembrámba, mintegy catornát nyitva a többi ionok számára.
A kalcium gátolja az MMP termelődést.
A cink szintén MMP-gátló hatású, és egyben a szövet regeneráció egyik fontos szereplője.
A kálium depolarizálja a sajtmembránt és gátolja az MMP termelődését. A kálium szintén fontos résztvevője a sejtregerációnak.
A citromsav szerepe: A sebgyógyulás első szakaszában igen fontos szerepet játszik a kémhatás (pH). A semleges pH-jú komplexek elősegítik a fém-ionok transzportját a sejtfelszínen. Normális sebgyógyulási folyamatban a seb pH-ja kissé savas (pH=5), ellentétben a krónikus sebekkel.
Igen. A Tegaderm Matrix dressing felhasználható nyomókötések alá is. Ilyenkor egy másodlagos kötszerre van szükség, hogy segítsen megtartani a nedves közeget a sebgyógyuláshoz.
A Tegaderm Matrx használata nem javallt elfertőződött sebeken. Jelenleg nincs birtokunkban adat más szerekkel, illetve hatóanyag-tartalmú dresszingekkel együttes hatásáról.
Igen. A Tegaderm Matrix felvágható, méretre alakítható, hogy illeszkedjen a sebbe. Mindemellett a többrétűre hajtás is közismert és elfogadott módszer - minden a seb méretétől függ. A szomszédos (ép) bőr lefedése nem okoz semmilyen káros hatást, illetve nem sérti a felhám integritását. A beteg érdeke szabja meg, hogy vágva, hajtva, vagy eredeti méretében használja.
A Tegaderm Matrix minden egyes kötéscserekor kicserélendő. Klinikai vizsgálatok igazolják, milyen ütemben javul a sebgyógyulás, ha naponta, hetente kétszer, vagy hetente egyszer cserélik a kötést.
Fontos megjegyezni, hogy a sebgyógyulás kezdeti időszakában a gyakoribb csere célravezető, mivel ez maximalizálja a fém-ionok áramlását és ezzel gyorsítja a sebgyógyulást.
